The Facts are clear: Existing policy as it relates to the availability of chiropractic services in Medicare is arbitrarily restrictive, anti-competitive, and works against the interests of beneficiaries. ACA will not rest until Congress takes decisive action to correct this unjust reality.
The chiropractic profession’s inclusion in Medicare, which dates back to 1972, is defined by statute (Section 1861(r) of the Social Security Act). Unfortunately, the inclusion is both written, and interpreted by CMS regulators, in such a way as to impose an “arbitrary” limitation of the services chiropractic physicians are allowed to provide (or order) for their patients. There is no scientific or valid policy basis for this purely arbitrary limitation of these services within Medicare.
As currently written (and interpreted), existing statutory language favors an anti-competitive provisioning of Medicare services by “competitor” providers experiencing an artificial market advantage over doctors of chiropractic (DCs), who are forbidden to furnish existing covered Medicare services that fall within their scope of practice. This artificial limitation restricts DCs to providing a single service (manual manipulation of the spine), thereby channeling patients to other providers. These competitor providers, for all practical purposes, are handed a “franchise” to serve Medicare beneficiaries that includes the full range of services DCs are restricted from offering. DCs, in turn, are prevented from “competing” fairly in the Medicare beneficiary marketplace.
Because current policy towards services provided by chiropractic physicians is “anti-competitive,” patients are, in effect, channeled to other providers whose standard treatment regimen involves the use of drugs, spinal injections, and surgery for a range of spinal conditions. In many cases, these services could be a less costly and safer alternative – enabling patients to avoid the use and dangers of drugs (opioids in particular) and unneeded spinal surgeries and injections. Spinal-related pain is widespread in society, including among the Medicare population. Medicare policy should seek to prevent unnecessary use of drugs and surgery, especially among beneficiaries who are already a “higher risk” cohort than the population at large. To the extent that current policy arbitrarily restricts access to services provided by chiropractic physicians, it exacerbates these problems.
THE ACA MISSION: Correcting current Medicare policy as it relates to services provided by chiropractic physicians would add no new services (not currently covered) by Medicare.
The American Chiropractic Association (ACA) does not seek to create or add “new” reimbursable services to Medicare that are not currently covered services and provided by existing providers such as MDs, DOs and others. We seek only a modification of the existing statute to ensure doctors of chiropractic are allowed to furnish and order the “existing covered services” they are lawfully permitted to provide under state law. To this end, ACA is dedicated—as called for by the ACA House of Delegates in 2015—to work with Congress to correct this disparity and, through grassroots and similar efforts, create a cacophony so loud, that Washington must act in the best interests of Medicare beneficiaries and allow DCs to perform at the highest level of their licensure.
WHAT YOU NEED TO DO: We’ve made it easy for you to “lobby” Congress from your own home. Simply go to the ACA Legislative Action Center to contact your representative and senators and urge them to cosponsor the Chiropractic Medicare Coverage Modernization Act (H.R. 539 in the House, S. 106 in the Senate). The letter is already written for you and your message to Capitol Hill will be transmitted immediately to your legislators. Additionally, we have plenty of resources for your clinic so staff and your patients can promote this vital federal initiative. You can find this information at our central Medicare website. Together, we can make Medicare reform a new and bright reality!
Dr. Quinn serves as ACA’s Missouri delegate and chair of the association’s Legislative Committee.
