M.D.s find "physician" title doesn't help with Medicare

One of the most heated battles over the Chiropractic Medicare Freedom Bill -- HR 2560 -- has involved the establishment of a separate chiropractic category under the Medicare system. The American Chiropractic Association (ACA) has opposed the bill, suggesting that chiropractors would be better off if they were lumped in with M.D.s and D.O.s as 'physicians.'

A glimpse at the way M.D.s are faring under the Medicare and Medicaid systems clearly shows that being in the physician category doesn't translate into more reimbursements.

According to a report on Physician's Compliance Wire, the Centers for Medicare & Medicaid Services (CMMS) draft regulation for the 2004 Physician Fee Schedule calls for payments to physicians to be slashed by 4.2% across the board next year.

The cuts could be much deeper in some cases. For example, many nursing facility care codes are slated for double‑digit decreases, and code 99311 (subsequent nursing facility care), will drop from an estimated $40.83 to $32.08. Two home visit codes, 99348 and 99350, will drop about 10% to $66.60 and $152.94 respectively.

"The idea that chiropractors are protected under the 'physician' banner is ridiculous," stated Terry A. Rondberg, D.C., World Chiropractic Alliance (WCA) president. "As the American public veers away from the medical model, cuts for physician services will be deeper and more broad‑based. Only by having a separate chiropractic category can we benefit from the coming wellness revolution, and protect our exclusive domain of subluxation correction."

HR 2560, lauded in Congress by Rep. Donald Manzullo, has won the endorsement of the Chiropractic Coalition, including the WCA, the International Chiropractors Association (ICA) and the Federation of Straight Chiropractors and Organizations.

C.J. Mertz, D.C., ICA president says: "This powerful legislative initiative has been so thoughtfully crafted and is so innovative, opening new doors for chiropractor and chiropractic patient alike in Medicare, that it deserves the strong and immediate support of everyone in the chiropractic profession."

Gary Horwin, D.C., FSCO president agrees. "This legislation offers our profession the best chance of solving many Medicare problems. It's proof that the Coalition is an effective and action‑oriented group of like‑minded organizations working together for the good of chiropractic."

The ACA, which is still engaged in a lawsuit with CMMS over the issue of which practitioners should be permitted to provide subluxation correction, has openly opposed the bill. So far, the organization has raised more than $5 million on its lawsuits and continues to solicit additional donations from the profession. Its vehement -- and at times malicious -- attacks against the bill and the Coalition supporters has once more raised Congressional eyebrows, leading some lawmakers to wash their hands of chiropractic legislation altogether.

"It's a shame that the ACA has been willing to sacrifice the entire reputation of the profession in order to stop a bill that was supported by so many doctors and organizations," stated Dr. Rondberg. "Many people are asking why, particularly since the Coalition was careful not to malign the ACA or its Medicare provision, despite widespread criticism of that provision from the media and even the White House."

The ACA went so far as to contact its affiliated state associations and recruit them to write letters attacking HR 2560. One legislator dropped his sponsorship of the bill after learning of the internal squabbling. If HR 2560 fails, it may mean that no chiropractic provision will pass the legislature, leaving the profession once more battling a Medicare system that can reimburse physical therapists for manipulations to correct subluxations.

Although ACA supporters at one point stated that the Association of Chiropractic Colleges opposed HR 2560 as well, it was determined that no vote had ever been taken on the issue and that the organization had no official stand on the bill. Other state associations have refused to take a position on the bill since their constituency is divided on the issue.

Time and again, the Coalition has urged the ACA to rescind its official policy of refusing to work with other organizations on joint legislative efforts, and join the greater chiropractic community in working on true Medicare reform that will benefit all D.C.s. "We hope the time will come when the ACA will be willing to put aside political and personal animosities and return to the table for the good of the profession," Rondberg said. "Until that happens, its obstinacy will continue to impede chiropractic progress."