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Memorandum to ACA Board of Governors, House of Delegates and Other Interested
Parties
From Gary Cuneo ACA Executive Vice President
Re: ACA Weekly Report:
Special Edition
August 18, 2001
This will be a special report regarding ACA's important legislation addressing
our status as secondary practitioners under medicare and ACA's position
regarding the efforts of the ICA in promoting their own legislative program in
this area. Included in this report are following items:
*Why It's Important to Support and Not to Undermine the Watkins Bill *The Muse
Report Will Help *Other Information Regarding the Muse Report
WHY IT'S IMPORTANT TO SUPPORT AND NOT TO UNDERMINE THE WATKINS BILL
As you may know, Representative Wes Watkins (R-Oklahoma), a long-time
chiropractic supporter and member of the House Ways & Means Committee with
jurisdiction over the federal Medicare program, has introduced H.R. 902, the
"Chiropractic Patient's Freedom of Choice Act." This legislation,
known as the "Watkins bill," was developed by the American
Chiropractic Association (ACA) and introduced in the House of Representatives by
Representative Watkins at the ACA's request.
The
Watkins bill would grant doctors of chiropractic "full physician"
status under Medicare, and would allow doctors of chiropractic to be reimbursed
for services that they are licensed to provide under state law, which are
covered services under Medicare. The enactment into law of the provisions
contained in the Watkins bill would significantly expand doctors' ability to
receive reimbursement for the services they provide in addition to the
correction of a subluxation under the Medicare program.
Obviously, enactment of the Watkins bill provision would accomplish a
significant part of ACA's long-standing goal of mandating the inclusion of
chiropractic care in all federal health care programs on a basis that allows
doctors of chiropractic to provide the full range of services they are
authorized to provide under state law and helps doctors of chiropractic achieve
a "parity" status.
Enactment of the Watkins bill will not be easy, and no one in the chiropractic
profession should underestimate the difficulty in advancing this critical
legislative initiative. To successfully advance this legislation will require
the enthusiastic and unified support -- including grassroots support -- of the
entire chiropractic profession.
Regrettably, support for the Watkins bill is now being undermined by the recent
actions of the International Chiropractors Association (ICA). Detracting from a
unified effort to advance the Watkins bill, the ICA has caused to be introduced
in the 2001 U.S. House of Representatives a
second, competing legislative proposal known as H.R. 2284. This proposal was
recently introduced by Representative John Lewis (D-Georgia).
Unfortunately, the Lewis bill is inferior to the Watkins Bill, in that it would
not confer full physician status on doctors of chiropractic and would limit
those services under Medicare for which a doctor of chiropractic could be
reimbursed. The Lewis bill would only allow reimbursement for "certain
chiropractic examination procedures."
It should be noted that the ICA's recent introduction of the Lewis bill occurred
months after the well-publicized introduction of the Watkins bill and well after
the ACA's issuance of grassroots bulletins calling for action in support of the
Watkins bill. Why is the ICA now seeking to cloud the issue by introducing a
limited Medicare bill? Why create a situation, which, in the very least,
confuses members of Congress and serves to dilute an effort (well underway) to
advance a "full physician status" bill -- a proposal that would
clearly benefit the entire profession? And why help create a situation where
"competing" proposals produce a congressional excuse for inaction?
ICA claims that they consulted with members of Congress
and were told that it would not pass an open-ended benefit expansion for
chiropractic services based on state scope. We are disappointed they would
accept the view that we should not be treated as other physicians under
Medicare. We are sure that they didn't talk to members of Congress in both the
House and Senate that approved legislation that includes chiropractic in the
military, since DoD relies on state law to determine the permitted scope of
practice.
The ACA's role and position regarding this matter is clear. Our proposal
(Watkins bill) moves doctors of chiropractic toward parity with other physicians
and seeks to uphold for doctors of chiropractic the reimbursement for services
typically reflected under state law. We do not seek, nor support, any
limitations on the practice or reimbursement rights of doctors of chiropractic.
We do not believe that what is good for the entire profession should be
subordinated to the narrow views or tactical maneuvers of any organization that
would place self-promotion and publicity above the worthy goal of achieving
concrete and positive results on Capitol Hill.
The ACA respectfully urges all doctors of chiropractic, chiropractic patients
and chiropractic organizations to aggressively work for the passage of the
Watkins bill (H.R. 902) and to unify their efforts in support of this endeavor.
We specifically urge the ICA to immediately cease any efforts to advance or
promote any less preferable or less-comprehensive approach to Medicare reform
than that which is embodied in the Watkins bill provisions. If, during the
legislative process, some modifications to the Watkins bill prove necessary,
then let the chiropractic profession negotiate with Congress from a high
watermark position of strength - and not from a weakened position where the
profession's ideal legislative proposal has already been compromised and
undermined.
If you have any questions about this matter, please do not hesitate to contact
ACA's Department of Government Relations at (703) 276-8800.
MUSE REPORT WILL HELP
The Congressional Budget Office (CBO) has long been a serious detriment to
chiropractic proposals. CBO is responsible for determining the potential cost to
the government of any legislative proposal and its "score" is
relied on by congressional leaders in determining whether a measure will fit
within a federal budget. Many a legislative proposal from many industries have
been "non starters" because of their projected cost. CBO is
independent of congressional pressure as it is composed of bureaucrats who are
responsible to no one and, therefore, hold a tremendous amount of power. CBO has
caused this profession particular heartburn because it had in the past no
reliable federal figures regarding our experience in Medicare beyond the use of
the manual manipulation of the spine. Therefore, in projecting our cost in a
particular bill, CBO has established its own model that has exaggerated the
cost. As an example, our successful legislation that eliminated the x-ray
requirement was scored at $1.2 billion dollars over 10 years. While I think we
can all argue that the costs were exaggerated, these were the figures that
Congress used in determining the passage of the bill. As it turned out, the
legislation was placed into effect two years later, lowering the CBO score to
$600,000.
We have a few things going for us this year that might make a difference. First,
the results of the DOD pilot program that showed the cost effectiveness of
chiropractic has to be considered. While these weren't Medicare patients, the
fact that chiropractic care reduced sick days in the military and eliminated
other health care costs can't be lost to the CBO or to Congress. Additionally,
the ACA recently commissioned a study by the well-known Muse and Associates, an
actuarial consulting firm based in Washington D.C., to research and document the
cost effectiveness of chiropractic care in the Medicare system. In a recently
issued study, they have concluded that chiropractic care significantly reduces
per beneficiary costs to the Medicare program and could potentially save the
program even more money in the future. The report found significant differences
in the utilization of services and Medicare payment for beneficiaries who saw
doctors of chiropractic versus those who did not. The report utilized data
compiled by the CMS (formerly known as HCFA), and focuses on Medicare
beneficiaries with primary diagnoses of selected musculoskeletal, dislocations,
sprains and strains of joints and adjacent muscle conditions. The report's
conclusion suggests that decreased access to chiropractic services would
increase the Medicare program's costs. In addition, the report found that,
overall, beneficiaries who used chiropractic services had lower medical doctor
costs. Due to these cost savings, the report suggests that during any
congressional debate on Medicare reform, consideration should be given to
providing increased access to chiropractic care. In addition, the study suggests
that some savings would probably accrue in the Medicare program if access to
chiropractic services were increased in concert with a Medicare prescription
drug benefit. It is worth noting that CMS (HCFA) reviewed and approved the
document before it was released by Muse and Associates to be sure that its
statistics weren't misused. Copies of the report have been submitted to members
of Congress.
FURTHER INFORMATION ON WATKINS BILL
In the last Congress, the ACA initiated an intensive grassroots and lobbying
campaign in support of the "Chiropractic Patients' Freedom of Choice
Act," H.R. 1046, introduced by Congressman Wes Watkins (R-Oklahoma) on
behalf of the ACA. Like the current legislation, HR 1046 would provide
reimbursement for doctors of chiropractic for all Medicare services in their
state scope of practice. This legislation received strong bipartisan support in
the House of Representatives. At the end of the 106th Congress, the legislation
had 89 cosponsors, almost equally divided between Republicans and Democrats.
Unfortunately, Congress failed to act and Medicare legislation in the 106th
Congress and this bill died as well. As a result, the ACA worked with
Congressman Watkins to reintroduce the "Chiropractic Patients Freedom of
Choice Act" earlier this year. Already this year, the bill has received
strong bipartisan support and already has 46 cosponsors (for a list of
cosponsors see http://thomas.loc.gov/cgi-bin/bdquery/z?d107:HR00902:@@@P |
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