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Chiropractic Reaches Consensus On Terminology For Stages Of Care

Chiropractic Reaches Consensus On Terminology For Stages Of Care

The Chiro.Org Blog

SOURCE:   ACAnews ~ November 2010

By Nataliya V. Schetchikova, PhD

For more than a century, chiropractic has largely existed in isolation from mainstream health care, evolving with its own philosophy, system of education and approach to patient care. And, like other groups that develop independently of the mainstream, the profession has created its own unique system of terminology.

The problem is, the terms—namely, preventive, supportive and maintenance care—are poorly understood by allopathic providers, patients and payers alike, which makes it difficult for DCs to communicate the value of their services and, essentially, prevents the profession from fully integrating into mainstream health care. And especially in the past decade, the difference in terminology started to cause problems in the reimbursement arena.

“The government and private payers started designing stages of chiropractic care using their own language and using this as a basis for denying care,” says Ritch Miller, DC, chairman of ACA’s Medicare Committee. “For example, Medicare doesn’t pay for maintenance care—but the definition of maintenance care is so gray that it’s left up to the claims adjusters to decide what it is, and many beneficiaries are wrongly denied care because of the interpretation of these terms,” he adds.

When claims for medically necessary chiropractic care started getting denied across multiple geographical areas and insurance plans, they were reported to the ACA’s Insurance and Managed Care (IMC) committee. “We began to see more clearly that there was significant misunderstanding, misinterpretation and misuse of the policy language we had at the time, especially in the payer industry,” says James L. Rehberger, DC, chair of the IMC Committee.

The policy language—specifically, definitions of supportive and maintenance care—was taken from the 1992 Mercy Guidelines and, in the beginning, served the profession quite well, says George McClelland, DC, former chairman of ACA’s Board of Governors. “The problem arose when insurance companies began abusing terms like ‘supportive care.’ It was dubbed maintenance care and deemed inappropriate to be billed for,” he says.

Reaching Consensus

ACA’s IMC Committee attempted to make improvements to the existing language numerous times. However, after debates in the House of Delegates, it became clear that “we needed to reach a scientific multidisciplinary consensus, improve the language and make it more available,” says Dr. Rehberger.

“All other provider types do the same thing—it’s time that we did it,” adds Dr. Miller.

To conduct a proper scientific process and reach consensus on terminology describing stages of chiropractic care, ACA commissioned the Council on Chiropractic Guidelines and Practice Parameters (CCGPP), an organization that has been accumulating evidence pertinent to chiropractic practice and developing consensus documents and literature syntheses.

From the existing literature and policy documents, CCGPP developed 15 seed statements describing the phases of chiropractic care. Then the Congress of Chiropractic State Associations and ACA were asked to nominate panelists—representing 14 states and 18 chiropractic organizations, with a broad range of philosophical perspectives—to review the statements. In addition, a nurse, a lawyer, an acupuncturist and a representative of the insurance industry were invited to join the panels to provide a multidisciplinary perspective, explains Wayne Whalen, DC, DACAN, COCSA representative to and past chairman of CCGPP and one of the authors of the consensus project.

The panelists were asked to rank the seed statements using the Likert scale— from “highly appropriate” to “highly inappropriate”— and were also “given an opportunity to provide comments, which helped to make changes to the seed statements until a consensus was attained,” explains Kara Murray, ACA’s director of federal and regulatory affairs, who managed the consensus project.

“The value in the consensus language is to facilitate proper use within the profession, in the broader health care community, among other provider groups and government regulatory agencies, as well as in the payer industry.”

James L. Rehberger, DC
Chairman of ACA’s Insurance
and Managed Care Committee

Defining Stages of Care

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