White House Commission on Complementary and Alternative Medicine Policy
December 4, 2000
Statement of the American Chiropractic Association before the White House Commission on Complementary and Alternative Medicine Policy
On behalf of the American Chiropractic Association, I appreciate the opportunity to provide comments to the White House Commission on Complementary and Alternative Medicine Policy. My name is Dr. Bruce Nordstrom I am a practicing doctor of chiropractic from the District of Columbia. I am also the Washington, DC delegate to the ACA. This afternoon, I encourage the commission to focus on wellness.
A key principle behind chiropractic care as well as many other complementary and alternative therapies is wellness. These alternative and complementary practices have a history and a focus of promoting health, and increasing the quality and span of life. For example, in my practice, in addition to providing chiropractic spinal manipulation or adjustment, I also counsel my patients on among other things diet and exercise to promote their well-being.
The role of chiropractic in the health care system has been described in a paradigm that was unanimously adopted by all the chiropractic college presidents and supported by the ACA. A copy of the paradigm is attached in my formal statement. This paradigm emphasizes a philosophy focused on wellness. Doctors of Chiropractic seek to optimize health, by recognizing that the body's innate recuperative power is affected by and integrated through the nervous system. Within this paradigm, a doctor of chiropractic establishes a diagnosis and uses chiropractic case management to promote health.
It remains a challenge of how to encourage insurers to recognize and reimburse providers for the promotion of health. Increasingly complex life styles, flaws in workplace ergonomics, longer life spans, increased survival from serious injury have created an inherent need to move from injury/disease management to a more primary care role that is wellness oriented and focused on preventative care. Insurance companies are slow to move in this direction. Payors must be encouraged to offer preventive alternative therapies as paid insurance benefits rather than a patient paid responsibility. In the case of chiropractic, coverage remains limited in terms of reimbursable services. These coverage constraints restrict a patient's ability to seek the treatment they need to promote their well-being.
By providing for early conservative chiropractic intervention, we may prevent many conditions that have neuromusculoskeletal origin from becoming more chronic and requiring more invasive procedures. One other aspect is the potential decrease in iatrogentic disease from intervention both medical and surgical that may have high risk for the patient. In fact, a 1999 Institute of Medicine publication entitled "To Err is Human: Building a Safer Health System" found that a substantial body of evidence points to medical errors being a leading cause of death and injury. Using conservative treatment provided by CAM providers could prove to be an important part of the solution to this problem.
Payors as well as policy makers need to understand the value of illness/injury prevention and wellness and realize the lost productivity, compromised quality of life and the cost of health care dollars that are associated with failed treatment approaches. However, creating the value associated with these practices means bringing wellness back into the health care equation. The value of health care delivery in the context of a wellness paradigm has been virtually lost in budget neutrality wars, administrative benefit cuts and other scenarios as an expense that the patients must pay themselves. Once payors and policy makers begin to see the bottom-line cost savings involved in wellness and the promotion of health, one would hope that they embrace early and regular wellness interventions as a viable option. The ACA urges the Commission to incorporate the overall recognition of the cost-effectiveness of wellness and the promotion of health as provided by a CAM provider in its final recommendations to Congress.
I would like to provide the commission with an example of a chiropractic primary care physician model in Illinois that stresses prevention over disease care and the remarkable cost savings this organization has had. Alternative Medicine Inc., (AMI) has a contract with HMO Illinois to utilize chiropractors as primary care physicians. AMI is a fully integrated medical delivery system that uses doctors of chiropractic as the portal to entry for all medical decision-making. AMI stresses prevention, using pharmaceuticals and surgery only as last resorts. Although the pilot program is still in its infancy, AMI is cutting costs. According to Richard Sernat, MD, president of AMI, since its inception, AMI has reduced the rate of hospitalization, procedures, surgery and everything to do with inpatient care by approximately 75 percent compared to the values of allopathic treatments.
The current health care system needs to allow for better-coordinated care between medical doctors and alternative providers and stress the importance of prevention. Medical students must be encouraged throughout their schooling to refer their patients to complementary and alternative care providers. In addition, it is critical that Doctors of Chiropractic and other alternative care providers be included in interdisciplinary teams that center on early patient intervention is critical. As health care costs continue to rise, policy makers and payors must consider recognition and full reimbursement for wellness and preventative practices as a viable option to contain costs.
Managing health care risk before it becomes unmanageable must rank as equally important as other business risks such as shifts in competition and market share. Including insurance reimbursement for treatment protocols that result in improved overall patient health, often at lower cost is a fundamental first step in the right direction.
Thank you for the opportunity to provide the views of the ACA. In closing, I would like to leave with the Commission this book entitled "The Chiropractic Profession" by David Chapman Smith. I hope that it will be a valuable resource to the commission as they move forward. Now, I would be happy to answer any questions you may have.
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