Government Report on Medicare HMOs Shows
Reduction in Chiropractic Services
CA Files FOIA Request for OIG
Survey Questions and Answers

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

Thanks to the American Chiropractic Association for the use of this article!

FOR MORE INFORMATION, CALL:
Felicity Feather or Teri Howell
(800) 986-4636

FOR IMMEDIATE RELEASE: July 3, 2000

---

WASHINGTON, DC -- A new government report on the utilization of chiropractic care in Medicare managed care plans reveals a "startlingly unexplainable reduction" in chiropractic services available to beneficiaries - especially to patients enrolled in Medicare HMOs that require a physician referral to a chiropractor, according to the American Chiropractic Association (ACA).

The report, released June 26 by the U.S. Department of Health and Human Services' (HHS) Office of Inspector General (OIG), is consistent with previous studies by the OIG and should bolster ACA's lawsuit against the Health Care Financing Administration (HCFA) regarding new Medicare+Choice regulations. In its lawsuit, ACA has charged HCFA with unlawfully allowing Medicare managed care plans to substitute the services of other health care providers for services that should legally be performed by doctors of chiropractic. Although the OIG has interpreted the results of the report to indicate an increase in utilization of chiropractic services, ACA officials disagree.

In 1996, more than 1 million Medicare beneficiaries participated in Medicare managed care organizations with a physician referral requirement. According to the latest report, titled "Chiropractic Care: Comparison of Medicare Managed Care and Fee-For-Service," only 6,200-or 0.61 percent -- of those beneficiaries were referred for chiropractic services. Although that number increased to 0.96 percent in 1997 and 1.08 percent in 1998, utilization of chiropractic services in Medicare fee-for-service ranged much higher during the same time period -- between 4.15 percent and 4.42 percent. In addition, the utilization of chiropractic services among the American public as a whole is approximately 6.5 percent.

"This report drives home the fact that Medicare managed care patients are systematically being denied access to doctors of chiropractic," said ACA President James A. Mertz, DC, DACBR. "It also underscores the importance - and validity -- of our lawsuit against the federal government. Doctors of chiropractic are obviously being discriminated against in these plans, and Medicare managed care patients are not receiving the chiropractic services they are entitled to by law."

According to ACA officials, a repeated statement contained in the report strikes at the heart of ACA's lawsuit against HCFA. The report states that chiropractic services, or manual manipulation of the spine to correct a subluxation, "can be provided by any provider meeting the definition of 'physician.'" The report further states that "the term 'physician,' as defined by §1861 of the Social Security Act, includes doctors of medicine, osteopathy and chiropractic." The government, in response to ACA's lawsuit, has recently acknowledged that physical therapists are not qualified to provide the chiropractic service; however, the OIG report continues to reflect the government's position that medical doctors and osteopaths are capable of providing chiropractic services to Medicare beneficiaries. This core issue is now before the federal court in ACA's litigation.

In its report, the OIG also indicates that chiropractors performed 91.42 percent of the chiropractic treatments in 1998 for the 110 managed care risk plans that responded to the OIG's survey. However, ACA officials point out that with only 110 out of the 310 plans responding to this inquiry, the information is not representative of the plans as a whole. In addition, ACA would like specific information about how the question regarding chiropractic treatments was posed and has filed a Freedom of Information Act request to review the survey questions and responses.

"If the question was, 'Who provides your chiropractic care?' such an inquiry begs a logical response of 'chiropractor,'" explained Dr. Mertz. "However, if the inquiry was more specific and stated 'Who provides manual manipulation of the spine to correct a subluxation?' -- the chiropractic service -- the expected response could better identify the providers actually providing this unique chiropractic service."

ACA officials are also concerned that news of its lawsuit against HCFA within the managed care industry could have skewed the results of the OIG's survey - with those surveyed responding in a manner they felt would be consistent with ACA's view of the law. "The government has been forced to agree with ACA's legal position that physical therapists should not be permitted to provide the uniquely chiropractic physician service of manual manipulation of the spine to correct a subluxation," added Dr. Mertz. " It is well known in the industry that ACA has filed litigation on not only that point, but also on the point of medical doctors and doctors of osteopathy providing chiropractic services. It may well be that the ACA litigation had an effect in terms of the responses received from those plans."

"Nevertheless," Dr. Mertz added, "even the results of the survey as presented by the OIG show that the percentage of chiropractic services provided in Medicare managed care plans is drastically lower than the percentage provided in Medicare fee-for-service plans."

ACA officials request that anyone with information regarding the denial or the minimalization of chiropractic services in Medicare managed care plans contact the ACA. In addition, ACA requests information regarding HMOs that are offering or providing the chiropractic service through physical therapists or other providers other than licensed doctors of chiropractic.

The Federal Court for the District of Columbia is currently reviewing a motion by the government to dismiss ACA's lawsuit against HCFA, along with ACA's response.

# # #

The American Chiropractic Association, the largest chiropractic organization in the country, provides lobbying, public relations, professional and educational opportunities for doctors of chiropractic, funds research regarding chiropractic and health issues and offers leadership for the advancement of the profession. The ACA promotes the highest standards of ethics and patient care, contributing to the health and well-being of millions of chiropractic patients.

Return to MEDICARE SAGA

Since 7-03-2000