The Squeaky Wheel

Associations & The Squeaky Wheel

THERE IS A DIVIDE IN OUR PROFESSION THAT DATES BACK NEARLY TO ITS INCEPTION. ALIGNING YOURSELF WITH AN ASSOCIATION AND BECOMING AN ADVOCATE MAY BE THE MOST PRODUCTIVE WAY FORWARD.

// By Sara Parsons //

Between juggling a loaded became what we still call it today, health and human potential through class schedule, clubs, clinic, the International Chiropractors specific and scientific chiropractic and for many of us a part- Association (ICA)1. It is the oldest care”3. The Mission of the ICA also time job, imagine throwing international association to make it to supports the philosophical values; in the mix researching position and 2020, and was developed with the “to protect and promote chiropractic political advocacy articles from aim of “advancing the profession of throughout the world as a distinct multiple chiropractic association chiropractic through advocacy and health care profession predicated websites. Even the best clowns would development”2 . upon its unique philosophy, have trouble keeping science, and art of all those knives in the subluxation detection air. “It is important to figure out and correction”3. It is

However difficult, it is important for your vision of the future of apparent from these statements that the ICA students to keep our chiropractic Chiropractic, find the association has a philosophical foundation, views index fingers on that has the same vision, join chiropractic as a the associations that represent our that association, and fight for the unique profession unlike any other, and profession. I present chiropractic you think is best.” supports the theory in the following of subluxation as the paragraphs a few cause of all disease. players in the game; The ICA lists its the International Chiropractors The ICA, as one might have objectives under its ‘about’ section

Association (ICA), the American guessed based on the individual of their website, and atop that list is

Chiropractic Association (ACA), that founded it, is an association the goal to “maintain and promote the International Federation of that champions vitalistic chiropractic chiropractic’s unique identity as

Chiropractors and Organizations and aims to support and protect the a vitalistic non-therapeutic, non(IFCO), and the World Federation of philosophy of chiropractic as the allopathic, drugless and surgical-

Chiropractic (WFC). keystone that supports our profession. free health science, based on The ICA vision statement reflects its fundamental principles and ICA this much like a still mountain lake philosophy”3. The rest of the list

In 1926, B.J. Palmer founded reflects the sky, the clouds and the includes spreading licensure and the Chiropractic Health Bureau trees that surround it with impeccable regulation of chiropractic to every (CHB). The organization held on accuracy. The vision is to “empower nation, working with other nations to that name until 1941, when it humanity to optimal life expression, “in a global humanitarian effort”3

to spread chiropractic around the globe, to raise the standard of professionalism and technical development, fight for medical freedom and choice, and demand non-discrimination for chiropractic in health care3 .

As mentioned above, the ICA is active in advocating for the profession and is currently tackling issues surrounding payment, coverage, and opt-out issues for Medicare beneficiaries, coverage for veterans through Tri-care, and fighting for chiropractic to remain drug free2. (For those interested in learning more about current bills presented to Congress, see my article “Senate & State” on page 20).

ACA

There have been three separate chiropractic groups to call themselves the American Chiropractic Association. The first time the name was used was by the first known chiropractic organization, formed in 1905, disbanded in 1918. The second time the name was used was in 1922, when the ACA was formed in Chicago in direct opposition to the Universal Chiropractors Association found in 1906 by B.J. Palmer (he later left the UCA in 1926 when he lost the election for secretary of the UCA, and formed the ICA as described above). When B.J. left, the UCA and ACA joined to become the National Chiropractic Association (NCA) which in turn became what we know today as the ACA in 19631 .

The ACA is currently the largest professional chiropractic organization in the United States. Their mission is “to inspire and empower our members to elevate the health and wellness of their communities”4 with a vision to “[lead] a modern movement of chiropractic care based on higher standards and focus on patient outcomes”5. They state their values as patient centered, focused on evidence-based care, service in the best interest of public health, and focus on collaboration and integration with other professions in the health care community5. The ACA’s focus is on evidence based care, patient outcomes, and public health initiatives. The ACA is heavily involved with lobbying, supporting research, and creating networks with other health professions to best serve patients.

Remember those bills mentioned above currently being presented to the House and the Senate with regards to (shout out Dr. Straub) Medicare, Tri-care, and the question of prescription drugs being integrated under the Chiropractic scope of practice? You guessed it, the ACA is heavily involved with lobbying on all three topics.

CLOSING REMARKS

There is a divide in our profession that has existed since the early 1900s. On one hand there are those that think the profession should keep at its center the philosophy upon which it was developed, that our profession is separate and distinct as long as we keep it by hand only, focused on the detection and removal of subluxation. On the other hand there are those who believe we the best way to progress and develop the profession is to use chiropractic only for what modern science has shown it is effective in treating, and incorporate chiropractic into the already established health care field working alongside others in an integrative way to reduce neck and low back pain. It is important to figure out your vision of the future of Chiropractic, find the association that has the same vision, join that association, and fight for the chiropractic you think is best. The squeaky wheel gets greased, and the only way to make a change is to stand up and say something. §

House &Senate

KEEP UP WITH CHIROPRACTIC POLITICS. HERE ARE THE CURRENT PROPOSED LEGISLATIONS PRESENTED TO CONGRESS, AND THE RESPECTIVE VIEWPOINTS OF THE AMERICAN (ACA) AND INTERNATIONAL (ICA) CHIROPRACTIC ASOCIATIONS.

// By Sara Parsons //

BILL H.R. 3654

The Chiropractic Medicare Coverage Modernization Act of 2019 was introduced to the House on July 9th, 2019. Currently, Medicare only covers spinal manipulation to remove subluxation and does not pay for any other physician services that are within a chiropractor’s scope under their state license1. Examples of other physician services are ordering x-rays, clinical labs, and other diagnostic procedures. The Medicare program started allowing coverage for chiropractic care in 1972 by accepting and paying for one service; “the manual manipulation of the spine to correct a subluxation”1 .

ACA POSITION

The ACA is in support of this bill passing through the house. They believe that as portal-of-entry doctors, chiropractors should be reimbursed for physician services they can legally perform under their state license including the examination, diagnosis, treatment and, when necessary, the referral of patients to the appropriate providers. Because of the current law, patients that have Medicare coverage and need physician services other than a manual manipulation will have to go to another provider to get a diagnosis likely to then be referred out again for necessary lab or diagnostic procedures. The ACA also argues that this system funnels patients into the medical paradigm where providers rely on more invasive standards of

care like prescribing drugs, spinal injections and surgery. They state that research shows chiropractic care is less invasive, more economical, and more effective in reducing pain syndromes than the above allopathic interventions. Therefore, the ACA claims passing this bill has the potential of removing barriers to care for the patient, reducing costs to the Medicare system, and acts in the best interest of the Medicare patients2 .

ICA POSITION

While the ICA wants to expand Medicare coverage to include payment for examinations and x-rays and believe this specific bill

will remove select barriers to care, namely that patients will visit their chiropractor more if it is covered by their insurance, the ICA is not endorsing this bill because it does not include changes to the “optout” policy. The “opt-out” policy of

“The ACA and ICA are actors at play on Capitol Hill, and work diligently to push through policy changes that will shape the chiropractic profession.”

Medicare allows patients to choose to privately contract with a certain group of health care professionals who are allowed to opt-out of Medicare coverage, and chiropractic is not one of them. Without the ability to opt-out, chiropractors must work under the Medicare umbrella, and will only get reimbursed for what Medicare decides is covered. The ICA states that they won’t back a bill unless it addresses this issue, and issue they view as discriminatory against our profession3 .

BILL H.R. 2883

Both the ACA3 and ICA are in support of this Bill, introduced to the house May 21, 2019, which aims to amend the same section XVIII of the social security act as H.R. 3654 to include chiropractors in the definition of authorized physicians. This would allow chiropractors to make private contracts with Medicare beneficiaries and opt-out of working with Medicare3 .

BILL H.R.344

the Department of Defense health care system, active-duty military members are eligible for chiropractic care through the Chiropractic Health Care Program. Once active members retire or are discharged, their TriCare insurance does not cover chiropractic care. This bill presented to the House on January 8, 2019 would direct the Department of Defense to include chiropractic care under TriCare covered benefits for retired military personnel, national guard and the reserves1 .

ACA POSITION

The ACA is in support of this bill and points out that musculoskeletal complaints are common among retired military service members, especially when they are at the point of retiring. Soldiers that have been receiving chiropractic care throughout their career are suddenly faced with having to pay for care out of pocket or go without. TriCare does cover prescription drugs, so many retired service members turn to drugs to handle their pain. The ACA claims this bill will help add a drug free option for those who wish to take a less invasive route to avoid opioid pain management2 .

ICA POSITION

The ICA is also in support of this bill because they say it will make chiropractic care a permanent benefit under TriCare health insurance, will mandate that only chiropractors can perform the chiropractic adjustment, and it will allow direct access to chiropractic care to TriCare beneficiaries3 .

There has been a bill presented to the Senate (S.30) as well3. In order for bills to become law, they must first pass through the house and the senate then be signed off by the president. The ACA and ICA are actors at play on Capitol Hill and work diligently to push through policy changes that will shape the chiropractic profession. To dig into more policies and keep tabs on the future of chiropractic, join an association! You can also find the specific bills and exact language on congress.gov. §