By Bonnie S. Hillsberg, DC, MHA, MEd; guest author for Rand Baird, DC, MPH, FICA, FICC
Source Dynamic Chiropractic
On Jan. 5, 2009, the U.S. Health Resources and Services Administration (HRSA) announced yet another chiropractic demonstration project. Haven’t we been there before? Isn’t this the third demonstration project? Why a demonstration project after full facts, research and empirical evidence indicate that chiropractic works and is already a fixture of the public health delivery system in the United States? Isn’t it time we were included as a permanent part of the National Health Service Corps?
What More Do We Need to Prove?
For more than 100 years, chiropractors have raised awareness of musculoskeletal and structural issues impacting the health of our society. The chiropractic profession has made valiant efforts to join with our communities to actively support public health programs. As professional health care providers, chiropractors promote the impact of structure on health, prevention and wellness.
In recent years, the profession has made giant strides as a partner in the health care delivery system at local, state and federal levels. Chiropractic is licensed in every state and the District of Columbia. Chiropractors pass national exams and undergo rigorous testing prior to licensure. For the past decade, the chiropractic profession has been working diligently to provide care in poor, underserved and rural areas through the National Health Service Corps. In addition, the chiropractic profession is trying to gain parity in the U.S. Public Health Service Corps. Here are some important facts to substantiate our inclusion in these programs:
* In 1992, Prevention magazine reported chiropractic as the most popular form of alternative care in the U.S., according to a survey reported by the American Medical Association.
* Up to 100 million Americans have used chiropractic care, including 27 million in 1999 alone.
* Chiropractic treatment is covered by many major health insurance plans.
* In 1999, coverage for chiropractic was offered by 78 percent of employer health plans. This represents a jump of 17 percent in that year alone. The study was conducted by a consulting firm, William M. Mercer, Inc.
* In 2009, HRSA’s Bureau of Health Professions, Division of Medicine and Dentistry, reported that low back pain is a major cause of functional disability, representing one-fourth of all disabling work injuries.
* A study published in the Feb. 9, 2009 issue of the Archives of Internal Medicine estimates that 80 percent of people will experience an episode of low back pain at some time in their lives.
* The annual direct and indirect costs of low back pain are estimated at $60 billion in the U.S.
* Joint diseases account for half of all chronic conditions in the elderly.
* Throughout the world, musculoskeletal conditions and deformities deprive children of normal development.
* Doctors of chiropractic are treating soldiers, sailors, airmen and marines in 49 health facilities throughout the nation.
* Doctors of chiropractic treated men and women after the 9/11 and Oklahoma City bombings, Hurricanes Andrew and Katrina, the Colorado fires, and at other catastrophic sites.
* The National Institutes of Health (NIH) has a chiropractor on staff as part of the research team in the Complementary and Alternative Medicine Center.
The Research Supports Our Inclusion
Chiropractic has been researched for decades. The research clearly shows that spinal manipulation is safe and effective for treating low back pain and other structurally related health issues. The research has determined that chiropractic adjustments are safe and effective, and that chiropractic care costs less and results in fewer lost work days. These findings are supported by studies conducted by federal, state and foreign governments, medical doctors, universities and private corporations, as well as by chiropractors themselves. This research includes the following:
The RAND Study: This independent, ongoing study by an expert panel of MDs and DCs reviewed 35 years of research on spinal manipulation, agreeing that chiropractic is an appropriate and effective treatment for many kinds of low back pain.
The AHCPR Guidelines: A panel of doctors of medicine and other health professionals developed these federal guidelines in 1994 for the Agency for Health Care Policy and Research. Based on a review of current research, the study recommends treating acute low back problems with spinal manipulation by a trained professional.
The Manga Report: This 1993 Canadian report examined the effectiveness of chiropractic for management of low back pain. The panel of health experts found that spinal manipulation by chiropractors is more effective, less costly, and often safer than medical treatment for low back pain.
On June 4, 2007, the Associated Press announced that the European Union had launched a Campaign to Tackle Back Pain. “The European Commission launched a campaign Monday to fight backache and other bone and muscle pains which are the most common work-related heath problem in Europe costing billions of dollars in lost labor hours.”
In November 2000, chiropractic care was offered in the emergency department in the Meadowlands Hospital Medical Center in Secaucus, N.J., in an effort to satisfy the Joint Commission on Accreditation of Hospitals mandate to better address pain management. The demand for the chiropractic care offered in hospitals today is very high, as is patient satisfaction with the service.
A study in the Journal of Human Hypertension found a possible connection between chiropractic cervical manipulation and a decrease in blood pressure.
The most recent national 2008 collaborative federal survey with the NIH and the Centers for Disease Control and Prevention gave a portrait of CAM use in children. Chiropractic was listed as the second most common therapy among children in 2007. Back and neck pain were listed as the most frequent diseases/conditions for which CAM is used among children.
And as recently as Feb. 1, 2009, the Washington Post published a timely article, “Weight of Combat Gear Is Taking Toll.” The article stated that “the loads are contributing to injuries that are keeping some troops on the sidelines.” There is rising concern over bone and muscle injuries resulting in debilitating conditions and causing the majority of hospitalizations and outpatient visits. Chiropractic care is welcomed by the Armed Forces. This is clear by the reception chiropractors receive.
Recognizing Chiropractic’s Value in Public Health
As President Obama begins to address national health reform, it is important to know he is on record as recognizing and fully supporting expanding chiropractic services coverage under Medicare and chiropractic inclusion in the Department of Veterans Affairs and the Department of Defense, as well as commissioning doctors of chiropractic as officers in the Uniformed Corps of the U.S. Public Health Service.
Chiropractic is about health and wellness, not just pain relief. Chiropractors influence public health policy, especially in the areas of complementary and alternative medicine and prevention, and represent our profession’s interests to the government, industry, health care system and public. At the present time, chiropractors serve on the American Public Health Association’s Governing Council, the Action Board, and other leadership positions, can propose policy change, and have presented on various topics that include chiropractic in the changing health care environment: issues in chiropractic and public health education; issues in chiropractic practice and research; chiropractic access and outreach; and chiropractic health promotion both internationally and nationally.
It is time for the chiropractic profession and others to urge legislators to recognize the importance of chiropractic services in the public health field. Now is the time to hear from you about the valuable role chiropractors play in reforming our health care system. We need to secure our seat in health care reform and highlight the need to address musculoskeletal issues impacting society. We cannot and should not be expected to again “demonstrate” our value in the public health delivery system. We’ve already done that. Please target members of Congress and your legislators to make this important leap.
I just got an e-mail from the Illinois Chiropractic Association, stating that the Inspector General of the Department of Health and Human Services just released a report.
They studied claims from 2006 that contained the -AT modifier (Active Care) for beneficiaries who had more than 12 visits with the same chiropractor. For each treatment episode, the medical records were reviewed to identify the initial visit and subsequent visits (if relevant) to determine whether each sampled claim was active/corrective treatment or maintenance therapy, the extent to which chiropractors supported their use of the AT modifier with proper documentation indicating active/corrective treatment, and whether claims were coded properly, and whether documentation met the Manual requirements.
The depressing news? In its report, the OIG found Medicare inappropriately paid $178 million for chiropractic claims in 2006, representing 47 percent of claims meeting their study criteria.
The primary issue is that the documentation did not suppport that care as needed “active care” (Medicare’s guidelines). That’s easily correctable IF doctors clean up their act. Meanwhile, our profession looks pretty bad.
Read the Full Report (Adobe Acrobat format)