ACA Vows to Continue Legal Battles
The Supreme Court has declined an appeal by the American Chiropractic Association (ACA), the Virginia Chiropractic Association (VCA), and a group of individual doctors and patients, who allege that Trigon Blue Cross Blue Shield had conducted unlawful acts against the chiropractic profession.
“The Trigon lawsuit may be over, but that is hardly the end of the story,” says ACA President Donald Krippendorf, DC. “We’re sending a loud and clear signal to the insurance industry that when it comes to abusive practices that discriminate against chiropractic, the battle is just beginning. Insurance organizations must understand that there will be a price to pay if they don’t reform their ways.”
A new potential weapon in the ACA’s legal arsenal is the use of the Racketeer Influenced and Corrupt Organizations Act (RICO) when filing future lawsuits against insurance companies.
ACA officials said positive developments have resulted from this litigation, including a chiropractic benefit in the Federal Employee Benefits Plan, which is worth an estimated $120 million to $140 million per year. It also offers coverage for physical therapy services performed by a chiropractor.
In another legal battle, the ACA has also vowed to appeal a decision by a US District Court judge who dismissed ACA’s lawsuit against the Department of Health and Human Services. The appeal was brought to protect the chiropractic profession’s services under Medicare for the manual manipulation of the spine to correct a subluxation.
In his decision, US District Judge John Garrett Penn said that Congress did not intend for only chiropractors to provide manual manipulation of the spine to correct a subluxation, and the Medicare statute is neither silent nor ambiguous in this regard.
“We thank the thousands of supporters and contributors within the chiropractic profession who continue to stand with us through this monumental legal battle,” says Krippendorf. “Because of your commitment to the cause, we will continue to ensure that Medicare beneficiaries receive the safe and effective chiropractic care they need and deserve, and that they receive it from health care providers appropriately trained and skilled to provide manual manipulation of the spine to correct a subluxation.”
Chiropractic Coverage Lowers Health Care Costs
A 4-year retrospective study, which compared more than 700,000 health plan members who had chiropractic coverage and 1 million members of the same plan without a chiropractic benefit, showed that chiropractic coverage decreased health care costs.“Prior to this, no study had ever linked chiropractic benefits to lower utilization levels in a real-world setting,” says coinvestigator Douglas Metz, DC, chief health services officer for American Specialty Health, California’s first specialized health plan for chiropractic and acupuncture benefit programs. “Our study shows that systematic access to managed chiropractic care may prove to be not only clinically beneficial, but can reduce key cost factors that drive up employer health costs in traditional care settings.” The study, reported in Archives of Internal Medicine, published by the American Medical Association, concluded that chiropractic care cut the cost of treating back pain by 28%, reduced hospitalizations among back pain patients by 41%, decreased back surgeries by 32%, and reduced the cost of medical imaging, such as X-rays and MRIs, by 37%. According to the study’s authors, systematic access to managed chiropractic care not only proves to be clinically beneficial, but can also reduce overall health care costs. |
Life University Receives Positive Audit
Charles Ribley, DC, chairman of Life University’s Board of Trustees, has announced that audit firm Anderson, Hunt & Co has removed the “going concern” qualification—defined as substantial doubt that resources to operate can be generated or raised—from the school’s year-end audit. This indicates the university is stable and could raise or generate enough resources to operate.
“It is gratifying to know that the commitment of the Life community to continue to produce a quality academic program is recognized by our accounting firm and that we are considered a viable entity,” says Bill Jarr, vice president of finance and operations.
According to Jonathan Anderson, one of the firm’s partners, the number one reason the going-concern qualification was removed was because of the new senior administration, headed by President Guy Riekeman, DC. Evaluating nonempirical information was a critical component of Life University’s turnaround and the school’s future.
For the past 6 months, the finance department, led by Jarr, has worked tirelessly to resolve finance issues and ensure a balanced budget. In addition, the Board of Trustees and the president have raised $4.85 million in cash to establish a successful future for the university.
FTC Takes a Stand
The Federal Trade Commission (FTC) is working on stopping deceptive national advertising on weight loss and is providing refunds and educating consumers against false claims.“This move is part of the push for broader consumer protection relating to health care and medical products,” says Mark Mandell, DC, president of BrainStorm Group and CP editorial advisory board member. “The recent advances in health care products are promising, but making false claims is misleading and can prevent people needing medical assistance from getting the real help they need in a timely manner.”  The weight-loss claims are part of the FTC’s Red Flag education campaign that assists media outlets with voluntarily screening claims that are too good to be true. As part of the Red Flag initiative, the FTC has sent reminder letters to media outlets to assist in identifying and rejecting advertisements that contain false weight-loss claims.
“Through our monitoring, we have seen a decrease in the frequency of [these] claims in the media,” says FTC Chairman Deborah Platt Majoras. “This tells us that many in the publishing and broadcasting industries are doing the right thing and stepping up their efforts to reject ads like the ones we targeted. This is good for consumers, good for the media, and good for honest advertisers.” |
Allstate Prevails in Fraud Lawsuit
A Dallas jury has ruled that Accident & Injury Pain Center Inc, Texas’ largest chiropractic chain, must pay $2.8 million in actual damages and $3 million in punitive damages for conspiring in a statewide scheme designed to defraud Allstate Insurance Co and Encompass Insurance, a subsidiary of Allstate.
“At Allstate we’re taking a stand to fight insurance fraud and get the defrauders, no matter where they’re hiding,” says Gary Briggs, Texas field vice president. “Our commitment is to deliver competitive insurance rates to our policyholders, and we can help do that by exposing insurance fraud and putting fraudulent enterprises out of business.”
Allstate and Encompass have alleged that the vast majority of x-rays of auto accident patients of Accident & Injury Pain Center were referred to Lone Star Radiology, which is located within Accident & Injury Pain Center’s corporate office in Dallas. On their first visit, patients were routinely referred for MRIs to one of four facilities owned by Robert Smith, the owner of Accident & Injury Pain Center. The second-opinion examinations were conducted at Accident & Injury Pain Centers.
Allstate and Encompass also have evidence that the wife of one of the defendants was receiving up to $10,000 per month for marketing services from a pharmacy where the majority of the Accident & Injury patients were receiving prescriptions.
Backpack Safety Pays Off
According to the United States Consumer Products Safety Commission, the number of emergency room visits related to backpack injuries was down from 7,860 in 2002 to 7,649 in 2003.
“For the first time since these numbers have been reported, we see that parents, teachers, students, and health care professionals are becoming aware of the issue and taking steps to address it,” says Marvin Arnsdorff, DC, of Chiropractic USA, cofounder of Backpack Safety America. “The bad news is that the numbers are still needlessly high, and the pain and suffering caused by overloaded and improperly worn backpacks is easily preventable.”
Arnsdorff joins thousands of health care professionals and educators throughout North America and around the world in helping school-age children use their backpacks properly and recommends the following tips: choose a backpack that is 75% of the length of your back; the weight of the loaded backpack should not exceed 15% of your body weight.
For proper lifting to prevent injury, face the pack, bend at the knees, check the weight of the pack using both hands, lift with your legs, and apply one shoulder strap at a time.
Arnsdorff also recommends wearing both shoulder straps at all times to avoid unnecessary pressure to one side of your body, using the waist strap to stabilize the load, and making sure pens, pencils, and other sharp objects are stored in a safe place.
Congress Considers Chiropractic Role in NHSC Program
A legislative directive intended to provide $3 million for chiropractic participation in the National Health Services Corps (NHSC) student loan program is in the final stages of consideration by Congress. This came a direct result of the 2004 lobbying campaign led by the American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC). If approved, the directive will ensure that DCs are appropriately represented in the ongoing NHSC chiropractic demonstration, a program mandated by Congress in 2002.In 2003, Congress provided $3 million for the program; however, only a portion was actually used for the chiropractic demonstration. According to ACA officials, even more disturbing was a decision to prevent any DCs from applying to the program in 2004 and to restrict the demonstration to eight participants. To secure fair treatment for DCs who are already in the NHSC program as well as those who are interested in applying, ACA sought the support of Sen Tom Harkin (D-Iowa), who is committed to fixing the NHSC program and ensuring that more DCs are included. |
ACA House of Delegates Meet Amid Hurricane
Despite the pounding rains and powerful winds of Hurricane Frances, the American Chiropractic Association (ACA) held its annual House of Delegates (HOD) meeting in St Petersburg, Fla, August 31–September 4.
“While I have always known that ACA members are the cream of the crop, this year’s HOD meeting was proof that our doctors are strong, persistent, and unwavering in their dedication to the profession and the ACA,” says ACA President Donald Krippendorf, DC, whose home in St Petersburg was damaged by the storm.
Key business topics included the development of resolutions that address specific health care issues, including workplace safety, airline seat ergonomics, and the effects of smoking on musculoskeletal health, along with an update on an appeal to the US Supreme Court in a case the ACA and the Virginia Chiropractic Association have against Trigon Blue Cross Blue Shield.
Veteran officers were reelected to ACA’s Board of Governors: Krippendorf as president; George McClelland, DC, as chairman of the Board of Governors; Lewis Bazakos, DC, to the ACA executive committee and as governor of District 4; Richard Brassard, DC, as ACA vice president; Daryl Wills, DC, continues as immediate past president.
In Council of Delegate elections, Glenn Manceaux, DC, was reelected as president; Rick McMichael, DC, as vice president; and David Herd, DC, as secretary.
Paul Smith, DC, a long-time member of the ACA HOD was newly elected to governor of District 7.
Drug-Resistant Bacteria Causes Infections
A form of flesh-eating bacteria, methicillin-resistant Staphylococcus aureus (MRSA), that is resistant to standard antibiotics, is causing a number of less serious skin infections in children; it is also emerging as cause of pneumonia, which can be deadly.
MRSA is a concern because antibiotics prescribed by physicians only a few years ago typically no longer work. Over time, bacteria can mutate and become resistant to specific antibiotics. Effective antibiotics are available to treat MRSA, but physicians are concerned that the bacteria will eventually become resistant to those as well.
“The more medical men interfere with nature, the more nature interferes with men,” says Jeffrey E Ptak, DC. “When we treat versus empower we create more of what it is we do not want. Whether it’s drugs or physiotherapy, outside-in does not cure but causes the very thing we are attempting to eliminate in our lives times infinity.”
In Los Angeles, there were 14 cases of necrotizing fasciitis (flesh-eating bacteria) caused by MRSA. None of the patients died, but all had reconstructive surgery to remove the infected flesh. All 14 patients were eventually successfully treated.
“This is about as serious an infectious disease emergency as you can get,” says Loren G. Miller, MD, MPH, principle investigator at the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (LA BioMed) and assistant professor of the David Geffen School of Medicine at UCLA. “Thankfully, no one died, but physicians need to be aware that if they see cases of necrotizing fasciitis, they should treat for this resistant bug (MRSA) in addition to the other known cases until they know the causative bacteria. This is a major shift in treatment approach.”
The MRSA is also causing infectious skin boils, called abscesses, in nonhospitalized children. The boils are typically red and raised, can be gumball to golf-ball sized, and can appear anywhere on the body. Treatment involves draining the abscess, cleaning the wound, and prescribing appropriate antibiotics.
A Centers for Disease Control and Prevention study being presented at Infectious Diseases Society of America reports on 17 people in nine states who got pneumonia caused by MRSA outside of the hospital during last year’s flu season. Of the 17, five died.
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