Court Overturns Decision
Allowing MDs and DOs to Manipulate Spine
On December 13, 2005, the United States Court of Appeals overturned a lower-court
decision to allow medical doctors and osteopaths to perform spinal manipulation to correct
a subluxation on Medicare beneficiaries. The court’s decision represents a major step
in the American Chiropractic Association’s (ACA) lawsuit against the United States
Department of Health and Human Services (HHS), and comes at a critical time as Medicare
patients are choosing Medicare-managed health care plans as their new prescription drug
benefit.In its decision, a three-judge appeals
panel reversed an October 14, 2004, District Court ruling that stated, “The court
will simply reiterate its conclusion that 42 USC 1395x(r) does not prevent doctors of
medicine and osteopaths from performing a ‘manual manipulation of the spine to
correct a subluxation.’” The appeals panel ruled that the District Court lacked
the jurisdiction to make this decision and that the final decision must be made through a
newly revised appeals process. Through the new process, DCs file complaints on behalf of
their Medicare patients through the managed-care organization; and from there, the
complaints move to an administrative law judge.
The panel further questioned the District Court’s
opinion on the issue of which health care providers are qualified to provide chiropractic
care, not simply which providers have a license to do so. The regulation states, “If
more than one type of practitioner is qualified to furnish a particular service, the HMO
may select the type of practitioner to be used.” According to the ACA, this suggests
that the MD or osteopath, in addition to possessing a medical or osteopathic license, must
prove that they are qualified through education and training to provide the chiropractic
service.
“The ACA is extremely pleased that the District
Court’s ruling allowing MDs and DOs to provide a uniquely chiropractic service was
nullified,” says Richard Brassard, DC, ACA president. “We are happy that the
issue is now whether or not a practitioner is ‘qualified,’ not whether or not a
practitioner is simply ‘licensed.’ The ACA’s position has been and remains
that only chiropractors are qualified by education and training to correct subluxations.
Because of the Appeals Court’s decision, chiropractors can continue to fight to
safeguard their right to be the sole providers of this service and to ensure Medicare
patients’ rights to access doctors of chiopractic.”
The ACA is currently exploring ways it can assist DCs through
the administrative review process and provide them with the resources and materials they
need to establish their unique qualifications to an administrative judge. |
Study: Chiropractic is Cost-Efficient for Treating Chronic
Back Pain
According to a study published in the October 2005 Journal of Manipulative and
Physiological Therapeutics, the costs of chiropractic and medical care are comparable for
treating chronic low-back pain, but chiropractic care produces better outcomes.
“With their mission to increase value and respond to patient preferences, health
care organizations and policymakers need to re-evaluate the appropriateness of
chiropractic as a treatment option for low-back pain,” the study concludes. The
study’s authors were: Mitchell Haas, DC, MA, professor and dean of research, Center
for Outcomes Studies, Western States Chiropractic College, Portland, Ore; Rajiv Sharma,
PhD, assistant professor, Department of Economics, Portland State University, Portland,
Ore; and Miron Stano, PhD, professor, Department of Economics, School of Business
Administration, Oakland University, Rochester, Mich.
The study involved 2,780 patients with mechanical low-back pain who referred themselves
to 60 doctors of chiropractic and 111 medical doctors in 64 general-practice community
clinics. Chiropractic care included spinal manipulation, physical therapy, an exercise
plan, and self-care patient education. Medical care consisted of prescription drugs, an
exercise plan, self-care advice, and a referral to a physical therapist. The
patients’ costs, treatments, pain, and satisfaction were assessed 3 months and 12
months after their initial visits to their prospective doctors.
The study found that the office costs for chiropractic treatment of low- back pain were
higher than for medical care. However, when the costs of advanced imaging and referrals to
physical therapists were calculated, the chiropractic costs for chronic patients were 16%
lower than the medical costs.
The study also found that acute and chronic patients showed better outcomes in pain,
disability reduction, and higher satisfaction with their care after undergoing
chiropractic treatment. In addition, the advantage of chiropractic care was significant in
the chronic-patient group at 3 months follow-up, but smaller in the acute group.
CCGPP to Release First
Best-Practices “Compass”
The Council on Chiropractic Guidelines and Practice Parameters (CCGPP) is set to
release the first of its "Clinical Compass" documents in February 2006.Established more than 10 years ago by the Congress of Chiropractic
State Associations (COCSA) and other chiropractic organizations, CCGPP is charged with
developing and updating a clinical "Best Practices" document for use by DCs,
their patients, students, faculty members, government agencies such as the Federation of
Chiropractic Licensing Boards, and third-party payors.
The council established a commission that recruited nearly 80
researchers and clinicians in the chiropractic profession. They were then charged with
obtaining, reviewing, and distilling the scientific literature; and, where appropriate,
developing a consensus on treating the kinds of conditions most frequently encountered in
a chiropractic office.
After 2 years of work, the commission is set to release a
draft of its first compass—on low-back conditions—in February 2006. The document
will be released online, and CCGPP will be asking all stakeholders—in particular
DCs—to provide feedback. Comments for each compass will be solicited for a 60-day
period, for each compass, after which they will be collected, made part of the document,
and may provide a basis for modifying the document.
"Stakeholder input is crucial," says Eugene Lewis,
DC, MPH, immediate past-chair of the council. "This document is intended to help
doctors do a better job with their patients by providing them with current information
they can rely on. We want to ensure we have looked at all aspects of these issues, and we
rely on doctors and the public to provide us with that feedback."
The low-back draft is expected to be released in February,
and interested parties will have 60 days to provide comments. Further information can be
found at www.ccgpp.org. |
MDs Consider Chiropractic Effective
Almost half of all surgeons surveyed in 2005 by HCD Research, a New Jersey-based
marketing and research firm, and the New York-based Louis Finkelstein Institute, consider
chiropractic one of the most effective forms of complementary and alternative medicine
(CAM) practiced in the United States and have recommended some form of alternative
medicine to their patients in the past.
The survey, in which 873 physicians participated, included 31 questions on the overall
effect of alternative medicine on American health care. The physicians were asked to rate
the effectiveness of 12 forms of CAM when used as a stand-alone therapy and as a
complement to conventional medical treatment. Each form of CAM was rated on a seven-point
scale, seven being “highly effective.”
Kim D. Christensen, DC, DACRB, CCSP, CSCS, PeaceHealth Hospital—St John Medical
Center, Longview, Wash, says he feels the survey results are completely different when
doctors of chiropractic practice directly with medical doctors.
“In my experience in the hospital setting, 90% of my referrals come from MDs due
to the fact patients request chiropractic services and then report back to their MD of
their success and satisfaction with chiropractic care," says Christensen.
In terms of individual therapies, chiropractic received the third-highest rating of any
CAM therapy in the survey; 49% of the physicians surveyed believe chiropractic is
effective to some extent, and 6% believe it is highly effective.
When evaluated as a complement to conventional medical treatments, chiropractic
finished third behind acupuncture and massage therapy; 55% of the MDs surveyed believe it
is effective to some degree, and 12% believe it is a highly effective complement to
conventional medicine.
Soldiers in Iraq Suffer From Bad Backs
A study published in the October 2005 issue of the journal Anesthesia &
Analgesia reports that more than half of US soldiers who have been medically evacuated
from Iraq and treated at military pain-treatment centers are suffering not from battle
wounds, but from bad backs. Although the soldiers are in good physical shape, they face
highly stressful conditions while on the battlefield. Sleeping on cots with little back
support, standing on their feet for hours at a time, and riding in convoys in crunched
positions does a number on their backs.
A recent study1 found that chiropractic manipulation was used in 4.9% of
patients evacuated from Operation Iraqi Freedom who were referred to two large
pain-treatment centers located outside the theaters of combat, says Dean Smith, DC, PhD,
Physical Education, Health, and Sports Studies, Miami University, Oxford, Ohio. “The
most common complaint was low-back pain, which occurred in 53% of subjects,” says
Smith.
Fifty-three percent of the soldiers presented with low-back pain, with lumbar herniated
disk being the most frequently diagnosed condition (24%). Seventy-two percent of the
soldiers received one nerve block injection; 22% were administered a lumbar epidural
steriod; 56% received nonsteroidal anti-inflammatory drugs; 49% received opioids; and 17%
received some form of alternative.
Reference
1. Cohen SP, Griffith S, Larkin TM, Villena F, Larkin R. Presentation, diagnoses,
mechanisms of injury, and treatment of soldiers injured in Operation Iraqi Freedom: an
epidemiological study conducted at two military pain management centers. Anesth Analg.
2005;101: 1098–1103.
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