All In?
Written by Chris Dalrymple D.C., F.I.C.C.   
Sunday, August 26, 2018 05:02 PM

Adapted from a Facebook posting

Medicare. Why are we continually asked to donate money at the national level.  We are focused more on Texas Chiropractic aren’t we?  Well, a recent Facebook posting by a chiropratic leader fully explains what’s going on and why it’s important that we all rally behind the support of congressmen as well as state legislators, especially when it comes to the issue of Medicare, a federal issue.

Medicare currently defines “for the purposes of Open Payments, physician is any of the following types of professionals that are legally authorized by the state to practice, regardless of whether they are Medicare, Medicaid, or Children’s health Insurance Program (CHIP) providers:  Doctors of Medicine or Osteopathic Medicine; Doctors of Dental Medicine or Dental Surgery;  Doctors of Podiatric Medicine; Doctors of Optometry; Chiropractors.  Note: Medical residents are excluded from the definition of physicians for the purpose of this program.”

While it would seem to imply that anyone with an active license in one of these three fields is a physician under Medicare, this intrepretation is not applied to doctors of chiropractic.   Says “Medicare Part B (Medical Insurance) covers manual manipulation of the spine if medically necessary to correct a subluxation when provided by a chiropractor or other qualified provider.”  It further notes that “Medicare doesn’t cover other services or tests ordered by a chiropractor, including X-rays, massage therapy, and acupuncture” and that “you pay all costs for other services or tests ordered by your chiropractor (including X-rays, massage therapy, and acupuncture).

The provision that Medicare covers manual manipulation of the spine…to correct a subluxation was included in the 1960s when the profession was still battling with each other as well as with organized medicine.  Its intention as to ensure that we were reimbursed for chiropractic adjustments. 

Unfortunately, it was poorly written, AND put in the wrong section of the guidelines. This provision is interpreted by CMS to mean that ONLY manual manipulation of the spine to correct a subluxationis to be reimbursed and nothing else.  They do NOT reimburse for exams, manual therapy, rehab exercise, passive modalities etc. This means that a grandmother who has Medicare, has to pay out of pocket for her exam, and any other necessary treatments you may want to provide. Oh, and if you don’t charge grandma for treatment rendered, you may be guilty of Medicare fraud.

This provision is also interpreted as a limitation of our physician status preventing us from opting out of Medicare as our medical cousins may. However, CMS is working towards removing the ability for any physician to opt out, so this battle is not for us to fight at this time.

The chiropractic profession at the national level is working to remove the limiting provision in the physician section and move the subluxation language to the section regarding scope of practice, where MD’s and DO’s have their scope defined.  The intention is that we are paid for our legally rendered, necessary service of Medicare patients.

The House Ways and Means Committee in Congress will most likely consider any bill introduced on this subject. This congressional committee controls our destiny, and we need to be a team player and support them as they consider what is best for Medicare and ALL the parties involved. They need to know we’re serious about this, and that we are willing and ready to go to work to see that payment for our legally provided necessary service is a covered Medicare expense. The American Chiropractic Association has been working on this bill for two years. Now it’s our turn to go to work.

Chiropractors must be more than passive thinkers, we must become active doers If we want change.  We accomplish this change by being team players, supporting the team players and making our desires known and rationally argued.  The TCA legislative committee are 100% behind making this happen. Will you help help make this happen and be #allin with us as well?I challenge each of you to step up and step in to do what you can do and maybe even a little more.

Why it it necssary that we struggle and scrifice for this issue?  It is currently being considered to expand Medicare to be a universal health care system in the U.S. If that were to happen, and our regulatory language is kept as it is now, it would be extremely difficult for us as a profession to make a living at our profession.

A change to the regulatory language of chiropractic at the federal level would be the single biggest legislative change in chiropractic in most of our careers. But truly, such change is about providing care for our elderly. It’s about helping those that need it. Our baby boomers are the largest demographic in our country, many of them are on fixed incomes, and they are the largest group affected by the opioid epidemic. They need the drugless alternative that is chiropractic!

We encourage you to support TCA’s Chiropractic Development Initiative and our struggle to assist the national organizations to improve access to chiropractic at the national level.