I write this article on the last day of 1998, a year that brought forth challenges our profession had to face; 1999 is likely to bring more of the same. Managed care continues to dominate the health care reimbursement plans and is growing at a rapid rate.
National legislative reform led by the ACA was a hot topic in the hall of legislators last year, but nothing was passed, largely because of Congress' preoccupation with the Clinton affair. Congress did very little last year. Indications for the coming year are that national managed care will again be a hot issue. ACA is hard at work shaping such legislation to be beneficial to patients and our profession. I would be surprised if some form of health care reform did not pass in 1999.
1998 saw ACA file a lawsuit against HCFA. HCFA passed illegal regulations that would allow Medicare managed care groups to eliminate chiropractic care rendered by the chiropractor. They said the chiropractic benefit must be a part of the new Medicare Part C, but that it could be rendered by non-DCs. This is a very serious threat to our profession. It is a fight ACA is committed to winning. It will require the help of the profession to fund it. It could last for years and cost millions of dollars.
1998 saw some strange and bizarre reports about chiropractic care in medical scientific journals that calls into question their integrity. Topping the list was the research study conducted in the state of Washington that claimed chiropractic care was only slightly more beneficial than a $1 educational booklet. The study was so flawed that you could drive a truck through it, yet the respected New England Journal of Medicine printed the study. There appeared to be a massive PR campaign to promote the study. This small, flawed study hit the front page of most newspapers across the country. Such studies do not normally get printed in a respected scientific journal, but the NEJM is owned by the Massachusetts Medical Society.
A lot has been written about this study, but the best critique I have seen was "Back Pain, Science, Politics and Money" by David Chapman-Smith in the November 1998 issue of The Chiropractic Report. I highly recommend you read it. The telephone number of The Chiropractic Report is (416) 484-9601. He points out many things about this research project that (to be kind) I will just say are strange. Several doctors of chiropractic and one of our chiropractic colleges were involved with the study. For many years, I have talked and written about the importance of research being done if we are going to advance our profession into mainstream health care. I still believe that.
There is a lesson here: to make sure any research projects we are involved with are done in a truly scientific manner. I have no problem accepting valid research data that may put chiropractic care in a negative light, but I have a big problem when research is poorly done and appears to be done with the goal of putting our profession in a negative light for market share and/or politics.
I do not for one moment believe that the chiropractic college and the DCs involved with this project had any idea that this study would be so flawed and used in such a political manner. On the surface, it appeared to be a well-constructed project done by reputable researchers. We have to be more careful about the research projects we're involved with. I realize that some may feel I am overreacting to this event. Again, I say read the article in The Chiropractic Report before you reach a conclusion.
Let's all get involved in making our profession better and stronger so we can serve more patients better. We need valid research, political clout, and education of the public about the benefits of chiropractic care. Have a great new year. Together, we can make 1999 the best year ever!
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
On Feb. 1, 2024, two more legislators – John R. Carter (R-Texas) and Robert “Bob” Good (R-Va.) – co-sponsored the Chiropractic Medicare Coverage Modernization Act of 2023, bringing the co-sponsor total to 155, two more than the total achieved over the entire two-year congressional cycle in which identical legislation last appeared (2021-22).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
