Independent Practitioners under Medicare (1968)

Stephen Barrett, M.D.
August 5, 2018

APPENDIX B: Statement by the
International Chiropractors Association
submitted to the Public Health Service
October, 1968.

In summary of our request for chiropractic inclusion in Medicare, we would like to say that because millions of Americans are cared for by doctors of chiropractic prior to retirement and reduction of income, it is only fair to them that the federal government make provisions for continuation of their care. We must be aware of the financial burden placed on the elderly who presently maintain health through chiropractic care, and who have no financial recompense through the Medicare program.

The question seems to focus on the fact that whether it be one elderly person or one million elderly persons, since these citizens are free to select the doctor of their choice prior to retirement, then we are restricting this freedom after retirement when we do not make this choice available without financial restriction.

Most certainly, the elderly person who is trying to maintain a home, health and a reasonable standard of living on a reduced income is forced to make sacrifices upon retirement. We would remind the committee that by including chiropractic in Medicare, we will not be responsible for forcing this person to neglect his or her health.

And we would remind the committee that this is not a lessening problem. With present population trends and the continued growth of the chiropractic profession, more and more people will be asking the question, “How do I continue under chiropractic care when my income level has been so drastically reduced and my Medicare provisions are not sufficient?”

We would offer the following statements from authorities in the field of insurance administration as a basis for our contention that chiropractic care can be included in Medicare without an increase in cost to the elderly.

“It has been determined in a study of the three year period involved that an average of 1.265% of the premium dollar has been the actual claims cost of inclusion of chiropractic in our contract with the United States Government under the Federal Employees Health Benefits Act.

“Actually I am very happy that you asked for this study because we have been quite concerned relative to the necessity some three years ago of putting restrictions on the total number of visits per year for chiropractic service. As you know we are firm believers that chiropractic is definable only as adjustments by hands only of the spinal column. You also are aware of the fact that we experienced considerable difficulty in claims submitted containing medical diagnosis and for services that were not definable in the scope of chiropractic as we understand it and accept it. I firmly believe that a liberalization of our contract with the United States Government under the Federal Employees Health Benefits Act can come about if assurance is given that the element of your profession that has elected to base its interpretations upon State Law rather than within the true scope of chiropractic as we believe the American Public desires it can be convinced. Certainly if this can be accomplished it should allay many of the difficulties now being experienced with the uninformed and unrealistic attitude of some of the medical profession.”

/s/ Charles L. Massie
Government Employees Hospital Association, Inc.

“We understand that the International Chiropractors Association is seeking recognization by the Department of Health, Education and Welfare to treat Medicare patients. We are in accord with your efforts. We believe that there is a definite place for the service of a chiropractor in the treatment of Medicare patients, as long as they confine treatment to the field that they are licensed.

“Just a word about our Association. Our Association was organized as a nonprofit benefit Association under the Insurance Code of the State of Washington in 1942. Our Association recognizes all state licensed practitioners as long as they confine their practices to the field to which they are licensed.

“About 15% of our members use the services of chiropractors and believe that they are receiving service that is beyond the medical doctor to treat, to which we will agree. As to cost, we find that in the majority cases the expense is a savings to both the carrier as well as the patient. In most cases the patients can continue their activities while under treatment and do not have the added expense of buying drugs.

“As stated above we believe that the chiropractor has a definite place in today’s society and should be recognized by the Department of Health, Education and Welfare to treat Medicare patients as long as they confine their practice to the field to which they are licensed.”

/s/ George Holt
Snohoniish County Beneficial Association

The Chiropractic Plan in Health and Welfare recommended by International Chiropractors Association is described below:

“Health programs designed by labor and management should concern themselves with the total good health and welfare of their members.

“Providing proper chiropractic services and care is fast becoming a part of the over-ail program of essential health services.

“International Chiropractors Association introduces this Plan offering chiropractic and chiropractors to care for the needs of labor and management in health and welfare plans.

“In 1895 chiropractic was ushered onto the scene of the healing professions. Today, it is reliably estimated that 35 million Americans alone depend and take advantage of chiropractic’s unique contribution of spinal analysis and spinal adjustment resulting in better health through release of pressures or interferences on the nervous system due to vertebral subluxations and misalignments.

“Many health plans include chiropractic services. Some of the plans participating in the Federal Employees Health Benefit Programs include chiropractic services. Most industrial accident plans administered by the states recognize and utilize chiropractic services. In addition over 500 insurance carriers regularly pay claims for chiropractic services delivered to their policyholders.

“International Chiropractors Association will furnish a list of available, responsible chiropractors for use in health and welfare contracts in the area of need.

“International Chiropractors will also furnish adequate cost control mechanisms so that maximum benefit may be obtained for the dollar spent.

“It is our recommendation that chiropractic services be included in existing plans at no extra charge or additional payment by union or management.

“We feel from experience gained that the addition of chiropractic services in health plans will not cost but will actually pay by less loss of time by the worker and less cost to the employer by those in need of chiropractic services.

“If desirable, other plans are available. In some plans the union welfare fund pays an annual per capita charge entitling all members to chiropractic care under the program. In this type of a plan, reduced charges for dependents of Union members is available.

“We recommend that chiropractic services provided by health and welfare contracts be confined to the following areas:

1) Spinal analysis through the use of proper analytical instrumentation. X-rays, to determine the structural relationship of the spine.

2) Spinal adjustments to release nerve pressures or interferences.

3) Spinal instrumentation to determine release or presence of subsequent nerve interferences or disturbances.

4) Periodic spinal check-up to maintain the nervous system free of pressures or interferences.

“International Chiropractors Association will furnish, and, through review committee procedure, supervise an adequate fee schedule for quality work and cost control.

“The following is a fee schedule which is recommended:

Spinal Adjustments for employees and dependents, Five Dollars ($5.00) per adjustment with a maximum limit of One hundred fifty dollars ($150.00) for adjustments of the same condition during any twelve consecutive months.

Spinal Instrumentation Including X-Rays

for analytical purposes for employees and dependents not covered under any Workmen’s Compensation or occupational disease law will be paid under the allowances for special charges without requiring hospital confinement when authorized by a doctor of chiropractic. The maximum amount for an employee or any dependent of an employee, of such analytical procedures arising out of the same condition during any twelve (12) consecutive months’ period will be seventy dollars ($70.00).

“The cost may vary slightly in different areas but is basically sound from a working procedure.

“Features of the chiropractic plan:

1) Quality control exercised. 2) Cost control maintained.

3) Standards high.

4) World Wide Insurance Review Committees maintained by the International Chiropractors Association for review of disputed or contested claims.

“Services excluded from all benefits under this plan:

1) Services of the chiropractor compensable under Employer Liability Laws or Workmen’s Compensation.

2) Surgery, in any form or degree, when performed by a chiropractor.

3) Physiotherapy, electrotherapy or hydrotherapy when performed by a chiropractor.

4) Vitamin therapy prescribed by a chiropractor.

5) Administration of drugs in any manner when prescribed by a chiropractor.

“Though the youngest in terms of years of the four major health professions classified by the Bureau of Budget, Washington, D. C., chiropractic has adequately proven its worth in the restoration and maintenance of health. Thirty-five million Americans attest to this fact.

“Due to demand for adequate cost control, the finest quality of service, and proper confined scope of practice, this chiropractic plan is offered in the interest of better health for those insured in health and welfare plans.”

The chiropractic profession has evinced some difficulty with insurance carriers; however, this difficulty is always traced back to a similar source; the failure of the insurance company at the initiation of inclusion to restrict and confine chiropractic claims to spinal analysis, x-ray analysis and spinal adjusting.

“As the time approaches for changes to he cleared through the U.S. Civil Service Commission for the new contract year of 1967, 1 feel the following information would be of value to you for consideration.

“Our placing a limitation on the number of adjustments (30 per year) has drastically reduced the incident of abuse that we were confronted with prior to this stipulation. However, we are still confronted by medical and physiotherapy claims submitted by chiropractors.

“It seems strange to me as a plan administrator that many chiropractors cannot and do not confine their activities to their special area of practice, namely spinal analysis and spinal adjustments. Why must they engage in the practice of diagnosis, medical treatments. medical practices, and the work of the physiotherapist. We are already paying for these services under the medical provisions of our program. Chiropractors have a separate service to render to be recognized as a separate profession, and only through such do they warrant inclusion.

“To this date we have never had a claim submitted by a medical doctor or physiotherapist for spinal adjusting. Why is it that some members of your profession feel that they must indulge in other professional practices when they do have a real specific service to render in their own field. Is it possible they have little or no faith in chiropractic; our experience has shown a real service rendered by your profession in spinal analysis and spinal adjusting, and only in this do we have faith in chiropractic.

“If our actuarial experience proves favorable as it appears at present, we may be able eventually to remove the restriction of 30 adjustments per year for chiropractic services. However, if chiropractors continue to present medical claims, diagnostic claims, physiotherapy claims and claims we know are outside the chiropractic field of practice, serious consideration must be given to withdrawing chiropractic benefits from our Plan. We sincerely hope that this will not become necessary.

“The valuable service of your organization in providing a claim review procedure and advising as to the proper scope of practice of chiropractic has been most helpful. For this we are deeply appreciative. If all chiropractors practiced within this scope we would have very few problems and it would most certainly hasten the day when all health benefits contracts would include chiropractic, this giving the American public the right of selecting the form of healing arts most beneficial to their health.”

/s/ Charles L. Massie
Government Employees Hospital Association, Inc.

International Chiropractors Association requests that Medicare provisions be confined to a reasonable scope of practice. Following, as an example, is the present fee schedule of the United Rubber. Cork, Linoleum and Plastic Workers of America (AFL-CIO) for its membership and dependents.

Maximum chiropractic service in any one calendar year, for each individual:

1. Spinal x-rays and spinal analytical instrumentation, $75.00.

2. Spinal adjustments to correct subluxations and misalignments, S250.00.

3. Sixty per cent (60% ) of above fees for members of the employee’s immediate family.

Note: Chiropractic services are confined to the instrumentation needed to arrive at a proper spinal analysis and the care necessary to release nerve pressures caused by spinal subluxations and misalignments.

Presently, International Chiropractors Association is cooperating with the Health Insurance Council of America.

The Association has established regional claims offices and representatives throughout the United States in order to assist in the adjudication of claims.

The doctor of chiropractic offers a separate and distinct health service to the elderly; spinal analysis and adjusting. Medicine, physiotherapy, psychotherapy and mechanotherapy are all available to the elderly as performed by competently educated and licensed medical doctors, physical therapists, psychologists, psychiatrists and osteopaths.

We would recommend:

1) Chiropractic inclusion in Medicare.

2) Strict confinement of chiropractic care to spinal analysis and adjustment in the restoration and maintenance of health.

These provisions can he made at no increased cost to the federal government or to the elderly, and in fact may reduce Medicare costs.

The inclusion would assure the public of freedom of choice and ethical chiropractic care.