The American Chiropractic Association (ACA) has launched a national grassroots effort to eliminate a blatantly anti-competitive provision of Medicare law that arbitrarily limits reimbursement for medically necessary services delivered by doctors of chiropractic (DCs).
The statutory change ACA seeks would define DCs as “physicians” under Section 1861 of the Social Security Act for the provisioning of any existing Medicare covered service that falls within the scope of practice of an individual DC as defined by their applicable state law.
The centerpiece of ACA’s campaign will focus on generating a robust level of patient grassroots support aimed at Congress that seeks to ensure that Medicare beneficiaries have full access to a broader range of covered services provided by chiropractic physicians than current law permits.
Selected Podcast
National Campaign Launched for Medicare Equality
Featured Speaker:
Miller, a respected Washington lobbyist, comes to his new position at ACA with over 35 years of leadership experience. He previously served as chief of staff to a U.S. Senator and a senior official of the U.S. Customs Service, a U.S. Department of the Treasury agency under the late President Ronald Reagan. In addition to representing the interests of the chiropractic association, Miller has also been involved in professional associations representing optometrists and dentists.
John Falardeau is the senior vice president for public policy and advocacy at the American Chiropractic Association (ACA) and is responsible for monitoring legislation, formulating policy and carrying out the overall political strategy for the organization. Before coming to the ACA, Falardeau was the director of government affairs for the Rubber Manufacturers Association. Prior to that, he spent 10 years as a senior assistant to two members of the House of Representatives. During his tenure on Capitol Hill, he was involved in drafting and monitoring legislation regarding transportation, taxes and health care. He was also active in several congressional campaigns. A U.S. Navy veteran, he holds a BS degree from the State University of New York, College at Brockport, and an MA degree from George Mason University.
John Falardeau and Richard Miller
Richard Miller has served as executive vice president of the American Chiropractic Association since January 2015. Miller first became affiliated with ACA 25 years ago when he spearheaded the Association’s response to the national health reform debate that took place under the administration of former President Bill Clinton. ACA’s advocacy campaign, devised and led by Miller, was voted by the American Society of Association Executives as the “best overall federal advocacy campaign” undertaken by any professional association at the time. In his past service to ACA, Miller also led the creation of the Patients’ Access to Responsible Care Alliance (PARCA), a coalition of organizations that represent the interests of millions of patients and non-MD healthcare providers. A central aim of PARCA was to pass a provider non-discrimination amendment to the Employee Retirement Income Security Act. This particular goal was achieved in 2010 when Section 2706 was included in the Patient Protection and Affordable Care Act that was signed into law by President Obama.Miller, a respected Washington lobbyist, comes to his new position at ACA with over 35 years of leadership experience. He previously served as chief of staff to a U.S. Senator and a senior official of the U.S. Customs Service, a U.S. Department of the Treasury agency under the late President Ronald Reagan. In addition to representing the interests of the chiropractic association, Miller has also been involved in professional associations representing optometrists and dentists.
John Falardeau is the senior vice president for public policy and advocacy at the American Chiropractic Association (ACA) and is responsible for monitoring legislation, formulating policy and carrying out the overall political strategy for the organization. Before coming to the ACA, Falardeau was the director of government affairs for the Rubber Manufacturers Association. Prior to that, he spent 10 years as a senior assistant to two members of the House of Representatives. During his tenure on Capitol Hill, he was involved in drafting and monitoring legislation regarding transportation, taxes and health care. He was also active in several congressional campaigns. A U.S. Navy veteran, he holds a BS degree from the State University of New York, College at Brockport, and an MA degree from George Mason University.
Transcription:
National Campaign Launched for Medicare Equality
Melanie Cole (Host): Researchers have estimated that chiropractic care may reduce the number of Medicare patient visits to primary medical physicians for back and/or neck pain resulting in an annual savings of $83.5 million dollars. The American Chiropractic Association has launched a major grassroots campaign to enact Federal legislation that would achieve full physician status for doctors of chiropractic in Medicare. This initiative would significantly improve the health and wellness of our nation's aging population. My guests today are Richard Miller. He's the executive vice president of the American Chiropractic Association, and John Falardeau. He's the Senior Vice President for Public Policy and Advocacy at the American Chiropractic Association. Welcome to the show, gentleman. Richard, I'd like to start with you and tell us, what is the National Medicare Equality Petition?
Richard Miller (Guest): This is a grassroots campaign nationally, in which we are trying to mobilize patients and concerned citizens to contact the Congress and urge them to change a Federal statute that discriminates against chiropractic patients and doctors of chiropractic in a way that is really harmful to the health delivery system overall and so, it's an effort, again, to gather a lot of grassroots support using a petition document as part of the mechanism of doing that.
Melanie: So, John, tell us why are you using the term "petition"?
John Falardeau (Guest): Well, "petition" is a well-known term and it creates a sense of urgency and a sense of change. What we are looking for is for our patients and, again, the public at-large, to recognize and to urge change with Congress to fix this "40-year-old wrong," is what we're calling it. The statute right now is basically one that is very limited. The Medicare patient has very limited access to a doctor of chiropractic and so, we're using the term petition to convey that urgency and that voice for change that we're looking for in the Congress.
Melanie: Richard, how can doctors of chiropractic enlist individuals for this national Medicare equality petition?
Richard: Well, typically, doctors of chiropractic have a great bedside manner with their patients and they know their patients well. And so, when patients come into their office, the doctor of chiropractic can raise this issue with them or have their office manager or office staff raise the issue when the patient comes and signs into the office. We find, generally speaking, the chiropractic patients are interested in health care policy and they want to make sure that they have access and coverage to the very best services possible. So, it would not be unusual for a chiropractic patient, having a good, close relationship with their doctor of chiropractic, to talk about things that deal with health care policy in a broad sense and to bring to their attention changes that are needed in Federal law to ensure that patients receive and have access to the very best treatment they can; the treatment options that they desire and need under the Federal Medicare program.
Melanie: So, John, if researchers have estimated that chiropractic care may reduce the number of Medicare patient visits, what is this for? We're talking about back and neck pain. How will this help?
John: Doctors of chiropractic are physician-level providers in Medicare, but the only thing that is covered currently is the manipulation of the spine to correct a subluxation. Basically, that's pretty much the adjustment; but, doctors of chiropractic can do so much more, especially under their state's code that Medicare covered benefits. However, current law does not allow doctors of chiropractic to perform under their state's code; therefore, the access for chiropractic patients in Medicare to their doctor of chiropractic is very limited. The thing to remember here is that we're not looking for any new benefits, or anything like that in Medicare. What we are looking for is that, if it is a Medicare-covered benefit, and a doctor of chiropractic can perform that service under their state's scope of practice, then the doctor of chiropractic should be allowed to perform that and the patient should have access to that doctor of chiropractic for the service that they're looking for.
Richard: I'd like to add, if I might, something to what John just said. It ought to be realized by people making public policy, making our laws, that the current restriction, which is really a barrier of sorts to obtaining chiropractic care, is purely arbitrary. There's no sound scientific basis for it and it should be changed because this would benefit patients in the health delivery system overall. Doctors of chiropractic, they treat via non-surgical methods. They treat via non-pharmacological methods. One of the big problems is that when people go to health care providers--medical doctors and doctors of osteopathy, for example--oftentimes, the type of treatment they receive or recommendation that they receive might be to undergo a back surgery. We know that there are many thousands of unnecessary back surgeries performed each and every year. It puts the patients at risk and these things are terribly expensive to the health delivery system. We also know there's an opioid epidemic in this country in which health care providers are prescribing these very powerful and addictive drugs while dealing with pain issues. Well, the chiropractic approach to dealing with pain doesn't involve the prescription for opioid drugs, for example. So, in many, many instances it is a much safer, much more conservative form of treatment that is equally, if not more so, effective for a wide variety of spinal maladies.
Melanie: So, Richard, I'd like you to continue along this line. Why do you think this has been resisted for so long?
Richard: Well, you know, people are conditioned to accept things the way they are, whether they are right or wrong. If you go back many years, the chiropractic profession, for all practical purposes, was somewhat excluded from the delivery of what we would call "mainstream medicine." Some of the theories, ideas and the training behind conservative-oriented chiropractic care differed significantly from the training that medical doctors received and not really understanding what the doctor of chiropractic was doing with his/her hands in manipulating the joints in the spine, the medical establishment really, wanting to preserve, in large measure, their monopoly, one might say, over the treatment of spinal conditions, they really resisted the competition from the chiropractic profession. They had sufficient influence in Congress to ensure that when doctors of chiropractic were first allowed into the Federal Medicare program back in the early 1970’s, that they were limited artificially in terms of the services they could provide. In other words, the statute was written in such a way as to deliberately be anti-competitive because of the influence of the medical lobby at that particular time. Now, thankfully, attitudes have changed significantly. Chiropractic care is very much mainstream, very popular with millions and millions of patients and policy-makers on Capitol Hill are coming to realize that we have a very damaging, unfair, and arbitrary limitation in statute that's anti-competitive, again, as I said earlier, and it needs to be changed. So, people making policy, and the public, their attitudes have changed in a very favorable way and it's now time for us to take advantage of that favorable climate and really right this long-time wrong.
Melanie: It's certainly is. So, John, what will the ACA do with the names that you collect? People sometimes don't want to sign a petition if they think they're not sure what you're going to do with the names.
John: Well, yes, the names will certainly be protected and won't be sold to an outside partner or anything like that. What we are going to do with those names, is that when we do have a bill in Congress, that we can go back to these people and we can ask them, urge them, to support that bill by contacting their member of Congress and urging them to co-sponsor that bill. The more co-sponsors we have, the better the likelihood of our success. So, this is the first stage, if you will, of a long-term, grassroots effort that will hopefully lead to victory. I can tell you both Rick and I worked on Capitol Hill and so we know the value of grassroots support and what it means for an individual constituent to contact their member of Congress in support, or in opposition, to something. So, we are prepared to launch a bill in Congress sometime in the near future and then, in turn, hopefully, unleash this grassroots support to a second stage which would be to contact the members of Congress directly and urge them to co-sponsor the bill. I can tell you, if we are successful in getting those numbers up and having a high number of people contact their member of Congress, then we are confident that this bill, this effort, will bear fruit. So, in the long run, this is going to be a multi-month, maybe even a multi-year effort, but we're prepared to take this to the highest level and petition the Congress, and urge them to make a change in the law so that Medicare patients have full and unencumbered access to their doctor of chiropractic.
Richard: I might add, I was going to say, the group that is most going to benefit from this campaign are America's Medicare patients because we're going to give them greater choices of the healthcare services they have available to them, types of providers they have available to them and we're going to provide them with coverage for services that they either can't access now or they have to pull their hard-earned dollars out of their pocket and pay for it. Really, the Federal Medicare program should be one of fairness and it should be one that promotes competition and provides the patient with the very best treatment options possible. That's really what our proposal is going to do. It's going to benefit patients in a very major way.
Melanie: John, people hear the word "Medicare" and with so many more young people seeing chiropractors today, for a myriad of reasons, are Medicare patients the only ones that are able to participate in this call to action?
John: No, and that's a very good question, because we've gotten it and we say, “No. Anyone can join this effort, anyone of voting age can become a member in this movement,” because everyone either knows someone that is on Medicare, or is about to join the Medicare ranks. There are 55 million Medicare patients today and that number is growing every day. The baby boomer generation is getting bigger and every day, they're joining the Medicare ranks. So, long answer short, no. Anyone can participate in this campaign. If you're 20 years old, you certainly know someone, a grandparent, for example, who is on Medicare and can be helped. If you're 40 years old, your parent could be on Medicare and this will benefit them, as well. So, we're asking all Americans to join in this effort and fight for either someone you know, someone you love, a friend, or a family member.
Melanie: And Richard, I'm going to give the last word to you. What do you want the listeners to know about this act, about this Medicare Quality Petition?
Richard: What I'd like people to understand is this, and I'm going to emphasize something John said, and that's that everyone can participate in this. This is a campaign for good public policy. It's a campaign for fairness and if you go to our website you can find, that within just a very few minutes, really, you can log on and add your name to this petition and you can participate in this very democratic grassroots effort to really do something good for the American people.
Melanie: Thank you, gentlemen, for being with us today. I applaud all the great work you're doing and thank you so much for being with us. You're listening to ACA Radio. And for more information on the National Medicare Equality Petition, you go to ACAToday.org/equality. That's ACAToday.org/equality. This is Melanie Cole. Thanks so much for listening.
National Campaign Launched for Medicare Equality
Melanie Cole (Host): Researchers have estimated that chiropractic care may reduce the number of Medicare patient visits to primary medical physicians for back and/or neck pain resulting in an annual savings of $83.5 million dollars. The American Chiropractic Association has launched a major grassroots campaign to enact Federal legislation that would achieve full physician status for doctors of chiropractic in Medicare. This initiative would significantly improve the health and wellness of our nation's aging population. My guests today are Richard Miller. He's the executive vice president of the American Chiropractic Association, and John Falardeau. He's the Senior Vice President for Public Policy and Advocacy at the American Chiropractic Association. Welcome to the show, gentleman. Richard, I'd like to start with you and tell us, what is the National Medicare Equality Petition?
Richard Miller (Guest): This is a grassroots campaign nationally, in which we are trying to mobilize patients and concerned citizens to contact the Congress and urge them to change a Federal statute that discriminates against chiropractic patients and doctors of chiropractic in a way that is really harmful to the health delivery system overall and so, it's an effort, again, to gather a lot of grassroots support using a petition document as part of the mechanism of doing that.
Melanie: So, John, tell us why are you using the term "petition"?
John Falardeau (Guest): Well, "petition" is a well-known term and it creates a sense of urgency and a sense of change. What we are looking for is for our patients and, again, the public at-large, to recognize and to urge change with Congress to fix this "40-year-old wrong," is what we're calling it. The statute right now is basically one that is very limited. The Medicare patient has very limited access to a doctor of chiropractic and so, we're using the term petition to convey that urgency and that voice for change that we're looking for in the Congress.
Melanie: Richard, how can doctors of chiropractic enlist individuals for this national Medicare equality petition?
Richard: Well, typically, doctors of chiropractic have a great bedside manner with their patients and they know their patients well. And so, when patients come into their office, the doctor of chiropractic can raise this issue with them or have their office manager or office staff raise the issue when the patient comes and signs into the office. We find, generally speaking, the chiropractic patients are interested in health care policy and they want to make sure that they have access and coverage to the very best services possible. So, it would not be unusual for a chiropractic patient, having a good, close relationship with their doctor of chiropractic, to talk about things that deal with health care policy in a broad sense and to bring to their attention changes that are needed in Federal law to ensure that patients receive and have access to the very best treatment they can; the treatment options that they desire and need under the Federal Medicare program.
Melanie: So, John, if researchers have estimated that chiropractic care may reduce the number of Medicare patient visits, what is this for? We're talking about back and neck pain. How will this help?
John: Doctors of chiropractic are physician-level providers in Medicare, but the only thing that is covered currently is the manipulation of the spine to correct a subluxation. Basically, that's pretty much the adjustment; but, doctors of chiropractic can do so much more, especially under their state's code that Medicare covered benefits. However, current law does not allow doctors of chiropractic to perform under their state's code; therefore, the access for chiropractic patients in Medicare to their doctor of chiropractic is very limited. The thing to remember here is that we're not looking for any new benefits, or anything like that in Medicare. What we are looking for is that, if it is a Medicare-covered benefit, and a doctor of chiropractic can perform that service under their state's scope of practice, then the doctor of chiropractic should be allowed to perform that and the patient should have access to that doctor of chiropractic for the service that they're looking for.
Richard: I'd like to add, if I might, something to what John just said. It ought to be realized by people making public policy, making our laws, that the current restriction, which is really a barrier of sorts to obtaining chiropractic care, is purely arbitrary. There's no sound scientific basis for it and it should be changed because this would benefit patients in the health delivery system overall. Doctors of chiropractic, they treat via non-surgical methods. They treat via non-pharmacological methods. One of the big problems is that when people go to health care providers--medical doctors and doctors of osteopathy, for example--oftentimes, the type of treatment they receive or recommendation that they receive might be to undergo a back surgery. We know that there are many thousands of unnecessary back surgeries performed each and every year. It puts the patients at risk and these things are terribly expensive to the health delivery system. We also know there's an opioid epidemic in this country in which health care providers are prescribing these very powerful and addictive drugs while dealing with pain issues. Well, the chiropractic approach to dealing with pain doesn't involve the prescription for opioid drugs, for example. So, in many, many instances it is a much safer, much more conservative form of treatment that is equally, if not more so, effective for a wide variety of spinal maladies.
Melanie: So, Richard, I'd like you to continue along this line. Why do you think this has been resisted for so long?
Richard: Well, you know, people are conditioned to accept things the way they are, whether they are right or wrong. If you go back many years, the chiropractic profession, for all practical purposes, was somewhat excluded from the delivery of what we would call "mainstream medicine." Some of the theories, ideas and the training behind conservative-oriented chiropractic care differed significantly from the training that medical doctors received and not really understanding what the doctor of chiropractic was doing with his/her hands in manipulating the joints in the spine, the medical establishment really, wanting to preserve, in large measure, their monopoly, one might say, over the treatment of spinal conditions, they really resisted the competition from the chiropractic profession. They had sufficient influence in Congress to ensure that when doctors of chiropractic were first allowed into the Federal Medicare program back in the early 1970’s, that they were limited artificially in terms of the services they could provide. In other words, the statute was written in such a way as to deliberately be anti-competitive because of the influence of the medical lobby at that particular time. Now, thankfully, attitudes have changed significantly. Chiropractic care is very much mainstream, very popular with millions and millions of patients and policy-makers on Capitol Hill are coming to realize that we have a very damaging, unfair, and arbitrary limitation in statute that's anti-competitive, again, as I said earlier, and it needs to be changed. So, people making policy, and the public, their attitudes have changed in a very favorable way and it's now time for us to take advantage of that favorable climate and really right this long-time wrong.
Melanie: It's certainly is. So, John, what will the ACA do with the names that you collect? People sometimes don't want to sign a petition if they think they're not sure what you're going to do with the names.
John: Well, yes, the names will certainly be protected and won't be sold to an outside partner or anything like that. What we are going to do with those names, is that when we do have a bill in Congress, that we can go back to these people and we can ask them, urge them, to support that bill by contacting their member of Congress and urging them to co-sponsor that bill. The more co-sponsors we have, the better the likelihood of our success. So, this is the first stage, if you will, of a long-term, grassroots effort that will hopefully lead to victory. I can tell you both Rick and I worked on Capitol Hill and so we know the value of grassroots support and what it means for an individual constituent to contact their member of Congress in support, or in opposition, to something. So, we are prepared to launch a bill in Congress sometime in the near future and then, in turn, hopefully, unleash this grassroots support to a second stage which would be to contact the members of Congress directly and urge them to co-sponsor the bill. I can tell you, if we are successful in getting those numbers up and having a high number of people contact their member of Congress, then we are confident that this bill, this effort, will bear fruit. So, in the long run, this is going to be a multi-month, maybe even a multi-year effort, but we're prepared to take this to the highest level and petition the Congress, and urge them to make a change in the law so that Medicare patients have full and unencumbered access to their doctor of chiropractic.
Richard: I might add, I was going to say, the group that is most going to benefit from this campaign are America's Medicare patients because we're going to give them greater choices of the healthcare services they have available to them, types of providers they have available to them and we're going to provide them with coverage for services that they either can't access now or they have to pull their hard-earned dollars out of their pocket and pay for it. Really, the Federal Medicare program should be one of fairness and it should be one that promotes competition and provides the patient with the very best treatment options possible. That's really what our proposal is going to do. It's going to benefit patients in a very major way.
Melanie: John, people hear the word "Medicare" and with so many more young people seeing chiropractors today, for a myriad of reasons, are Medicare patients the only ones that are able to participate in this call to action?
John: No, and that's a very good question, because we've gotten it and we say, “No. Anyone can join this effort, anyone of voting age can become a member in this movement,” because everyone either knows someone that is on Medicare, or is about to join the Medicare ranks. There are 55 million Medicare patients today and that number is growing every day. The baby boomer generation is getting bigger and every day, they're joining the Medicare ranks. So, long answer short, no. Anyone can participate in this campaign. If you're 20 years old, you certainly know someone, a grandparent, for example, who is on Medicare and can be helped. If you're 40 years old, your parent could be on Medicare and this will benefit them, as well. So, we're asking all Americans to join in this effort and fight for either someone you know, someone you love, a friend, or a family member.
Melanie: And Richard, I'm going to give the last word to you. What do you want the listeners to know about this act, about this Medicare Quality Petition?
Richard: What I'd like people to understand is this, and I'm going to emphasize something John said, and that's that everyone can participate in this. This is a campaign for good public policy. It's a campaign for fairness and if you go to our website you can find, that within just a very few minutes, really, you can log on and add your name to this petition and you can participate in this very democratic grassroots effort to really do something good for the American people.
Melanie: Thank you, gentlemen, for being with us today. I applaud all the great work you're doing and thank you so much for being with us. You're listening to ACA Radio. And for more information on the National Medicare Equality Petition, you go to ACAToday.org/equality. That's ACAToday.org/equality. This is Melanie Cole. Thanks so much for listening.