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MEDICARE REFORM INITIATIVE TO BE OFFERED BY BUSH ADMINISTRATION

 

The Bush Administration will be announcing as early as this week a major Medicare overhaul initiative that will center on fee reductions for providers, major incentives to push Medicare beneficiaries into managed care programs, and some sort of prescription drug benefit.  ICA's Legislative Team has been meeting with Members of both Houses of Congress on the committees of jurisdiction for Medicare, and even prior to any official White House announcement, it appears that there is little inclination on the part of most Members to make drastic changes in what all agree is a popular program.  At issue in the minds of most Members with whom ICA consulted is an anticipated White House proposal that would require Medicare beneficiaries to enter into a managed care program to be eligible for any prescription drug benefit. 

 

Most Democrats and many Republicans do not believe that a further shift to managed care plans will impact the cost of the program in any positive way and all anticipate that such a change will certainly add to the massive stream of constituent complaints to Congressional offices about the problems of access, concerns about quality care and the severe limitations managed care plans place on services.  One Democratic Senator told ICA's representative, "The idea that managed care can solve Medicare's problems is known in Congress for what it is, a myth the Administration wants to use to paper over major cracks in the program." 

 

Chiropractic's voice is essential in this debate, not just for the chiropractic profession but also for the good of program beneficiaries and national health policy in general.  Any new Medicare reform effort must:  Guarantee direct access to chiropractic services, offer expanded access to a wider range of chiropractic services, including exams and x-rays, and insure that the public is protected from inadequately trained providers by enacting provisions that require all chiropractic services reimbursed under Medicare be provided by a doctor of chiropractic. 

 

"The ICA is going to fight this issue with all available resources and with a powerful resolve to do what is right for chiropractic in this vital federal program," said ICA Legislative Committee Chair Dr. Michael S. McLean.  "Included in this determination is a recognition of the need to work together as a profession and seek a broad front to secure for chiropractic the status it deserves in Medicare."   Legislation will soon be introduced at the request of the Chiropractic Coalition comprised of the ICA, World Chiropractic Alliance (WCA) and the Federation of Straight Chiropractors and Organizations (FSCO) that will address these key points. 

 

ICA recognizes that opportunities for any major expansion in chiropractic spending will be limited by shrinking federal revenues and any chiropractic initiative will be in savage competition with those of other provider groups.  The budget situation will not preclude improvements in the way the chiropractic services program is administered, such as mandating direct access to chiropractic services in managed care programs with Medicare contracts, more clearly defining the chiropractic "adjustment", or provisions that preserve chiropractic care delivery to doctors of chiropractic only.  These efforts deserve the full support of a united chiropractic profession and the Chiropractic Coalition will be seeking to work with all organizations to secure the best possible deal for chiropractic in the new Congress. 

 

ICA clearly recognizes that only legislation will provide any major relief for the chiropractic beneficiary and the chiropractic provider in the Medicare program.  Neither the courts nor administrative changes are likely to yield any lasting benefits for chiropractic in this hotly contested federal program. 

 

A 4.4 percent cut in Medicare payments was announced for 2003 prompting more providers to respond by announcing that they will no longer care for Medicare patients.    A major Congressional battle is underway to restore those cuts.  The $390.5 billion omnibus budget package that passed Senate on Jan. 23 included a provision that would freeze physicians' Medicare fees at 2002 rates until Sept. 30, the end of the government fiscal year. While only a temporary solution to the problem, enactment of the legislation would stop the 4.4 percent across-the-board cut in Medicare reimbursement that doctor level providers are scheduled to receive on March 1. The legislation-which is actually eleven FY 2003 appropriations bills rolled into a single bill-must now go to a House-Senate conference to work out differences between the appropriations bills passed by the House last year.  The Administration is ominously quiet about where it wants the fee cut issue to go.

 

If the proposed fee cut is sustained, and not eventually overturned by Congress, on top of the 5.4 percent cut in 2002, Medicare fees, if not corrected, will have plummeted 20 percent from 2001 to 2005.  

 

The record of managed care programs with regard to chiropractic is questionable at best, with some plans seeking to substitute the care of other providers for the congressionally mandated chiropractic benefits, or using a stringent gatekeeper system to reduce access to chiropractic care.  The U.S. Department of Health and Human Services' (HHS) own research clearly shows the barrier that the gatekeeper system can place between chiropractic services and the beneficiary.  In a study by the HHS Inspector General published in 1999, the Department reported that:  "More Medicare beneficiaries used chiropractic services when a managed care organization (MCO) allowed direct access versus requiring a physician referral. To illustrate, almost 2 percent of the beneficiaries with direct access used chiropractic services from 1995 and 1996.  Conversely, less than .05 percent of the beneficiaries with physician referral requirements used chiropractic services during the same period."  Thus, referral requirements were shown to reduce utilization by 75 percent. (The full text of this HHS report is available online at: http://oig.hhs.gov/oei/reports/oei-04-97-00494.pdf.  A more extensive report comparing chiropractic in managed care and fee for service programs, published in 2000 is also available online at: http://oig.hhs.gov/oei/reports/oei-04-97-00495.pdf.

 

Medicare and HHS administrators have yet to give any indication of a willingness to work with the chiropractic profession in any meaningful manner, despite some dialogue attempts through senior political policy makers and assurances given in Congressional hearings last May by the chief Medicare administrator, Dr. Tom Scully.  ICA has obtained a copy of the HHS Inspector General's "Work Plan for 2003" and near the top of this list of enforcement priorities is: "The Office of the Inspector General (OIG) will determine the inappropriateness of Medicare billings for chiropractic care." You can read about this direct targeting of chiropractic yourself on the Internet at:

http://finweb.mc.vanderbilt.edu/CPC/vmgcoding/Coding_DHS2K3Plan.pdf.

 

The profession will need to mobilize on a very determined and sophisticated level to secure what chiropractic patients of all ages, and most especially the elderly, need and deserve; unfettered access to the care of a doctor of chiropractic, and the right to make that choice without government interference.  ICA will keep the chiropractic profession fully informed on this vital national debate.  "This is why ALL chiropractors need to belong to a national organization, and not allow chiropractic to be relegated to the sidelines because of non-participation," said ICA President Dr. D.D. Humber.   "We would welcome the support of new members allowing us to better protect your patients' rights and your paycheck!"

 

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For More Information, Contact the International Chiropractors Association, a Worldwide Community of the Most Successful Chiropractors on Earth at chiro@chiropractic.org or visit the ICA website at www.chiropractic.org.

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