ChiroView Presents: We should all be concerned! (webinfo@ChiroViewPresents.com) Topics: 1. Case of the month - Ian McLean, DC, DACBR 2. ICA releases practice guidelines 3. You're off the managed care panel - Say what? 4. CCA responds to ASHP #1 Here is the "case of the month" provided by Ian McLean, DC, DABCR, ChiroView Presents Department Head for Diagnostic Imaging. Many enjoyed this part of the broadcast so here you go! Just click http://members.tripod.com/IMcLeanDC/. #2 I just received the following notice so check it out: "Chiropractic practice guidelines from the International Chiropractors Association were released today, marking the beginning of an international distribution effort that will place this historic document into the hands of tens of thousands of chiropractic practitioners, educators, health care policy makers, news agencies and third-party payment organizations. ICA's Recommended Clinical Protocols and Guidelines for the Practice of Chiropractic is published in an easy to read soft-bound edition and will shortly be released on CD-ROM. A copy of this first printing will be sent free-of-charge to every ICA member and the full published text will be available shortly on ICA's Internet website at www.chiropractic.org." On a much more serious note, I received the next two posts this past week and thought I would be doing a disservice not to pass them along. I am concerned, you should be concerned, our profession needs to be concerned...and we need to be speaking in one voice! Sig Sigmund Miller, DC http://www.eChiropractor.com http://www.ChiroViewPresents.com #3 Dear Sig, I was recently terminated from Landmark Healthcare. The reason: When asked if I advised patient's against immunization I said "no" but wrote a short not that I would advise against immunization if they had a bad reaction to the injection. After receiving the termination notice I called them. They advised me to send a letter clarifying what I meant by this. I wrote a letter stating that I have never, in 14 years, advised a patient against immunization and that if asked I would refer them back to their pediatrician. I was sent a certified letter stating Landmarks decision was upheld. Landmark is the 3rd party administrator for a large HMO in our area called MVP. I work in a multidisiplinary medical arts building and MVP constitutes 1/3 of my patient base. I have contacted my attorney but am interested whether other chiropractors are being subjected to this type of termination which could potentially be financially devastating. #4 Brad Sullivan, DC has done an extraordinary job over the years on behalf of CCA and for chiropractic. I thought it appropriate to post the following press release so more can become aware of what is going on: Brad Sullivan, DC - Chair, California Insurance and Managed Care Committee wrote: "I am very gratified to see the positive response this press release has generated amongst all doctors of chiropractic! Several calls received today in my office were from non-managed care providers congratulating us for taking action to protect the quality of chiropractic care rendered to our patients! If you have any questions, feel free to call my office at 818-990-1742 orany member of your CCA Executive Committee! California Chiropractic Association Press Release - For Immediate Release Rebecca Downing, Executive Director, 916-648-2727 x133 HMO Actions Compromise Patient Care SACRAMENTO, CA -- American Specialty Health Plans (ASHP), California's largest multi-specialty network based in San Diego, California, notified doctors of chiropractic that they will be implementing a policy beginning August 1, 2000 that may compromise patient care and may force closure of chiropractic offices statewide. Calling it a "development" plan, ASHP officials implemented a reduced reimbursement policy that, in effect, establishes a significant barrier to patients who need specialized care and who have been led to believe they have chiropractic benefits. This plan will, by economic necessity, force the doctor to endure great economic hardship in order to provide clinically indicated care to their patients. These changes are drastic. Under the rate reduction, ASHP essentially does not pay a participating doctor of chiropractic for many services that are within his/her scope of practice. ASHP's actions raise moral and ethical issues surrounding the role of the managed care organization and reimbursement for appropriate clinical care patients deserve. Some of the ASHP contract restrictions include no separate reimbursement for the use of physical therapy modalities to treat a patient, and no reimbursement for x-rays to rule out dangerous contraindications to treatment, without permission. Economic necessity will also likely force doctors to discontinue patient counseling and rehabilitation services. The California Chiropractic Association is opposed to other activities of ASHP including: ASHP controls 93% of its niche chiropractic HMO market through contracts with major health plans like Kaiser Permanente, Blue Cross, HealthNet, PacifiCare, Aetna, Cigna, Blue Shield HMO, Prudential Health Care Plan, Secure Horizons, Sharp Health Plan, and others. ASHP excludes access to over 75% of the doctors of chiropractic in the state. ASHP withheld over $5,000,000 in FY 1998 from what could have been paid to its contracted doctors and again withheld millions of dollars more in FY 1999 from what could have been paid to doctors providing quality care. ASHP earned nearly $75 million in revenues in FY 1999, yet it paid less than half of that sum for the health care. ASHP had administrative costs of over 30% in FY 1999, though the Knox-Keene law that governs it has established a guideline that only 15% or less is to be used for administrative costs. Coincidentally, the company just relocated into new luxurious accommodations and still profited over $5 million in FY 1999. ASHP's recent activities underscore the need for the government to enact stricter laws governing HMOs. CCA supports a federal "Patient's Bill of Rights" and the antitrust reform measures contained in the proposed federal "Campbell Bill," as well as "Any Willing Provider" legislation. The California Chiropractic Association urges patients who suspect their health care may be at risk from ASHP's actions, to contact California Department of Managed Health Care, Consumer Resources and Support Center, 320 West Fourth Street, Suite 880, Los Angeles, CA 90013-1105. Voice: (888) HMO-2219 FAX: (213) 576-7184 E-mail: helpline@dmhc.ca.gov Web: HMOHelp.ca.gov