Chiropractic Lobbies Push for ChangesMon Sep 23, 2002By SHARON THEIMER, Associated Press WriterWASHINGTON (AP) - After years of being treated as second-class providersin the medical profession, chiropractors are lobbying hard to shape theDepartment of Veterans Affairs ( news - web sites)' new coverage ofchiropractic treatment in hopes of winning broader access to patientsnationally.The effort will determine what services chiropractors will provide tothe 70 million Americans ‹ veterans and their relatives ‹ eligible forVA care and whether veterans will be permitted to seek chiropractictreatment without having to get a medical doctor's permission first.Many chiropractors also want the right to coordinate patients' care.That idea has earned a powerful opponent ‹ the main doctors' lobby,which argues that coordinating patients' health care should remain withphysicians and not with chiropractors, who do not attend medical school.Health insurers are also watching. All sides are aware of the highstakes."What happens in the VA will set the tone for all future involvementwith chiropractic in the federal government," said Terry Rondberg, achiropractor and president of the World Chiropractic Alliance.The intensity of the lobbying has been affected by disagreement amongchiropractic groups.The American Chiropractic Association wants chiropractors to be able toserve as primary care providers, diagnosing illness. In addition, theassociation wants chiropractic treatment to focus beyond the spine tomuscles, bones and nerves.The World Chiropractic Alliance argues chiropractors should focus ontheir specialty ‹ the spine and nervous system ‹ rather than mirroringthe work of physicians. The alliance wants the VA to let patients seechiropractors for preventive care in addition to existing problems.Both groups are pushing for the common goal of expanded access topatients ‹ without physicians as gatekeepers.To make their pitch, chiropractors jockeyed hard to win spots on the11-member VA advisory committee shaping the policy. The panel includesseven chiropractors, two medical doctors, one physical therapist and oneosteopath.Whether the panel reaches consensus or not, it's a chance for people toget their views on the table, said Sara McVicker, clinical programmanager at Veterans Affairs and manager of the advisory committee."There are some very clear divisions of opinion," McVicker said. "Theremay not be as many divisions of opinion as they think. You never know,until they start talking to each other."Chiropractors also have pressed Congress, sending letters and makingpersonal visits to Capitol Hill. One of the chiropractor lobby groupseven offered free spinal screenings to lawmakers.The American Medical Association, the main doctor's lobby, is pushingback with its own political clout. It wants to keep chiropractors fromwinning a "massive expansion of their scope of practice in order to bedeclared primary care physicians," said Dr. Richard Corlin, a physicianand former association president."The bottom line is you don't get to be a primary care physician by theaction of a committee," Corlin said. "You get it by going to medicalschool."The AMA is much larger and better financed than the chiropracticlobbies. It spent about $7.3 million on lobbying last year, comparedwith about $60,000 by the American Chiropractic Association and $15,000for the World Chiropractic Alliance.The AMA also dwarfs chiropractic groups in campaign contributions. Itand its members gave more than $1.1 million in the 2000 election,compared with about $140,000 from the American Chiropractic Associationand its members.Insurers are also keeping a watchful eye on the VA debate for itsimplications to their coverage.A spokesman for Kaiser Permanente, the giant not-for-profit healthmaintenance organization, said it's too soon to gauge the impact of theVA's decisions. "But obviously, given the size and scope of someone likethe VA or Medicare, if they were to change their practices obviouslypeople would have to look at that," Matthew Schiffgens said.Until recently, the only federal program that chiropractors were allowedto participate in was Medicare. The Defense Department is now addingchiropractors to its health system.Each advance in government coverage helps chiropractors make their caseto the larger audience of patients."When we got into Medicare, we tried to tell everybody we could affordto tell that now we were in a major government program," the AmericanChiropractic Association's Jerome McAndrews said. "This is a sign offurther establishment of our services to the country."___