The best thing we can do right now is to build a patient database. Our government relations people, who are representative of the ACA, ICA and ACC, are telling us that we are going to need to demonstrate the public’s desire to have chiropractic services. And that we’re not going to be able to do that with 100,000 or 500,000 people. We’re going to need millions of patients advocating, telling their legislators that they want to see chiropractic included in any type of health care reform that comes out of the federal government. To that end, the ACA and the ICA have formed Chirovoice (www.chirovoice.org) and Adjust The Vote (www.adjustthevote.org), where one can log on and get their patients registered into this database that is being built by both of those organizations, so that when the time comes and we need to push the button, we can get all of these people activated.

What is the best possible outcome for chiropractic in the health reform process, including not only laws that might be passed this year but also later rule-making by the executive branch, which determines how to carry out those laws?

I think the best case scenario for us would be to be included in any reform plan, at parity with other health care professions, so that we can receive payment for all that we do. Right now, we can’t. One of the big goals is to not only be included but to also get paid for what we do, for once and for all.

Aside from the White Paper recently released by the Chiropractic Summit, which provides substantial detail as to why chiropractic should be included in health reform legislation, does the Summit have a brief capsule statement on the profession’s key aims?

Yes. We are asking that essential chiropractic services be included as a covered benefit under any national reform plan; that every patient should have the right to choose and be reimbursed for all health care services from doctors of chiropractic without barriers and limitations that unfairly restrict their freedom of choice; and that there be no MD-referral requirement for patients to obtain access to chiropractic care.

You’ve explained what the best possible outcome would be in health reform. Regarding possible negative outcomes, what are we particularly trying to avoid?

What we’re trying to avoid, first and foremost, is being excluded. One thing that is not going to help us is the recent report from the Office of the Inspector General (OIG), which said that our profession is insufficient when it comes to proper documentation. That will come back to bite us. There are a number of key legislators – Senator Grassley (R-IA), Senator Harkin (D-IA) – that are friends of the profession and are trying to help us through this process. But then you have other people in government who sit and look at the documentation issue and will say, “Hey, you guys are looking for inclusion or expansion and you don’t even know how to document properly. How do you expect me to say this profession belongs in the loop?” It makes it tough on them. So that’s something that we have to correct because it’s going to work against us.

In addition, you have other health care professions – medicine, osteopathy, physical therapy – competing for a similar piece of the pie. And you have other providers out there now who say they do manipulation. They may not do it for the same reasons that chiropractors do it, but they’re going to claim that they do it. So an insurance company can turn around and say that they are providing that service, but it’s just not going to be provided by a DC. It may be provided by a physiatrist or a physical therapist. So those are the types of things that we need to be careful not to fall victim to. We have to be sure that we stay in the game, and that’s going to take a huge effort. It’s going to require pooling resources across organizational boundaries. That’s the only way it’s going to happen for us.

Looking back to past legislative efforts by chiropractors (inclusion in Medicare in 1973, inclusion in the Veterans Administration and Department of Defense programs around the turn of the 21st century, and stopping federal legislation such as S.B. 1955 that would have eliminated state insurance equality laws), what lessons have we learned that are most relevant to the current situation?

When you look at the VA, the DOD and the stopping of 1955, the profession was working together on them, but not to the degree that it is now. We’ve also worked together on some other issues that have come up, such as efforts by insurance companies to restrict chiropractors from providing services to children. So when then profession works together and is aggressive, good things can happen. I know that we as a profession have a strong presence on Capitol Hill that is respected. And I think that maintaining that is what is going to work best for everybody. This is a strength that can help us greatly going forward. On the VA, the DOD and 1955, when we came together we were successful.