February 2004

CCA supports measures to certify all WC providers

In a state senate hearing, the California Chiropractic Association opposed efforts to further limit access to chiropractors but supported measures to ensure that all medical providers participating in the workers' compensation system are certified.

"The California Chiropractic Association supports certification of all who provide medical care under workers' compensation," testified Kassie Donoghue, a doctor of chiropractic from Sacramento. "With certification of all providers, any medical provider that may try to game the system could be decertified and no longer allowed to provide care under workers' compensation. We think this is a good way to remove the few bad actors from the system."

Donoghue also said CCA supports provisions in ABX4-1 and SBX4-3 that would create an Independent Medical Review (IMR), as long as the review is done by a like provider.

"Like provider review is the standard in other IMR systems and must be in this one as well," Dr. Donoghue testified. "We also are concerned that current IMR proposals allow only for a paper review of a patient's case. Reviewing the file of a patient in a complicated arena such as California's Workers' Compensation system is not adequate to accurately assess a patient's condition."

She also requested provisions be included in the legislation to ensure a request for an IMR is not used to delay patient care and to ensure there is an opportunity for appeal.

"Last year's workers' compensation legislation capped chiropractic visits at 24. The American College of Occupational and Environmental Medicine (ACOEM) guidelines only allow six visits to a chiropractor for most conditions. Those limits, coupled with fee reductions, means chiropractic care will be cut by as much as 70 percent this year," Donoghue said.

Donoghue told the committee that it would be counterproductive to further limit or eliminate chiropractic care from the workers' comp system. She cited a July 2001 study by Muse & Associates, a respected Washington, DC research firm that examined the utilization, cost and effects of chiropractic services on Medicare.

The Muse and Associates study concluded that chiropractic care significantly reduces per beneficiary costs to the Medicare program currently and could potentially save even more in the future. CCA believes the same conclusion can be made for California's workers' compensation program.

A few facts from the study when considering global patterns of utilization:

• Beneficiaries who received chiropractic care averaged fewer Medicare claims per capita than those who did not (33.4 claims v. 38.5 claims).

• Beneficiaries who received chiropractic care had lower average Medicare payments for all Medicare services than those who did not ($4,426 v $8,103).

• Beneficiaries who received chiropractic care had lower average Medicare payments per claim than those who did not ($133 v. $210).

• Beneficiaries who received chiropractic care had lower average costs for each type of claim during 1999 than those who did not. "

Source: California Chiropractic Association

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