June 2006

Wisconsin DCs raise issues about CCGPP guidelines

The Wisconsin Chiropractic Association (WCA) has raised concerns about the draft Low Back Best Practices Guidelines developed by the Council on Chiropractic Guidelines and Practice Parameters (CCGPP). CCGPP has invited public comment on the guidelines until June 30.

According to press release from Russ Leonard, executive director, although the Wisconsin association “would enthusiastically support” a document that is developed without bias and represents the practice of chiropractic, the WCA believes the guidelines have a fatal flaw. He said, “We believe the document fails the initial test of credibility and should be withdrawn.”

The organization points to several areas with which it has concerns:

• Developed on evidence-based medicine. The press release criticizes the guidelines for being developed on evidence-based medicine, because “this model is critically dependent on large volumes of high-quality research … As the CCGPP documents dramatically illustrates, when the chiropractic profession wants to develop ‘best practice’ guidelines for the use of modalities in the treatment of low back conditions, we have virtually no research from which to draw upon.”

• Grading system. The WCA also raised concerns about the grading system used for various practices. “The most damaging result will likely be the gradual elimination of reimbursement for any service that does not receive an ‘A’ or ‘B’ grade. After all, why should an insurer pay for something that received a ‘C’ or ‘D’ in a best-practices document? To the biased reader, the fact that there is “no good evidence from relevant studies” supporting the use of modalities will be viewed as a deficiency of the chiropractic profession,” said Leonard in the press release.

• Comments from medical profession and consumers. The WCA feels that asking for comments from these groups at the draft stage is premature.

• Comments from insurance industry. “Comments by the insurance industry should never have been allowed,” says WCA.

The Wisconsin group says that because of these reasons, the document fails the credibility test.

The document is open for comment until June 30. It can be accessed at www.ccgpp.org.

Source: Wisconsin Chiropractic Association, www.wisconsinchiropractic.com

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