VA, TRICARE and HPSAs don't need chiropractors

VA, TRICARE and HPSAs don't need chiropractors

Chiropractors are again trying to muscle their way further into the American health care system, not by dint of their being a demand for their services, but rather through the political process. Two bills now before Congress would force the VA and TRICARE, the military's health benefit system, to offer chiropractic services. Another would give chiropractors access to scholarship and student loan repayment programs for primary health care professionals willing to work in underserved areas.

This effort is in keeping with the chiropractic strategy of using political prowess, rather than actual patient demand or evidence of cost-effectiveness, as a means of legitimization. Not to mention access to the taxpayer's wallet. In the early part of the 20th century, lawyers for chiropractors arrested for unlicensed practice hit on the strategy of lobbying state legislatures for separate chiropractic practice acts. Since then, chiropractors have successfully used state and federal legislation to enhance their image and their bottom line through such devices as insurance mandates, access to federal student loans, expansion of their practice acts and limited inclusion in the VA.

Until a few years ago, there were no chiropractors on the VA staff, although a veteran could get a referral to see a DC in private practice. Then Congress intervened, forcing the VA to add chiropractors to the its staff. Apparently, though, this effort hasn't gone quickly enough for chiropractors, so now they've convinced supporters in Congress to introduce yet further legislation. S. 398 and H.R. 1170 would require all VA Centers to offer in-house chiropractors by 2018. The bills would also add chiropractors to list of health care providers offering rehabilitative services. This effort is in spite of the fact that previous analyses of chiropractic services in the military showed that this increases cost, with no demonstrable increase in results.

Most disturbingly, the definition of "medical services" available to veterans would be amended to include "periodic and preventive chiropractic chiropractic examinations and services," a term that is not otherwise defined. This additional provision is not mentioned in the American Chiropractic Association's promotional "Issue Brief" touting the bills. The ACA focuses solely on pain management, an omission that looks suspiciously intentional and designed to divert attention from this potential bonanza to chiropractors, who would be left to dump whatever pseudoscience they wished into this nebulous phrase. Perhaps more valuable would be the PR possibilities. They could crow that chiropractors are now authorized to offer "periodic preventive chiropractic examinations and services" in the VA, no doubt a boon to their efforts at rebranding chiropractors as "primary care physicians."

Another bill, H.R. 802, would force the inclusion of chiropractic services in TRICARE benefits offered to millions of military-connected beneficiaries around the world. This, again, is without any demonstration whatsoever of demand or cost-effectiveness.

The ACA's Issue Brief on this bill deceptively describes the scope of chiropractic services as "access to doctors of chiropractic and services to address pain management, neuromusculoskeletal disorders and related maladies." But that is not at all what the bill says. It defines "chiropractic services" as "diagnosis (including by diagnostic x-ray tests), evaluation and management, and therapeutic services for the treatment of a patient's health condition, including neuromusculoskeletal conditions and the subluxation complex, and such other services determined appropriate by the Secretary and as authorized under State law." Diagnosis and treatment for the "subluxation complex" is, as we know, impossible, because the "subluxation complex" is a chiropractic fiction.

This is far broader than pain management and neuromusculoskeletal disorders, even if you throw in the nebulous "related maladies." The bill would actually include any "health condition" which may, or may not, be related to a neuromusculoskeletal condition. Coordinating nicely with the chiropractic lobby's continued effort to expand its scope of practice via state legislation, chiropractic services would include any "other services . . . authorized under State law." To ensure that there is no interference with this scheme, the bill specifically does away with any requirement for a referral.

The National Health Services Corps was established "for the purpose of eliminating health manpower shortages in health professional shortage areas [HPSAs]." The NHSC includes physicians, dentists, nurses, physicians assistants and mental health professionals who provide primary care services. It offers scholarships and loan repayment programs as incentives for those will to work in underserved areas.

Lack of a demonstrated need for chiropractic services has not prevented the introduction of a bill (H.R. 542) requiring that chiropractors be included in the NHSC, including eligibility for scholarships and loan repayment. If anyone needs loan repayment assistance, it is chiropractors, given their poor record of repaying these loans on their own.

Once again, this appears to be part of an effort to rebrand chiropractors as "primary health care providers," who, as described in the ACA's Issue Brief on this bill, "are primary care portal-of-entry providers licensed in all 50 states to treat a wide-range of health care conditions, including wide-spread spinal maladies." Of course, "licensed to treat" is not the same as "being sufficiently educated and trained" to treat. The ACA says that this bill is "budget neutral;" it will not add any new costs to the federal budget. That is entirely correct. But what it will do is siphon off taxpayer dollars that would otherwise go to encouraging desperately needed physicians, dentists, nurses, physicians assistants and mental health professionals to practice in underserved areas.

Points of Interest 09/28/2015
Points of Interest 09/26/2015

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