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October 2006, Vol. 16, No. 4

Table of Contents

Do 90% of Acute Low Back Pain Episodes Resolve Within Two Months Regardless of Treatment Rendered?Blues Already Using CCGPP to Cut Claims!CBP® Annual AwardsChiropractic, Disease, Adjustments and Other Voodoo!Effective Initial ExamIt's Don's OpinionLetters to the EditorNeurosurgeon Heralds Posture Pump® MRI StudyNew PCCRP X-ray Guidelines Will Protect Your RightsAssociation of NJ Chiropractors OPEN LETTER to the CCGPPPosturePrint® Head Manuscript Accepted by JMPTResearch CornerThe Benefits of Short Duration Whole Body VibrationTriano and CCGPPs Will Give You Six Visits Part II PostureRay™: Digital X-ray Digitization and Analysis has Finally Arrived

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ICA: I Hate to Say We Told You So

The Blues are Already Using CCGPP to Cut Claims!

by John Maltby, DC, FICA

President of ICA

        

Hopefully you have been staying up on all the information coming your way on the CCGPP “Best Practices” Document. A major concern of the ICA’s has not only been the selective research process, but we knew that as soon as this document was published, 3rd party payers would use this document to reduce care and cut claims of chiropractors. The authors of the CCGPP assured us that nothing could be further from the truth. In a Q and A section on COSCA’s web site, the promoters of CCGPP state the following:

              “Insurers, third party payers and state regulators (i.e., work comp) are all important stakeholders in the chiropractic profession, regardless of how we feel about them. What chiropractic is, and chiropractors do, impacts them just as their actions impact the profession, and more importantly, our patients. Giving them the opportunity to comment on our process ensures greater credibility of the document. It does not give any of them an opportunity to dictate to us what we can and cannot do. On the contrary. (Emphasis added)

              “For too many years DC’s have been hammered over the head by guidelines which were crafted by people out side our profession. We now have an opportunity to educate those outside our profession with a resource which includes a very credible review of the scientific literature, filtered though and interpreted by chiropractors, not outside “authorities” who would impose their vision of our profession, rather than the chiropractic profession’s vision.”

              Oh really? I have just received a copy of a letter to a DC from Blue Cross Blue Shield sent September of 2006. In the letter to the DC, they state,

              “As part of our efforts, we monitor claim payments and at times review medical records to ensure that payments have been made properly.”

              “More recently, the Council on Chiropractic Guidelines and Practice Parameters - The Chiropractic Best Practices Document for Lower Back Pain reported that the literature...”(emphasis added)

              Wait a minute. I thought the Low Back Document was out for review and Insurance carriers, namely Blue Cross Blue Shield, are already using it to evaluate chiropractor’s claims. I knew this was going to happen, even though we have the assurance of those involved that this would not. What really surprises me is that the 3rd party payers apparently didn’t even wait for the ink to dry before they started using it.

              The problems and bias represented by this document are many, but perhaps one of the most interesting developments is the discovery of citing “bogus” research in order to justify it. Please take the time to read the article by Dan Murphy, DC. He took the time to track down a document that has haunted us for years, and shown that in fact this was based on nothing more than the statements of a general practitioner who admitted he wasn’t an authority.

              It is time to get mad, it is past time. Let your voice be heard. ICA will continue to fight the battle, defending your right to practice chiropractic. Join the association that is not afraid to step forward and take a stand. Join the ICA today.

 

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