This last week I became aware of two aspects of chiropractic and Medicare that are sobering, to say the least.
The first came as an email from one of the state chiropractic organizations promoting membership in a chiropractic advocacy group to influence the direction of the national health care debate. Ostensibly, to make sure Congress doesn’t limit access to chiropractic, while also expanding the coverage of services offered by chiropractors that are reimbursed by Medicare.
The other was a 36-page document from the Office of the Inspector General entitled, Inappropriate Medicare Payments for Chiropractic Services dated May 2009. Since many believe that the so-called health care reform will be an enlargement of Medicare, I thought it wise to read this document and get the general mood of the legal arm of the Department of Health and Human Services.
One of the major findings of the report is that as recent as 2006 Medicare inappropriately paid chiropractors $178 million for chiropractic claims. Inappropriately, meaning that almost half (47%) of the claims that they studied were seeking payment from what they call “maintenance therapy” and that the chiropractic intervention “didn’t provide a reasonable expectation of recovery or functional improvement.”
There were other problems. Poor documentation, inappropriate upcoding, lack of a treatment plan and other basics related to justifying one’s “doctoring.” But it was the large number of chiropractors attempting to deliver a supportive lifestyle intervention within a system set up to deal with short-term episodic treatment of symptoms that seems to have caught the ire of the Inspector General.
The section on suggested recommendations begins on page 18. Not surprisingly, one recommendation is to withhold payments to chiropractors pending a review of their claims when required documentation is missing, along with a form of “profiling” in which a prepayment review is conducted on all claims from chiropractors with a history of failing to meet documentation requirements.
I prefer to believe that what the lawyers consider “inappropriate” or even “fraud” among chiropractors is either ignorance, philosophical differences or a combination of both. Unfortunately, either way it will be expensive for individual chiropractors and, in light of the current posturing for a piece of the government-run system of so-called health care, expensive in terms of the limited political capital available for the profession in Washington.
But then, I’m not in favor of chiropractic being included anyway. (You can read my rationale written just over two years ago here. In fact, rather than petitioning decision makers in the hopes of avoiding the need for a medical doctor referral, I’d recommend focusing lobbying efforts on a far more practical goal: for chiropractors to have the option (like medical doctors) to opt out of the system.
In light of the recent findings by the Office of the Inspector General, it just might be an achievable goal.