We need your help to pass bills on Chiropractic Fair Pay, Prior Authorization


On Tuesday, Feb. 20, in the House Health Care Committee, Washington State Chiropractic Association representatives testified before the House Health Care Committee regarding the Chiropractic Fair Pay Bill, ESB 5518. When you watch the video you will have a clear picture of how the insurers value chiropractors and chiropractic care. Following this hearing, on Wednesday, February 21, 2018, the committee passed the bill to the next step in the legislative process 12 in favor and 5 opposed. Even our “no” votes understand how unfair the insurers are being, they just don’t like putting this kind of thing in statute.

The committee also heard ESSB 6157, the bill allows access to up to 6 consecutive visits of chiropractic care (and other therapies) in the same episode of care without having to request prior authorization. An episode of care is definined by a period of 90 days or more without treatment for the same or similar conditon. This bill is scheduled for Executive Action Friday, February 23, 2018 and needs to move from committee to continue in the legislative process before the 5:00pm cut off on the same day. We need you to call your House members and ask them to vote YES on ESSB 6157.

Watching the Video: You can find the Fair Pay testimony from the 1:06:10 mark to the 1:29:27 mark. The Prior Authorization testimony runs from 0:00 to the 02:04, and again from 12:30 to 45.40.

It’s disturbing to see what health insurers are saying about chiropractors and the services we provide, and it’s critical for doctors to review their arguments. Find your legislative district and legislators and call them to urge their support for ESSB 5518 and ESSB 6157.

Talking points for the Fair Pay bill, ESB 5518:

• This bill gives insurers the option of:

A. Raising the pay UP to chiropractors to match what they pay others for spinal manipulation services (identified by the same or substantially similar code); or
B. Lowering others DOWN to the same rate they pay chiropractors for spinal manipulation services (identified by the same or substantially similar code); or, what we recommend-
C. Pay chiropractors using the appropriate payment methodology identified by CMS using the RVU formula to set fair payments for ALL providers.

Your contracts are not negotiated — they are “take-it-or-leave-it”.

Insurers haven’t raised your fee schedules for spinal manipulation in more than14 years! In fact, Regence pays chiropractors 14% less in 2018 than they did in 2003.

Talking point for Prior Authorization, ESB 6157:

• When patients are prevented from obtaining their benefits by obstructive prior authorization requirements, it drives them away from drugless providers into opioid prescriptions.
Every day non-drug treatment is delayed, another opioid prescription is provided.

CALL TO ACTION:

1. Come to Olympia. Your presence changes the outcome in a positive way! Once the bills pass through the Rules Committee they are eligible for Floor Action (a full House vote) and will need your help “at the doors” with Lori to help count votes. The bill must be heard by March 2, at 5:00pm. If you can come to Olympia email Lori at LGrassi@chirohealth.org or text her at 253-988-0500-be sure to put your name in the text message!
2. Call your State Representatives and ask for an appointment to meet with them. You can find your legislative district to know who to contact!

— By Dr. Dave Butters, President Washington State Chiropractic Trust

We need you in Olympia Jan. 25 for our 2018 Chiropractic Legislative Day


Join us at the State Capitol in Olympia Jan. 25.

It’s critical that you attend our 2018 Annual Legislative Day on Thursday, Jan. 25 in Olympia. It’s your opportunity to meet legislators who represent you, and to advocate for your profession and your patients.

Make appointments with your legislators now. You can find your legislators easily by using this link: http://app.leg.wa.gov/districtfinder. Once those meetings are confirmed, contact the WSCA with the time of the meeting, your legislator’s name and the room number. If you need assistance coordinating with your legislator, call the WSCA office at 206-878-6055.

Plan a carpool with other chiropractic colleagues from your legislative district. You can learn more about available parking options as well as shuttle service at this link.

We will meet in the Capitol Rotunda at 8 a.m. Jan. 25. Our lobbyist Lori Grassi will be briefing WSCA members on the association’s agenda before we set out on our day of public advocacy – both for our profession and for those who rely on us for their chiropractic care.

You can find our 2018 Chiropractic Legislative Agenda here.

If you cannot attend Jan. 25, you can still come any day during the legislative session. Just schedule your time in advance with Lori Grassi by calling the association office at 206-878-6055.

I look forward to seeing you in Olympia on Jan. 25.

— Dr. Dave Butters, President

Washington State Chiropractic Trust

Join us for X-ray panel discussion Jan. 20, Chiropractic Legislative Day Jan 25


Dr. Dave Butters

I hope you had a great holiday and are ready for the New Year – which means the start of the 2018 legislative session will be here before we know it. You’ll find more details below on our Jan. 25 Legislative Day, and I also want to alert you to a panel discussion on X-rays Jan. 20.

Please plan to attend our 2018 Annual Legislative Day, this year on Thursday, Jan. 25, 2018 in Olympia. It’s your opportunity to meet legislators who represent you, and to advocate for your profession and your patients. We will meet in the Capitol Rotunda at 8 a.m. for a briefing.

Contact your legislators in advance to set up an appointment for Jan. 25. You can find your state legislator at this link: http://app.leg.wa.gov/districtfinder. We are counting on a large chiropractic turnout for our Legislative Day to ensure that legislators are focused on our issues.

On the weekend before our Legislative Day – Saturday, Jan. 20 – I encourage you to attend a panel discussion regarding the American Chiropractic Association recommendation that chiropractors do not obtain X-rays for patients with acute low-back pain during the first six weeks after onset of pain.

You can learn more about that program on the back of this page.

Here is the 2018 Legislative Agenda as approved by the Washington State Chiropractic Association Board:

1) Remove Chiropractic access barriers and reinforce our alternative drugless approach to the opioid crisis.

2) Ensure that chiropractors are paid fairly for CMT services

3) Identify chiropractors as primary care providers within their scope of practice.

4) Secure a manipulation benefit for adult Medicaid recipients-who can only see an osteopath or naturopath for manipulative services.

5) Remove the sunset provision on the independent pilot for the Chiropractic Quality Assurance Commission.

If you cannot attend Jan. 25, you can still come any day during the legislative session. Just schedule your time in advance with our lobbyist Lori Grassi by calling the association office at 206-878-6055. More details on the legislative agenda are available here.

Finally, here’s an important reminder during this season of giving: If you are a regular WSCT contributor, it is appreciated. If you haven’t donated, please do so today. Click on the DONATE button to make either a one-time or recurring donation. Or, if you prefer, fill out and return the enclosed contribution envelope. You can make a one-time contribution of $1,000, $500, $250, $100 or you can sign up for monthly credit card withdrawals.

Happy New Year to you and yours!

— Dr. Dave Butters, President
Washington State Chiropractic Trust

With gratitude, as we prepare to advocate for chiropractic during 2018


We are almost at Thanksgiving, and I want to express my gratitude to those of you who have given so much to our profession. You volunteer for committees. You donate time and money. You engage in our mission of protecting and promoting patient access to chiropractic care.

The holiday season also means that we are getting closer to the start of yet another session of the Washington State Legislature, and our Legislative Day, set this year for Thursday, Jan. 25, 2018 in Olympia. It’s your opportunity to meet legislators who represent you, and to advocate for your profession and your patients. We are counting on a large chiropractic turn out for our Legislative Day to ensure that legislators are focused on our issues.

Your participation in the legislative process is critical to our outcomes and truly makes a difference. If you cannot attend the legislative day, you can still come any day during the session. Just schedule your time in advance with our lobbyist Lori Grassi, and she will make sure that you get a chance to share your issues.

Here is the 2018 Legislative Agenda as approved by the Washington State Chiropractic Association Board:

1) Reinforce the importance of chiropractic’s drugless approach to address the opioid crisis

The WSCT, in partnership with the Washington State Chiropractic Association’s Insurance Committee, has been working with legislators and insurers to educate them on how chiropractic can save money assisting in the decrease of opioids for pain management. Patients can see their MD as many times as they want in any health plan and their first plan of attack on pain is an opioid. We want insurers and legislators to encourage patients to engage in a drugless option first, by reconsidering their approach and removing the barriers to access, which include high copays and visit limits. Another concept we’re pursuing is no prior authorization for the initial 12 visits.

2) Identify chiropractors as primary care providers within their scope of practice.

Our message to legislators: Primary care providers aren’t expected to manage and treat every condition that enters their office, but they are expected to triage and work within their scope of practice and refer when appropriate. We are citing results of the Optum study, which demonstrated that the most common health conditions presenting in a PCP’s office are musculoskeletal. If chiropractors were included by definition as PCPs the insurance specialist classification would go away, copays would drop and the patient would have a greater incentive to seek their chiropractor first – thus reducing exposure to an opioid.

3) Ensure that chiropractors are paid fairly for CMT services

We are again submitting a bill that would require insurers to pay chiropractors fairly for CMT services. The bill also encourages carriers to use the nationally established Relative Value Unite (RVU) system and its conversion factors in paying all providers. Currently, most insurers overpay some provider types and underpay chiropractors for CMT. They should be following the national standards instead of paying others more than the formula and chiropractors less.

4) Secure a manipulation benefit for adult Medicaid recipients-who can only see an osteopath or naturopath for manipulative services.

For the fifth year, we are working to include chiropractors in the list of providers who can deliver manipulation benefits. While we recognize this benefit doesn’t pay well, we believe that under-served communities deserve to have access to drugless services too, and it will save the entire Medicaid system money if they see a chiropractor first. We are also working with the Governor and the State Health Care Authority on a pilot project that would direct Medicaid patients to drugless options for pain management.

5) Remove the sunset provision on the independent pilot for the Chiropractic Quality Assurance Commission.

The Chiropractic Quality Assurance Commission regulates the competency and quality of chiropractors to ensure they are delivering high quality services to state residents. For the past four years, the commission has participated in a pilot project under which it has assumed responsibility for several functions that were previously provided by the Department of Health – including budget, licensing and disciplinary compliance. The pilot is set to expire in mid-2018, and we are advocating that the 2018 legislature grant the commission permanent status as an independent body.

As we prepare for the 2018 legislative session, and for our Jan. 25, 2018 Chiropractic Legislative Day, it is critical that each of you get to know your local legislators. Invite them for coffee or a lunch at your clinic and get 4 or 5 of your colleagues to come as well. You can find your state legislator at this link: http://app.leg.wa.gov/districtfinder. If you would like help setting up meetings with your legislators, contact Lori Grassi, Lobbyist and Executive Director for the WSCA, at LGrassi@chirohealth.org or 206-878-6055.

Finally, I began this letter by expressing my gratitude for those chiropractors who give back to our profession. If you are a regular WSCT contributor, it is appreciated. If you haven’t donated, please do so today. Visit www.washingtonchirotrust.org and click on the DONATE button to make either a one-time or recurring donation. Or, if you prefer, fill out and return the enclosed contribution envelope.

You can make a one-time contribution of $1,000, $500, $250, $100 or you can sign up for monthly credit card withdrawals.

Wishing you and yours a wonderful Thanksgiving holiday.

Dr. Dave Butters

— Dr. Dave Butters, President
Washington State Chiropractic Trust

Engage: Don’t turn your back on your profession


Dr. Dave Butters

This month, as chiropractic turns 122 years old, I have an important question:

Have you turned your back on your profession?

There are 2,000 chiropractors in our state. Yet, when it comes to engaging with our legislators and fighting for what we believe in, most don’t engage. It’s always a small percentage of us working to ensure doctors of chiropractic are compensated fairly — and that our patients have unimpeded access to chiropractic services.

However, thank you to those who did respond to our July 2017 request for help; you got us over half way to where we need to be.

This fall, control of the State Senate will depend on a key race in the 45th District. How we participate financially in both the Democratic and Republican caucuses will not be unnoticed and likely impact our chiropractic issues. It’s critical that we raise another $40,000 in October, mostly for the state House and Senate soft money PACS. When we go to the state Legislature in January 2018 session our support now on both sides of the aisle is what opens the doors to our conversations and concerns.

We continue to have major legislative issues to tackle, including Fair Pay for our services and Prior Authorization obstacles to the care of our patients and the huge administrative burden it’s placing on our offices. Our state and nation are in the midst of an opioid crisis, and our legislators need to know that we are the viable solution. Restricting or impeding access to our services is unacceptable!If you’ve left this work to others in your profession, just couldn’t find the time – now is the time to engage! Do it for your Patients. Do it for your Family. Do it for Yourself.

Click on the DONATE button. Or, if you prefer, mail a check to PO Box 2163, Seattle, WA 98111. Make a one-time contribution: $1000, $500, $250, $100 or sign up for monthly credit card withdrawals of any amount.

— Dr. Dave Butters, President
Washington State Chiropractic Trust

Urgent call to action: Contact your U.S. senators to support H.R. 372


It’s time to contact your U.S. Senators and ask them to support H.R. 372 – aimed at increasing competition in health insurance markets and lowering prices for consumers.

A nationwide coalition of health care providers is supporting H.R. 372, also known as the Competitive Health Insurance Reform Act of 2017. This bill, if passed by the U.S. Senate and signed by President Trump, will repeal the 1945 McCarran Ferguson Act antitrust exemption for the insurance industry.

According to an American Chiropractic Association update, the bill will ensure that health insurers “are subject to the same laws which prohibit unfair trade practices that other businesses are required to comply with.” These include price fixing, collusion or market allocations to the detriment of consumers, the ACA said.

The bill would authorize the Federal Trade Commission and the Department of Justice to enforce the federal antitrust laws against health insurance companies. It passed the U.S. House of Representatives by a 416-7 vote in March 2017, and now awaits action in the Senate.

Contact your Senators NOW and ask them to take up H.R. 372  — and deliver it to the President for signature.

Sen. Maria Cantwell

Sen. Patty Murray

You can find details on H. R. 372 at Congress.gov.

It’s time to fight — for your profession, your patients and yourself


Dr. Dave Butters

Our profession has survived for 120-plus years because we fight for what we believe in. During the early years, doctors of chiropractic were thrown in jail – just for providing care to their patients. We owe it to those who paved the way for us – and those who are following in our footsteps — to make sure doctors of chiropractic are compensated fairly and that our patients have unimpeded access to chiropractic services.

As frustrating as the last couple legislative sessions have been we must remember this is an ongoing process and our legislative successes have always required persistence over time to achieve.Every year we run offense and defense! Our current offensive priorities continue to be Fair Pay for our services and Prior Authorization obstacles to the care of our patients and the huge administrative burden it’s placing on our offices. We’re aggressively working both of these issues from every angle possible legislatively, administratively and legally. Defensively, we stand ready to again stop efforts to erode or eliminate the Every Category of Provider protections that require health plans sold in Washington state to provide chiropractic benefits. We have to be at table and in the discussions as this health care system morphs into whatever it becomes. Our state legislators need to know that we are the viable solution to the opioid crisis and that restricting or impeding access to our services is ridiculous!

WE NEED YOU TO ENGAGE financially and physically! Do it for Chiropractic, Do it for your Patients, Do it for your Family, Do it for Yourself. There are more than 2,000 of us practicing in Washington and frankly our performance on behalf of our great profession in numbers is pathetic and we still have one of the best states in the country for chiropractic. What are you going to do to keep it that way or make it better yet? If just half of us engaged, the influence we would achieve would be staggering!

So what do we need you to do?

To meet our contribution goals and most effectively give to State Senate and House campaigns and House and Senate soft money PACs, we need to raise $100,000 over the next three months. WOW that’s $50 per Chiropractor in our state. Unfortunately, my past experience says everyone won’t play. Therefore many of us will need to do more.

It’s also important that you spend time this summer meeting with your legislators. Have coffee, write them a modest check and invite a few of them into your clinic! It makes a difference! You can find your state legislator at this link: http://app.leg.wa.gov/districtfinder. If you would like help setting up meetings with your legislators, contact Lori Grassi, Lobbyist and Executive Director for the WSCA, at LGrassi@chirohealth.org or 206-878-6055.

If you are a regular contributor to the WSCT, it is appreciated. If you haven’t contributed, I urge you to do so today. Visit www.washingtonchirotrust.org and click on the DONATE button to make either a one-time or recurring donation. Or, if you prefer, mail a check to WSCT, PO Box 2163, Seattle, WA 98111.

Make a one-time contribution: $1000, $500, $250, $100 or sign up for monthly credit card withdrawals: $100, $50, $25 monthly.

— By Dr. Dave Butters

We need your help to address unfair pay issue


Dr. Dave Butters

As many of you know, we were not successful this legislative session on our first attempt to pass our Fair Pay Bill. It’s important to remember that the legislative process is a marathon, not a sprint. We currently continue to work with key legislators and the Office of the Insurance Commissioner (OIC) to address the unfair pay issues. We are collecting EOBs for all insurance companies for spinal manipulation services provided by DOs and NDs, along with corresponding DC EOBs for the same geography and approximate time (within the same month).

Washington State Chiropractic Association (WSCA) lobbyist Lori Grassi and WSCA member Dr. Gina Wolf from Spokane participated in a prior-authorization hearing on March 29 with the House of Representatives Health Care Committee testifying to the concerns with the behaviors of eviCore. We exposed the practices of eviCore and their irrational, baseless and unfair allocation of visits to providers. (Watch the TVW video here.)

Let’s talk about why our bill, SB 5518, didn’t pass. We had a lot of legislative support but the (relatively) few people attending our legislative day questions our resolve and lets legislators on the fence off the hook. We have 2,400 chiropractors in our state and yet fewer than 50 attended). The chiropractors who participated did a good job delivering our message to lawmakers, but lobbying is one of those rare things where sometimes quantity can make the difference. We need a larger presence at our Legislative Day (300-plus DCs). By contrast, our medical and osteopathic counterparts (and the PTs) turn out in the hundreds on their legislative days. When Washington State Chiropractors are ready to compete at that level, we’ll move mountains.

The legislation that we introduced exposed a very technical issue with formulas that the DCs at Legislative Day needed to understand in order to explain to legislators.

Explaining those issues to legislators in 15-minute appointments proved very challenging; especially when they were meeting with lobbyists and constituents in back-to-back meetings. In order to pass this kind of legislation we have to have a repeated, consistent message relayed by many DCs. The call volume by DCs to their legislators on this issue, while strong and impressive, didn’t meet the challenge of such a piece of policy. We have called out disparate pay to other professions who stand to lose income, who don’t want our bill to pass. We have challenged the inappropriate payment practices by influential insurers in Washington State; however, to succeed with this kind of a challenge with opposition from Premera, Regence and Aetna it takes time and large numbers of chiropractors engaging their legislators throughout the session.

Remember that Regence, Premera and Aetna all contribute large amounts of money (part of this equation) to the House and Senate. It’s critical we continue to raise and strategically contribute funds to political campaigns. Less than 15 percent of Washington state chiropractors contribute financially to the political activities that protect and enhance your profession and your patients’ access to your services.

So what happens next? Be assured that we will continue to fight for fair pay and against intrusive, disruptive and costly prior authorization practices and any other actions that interfere with our patients’ access to our services and our ability to compete fairly in the market place.

I am calling on you again to donate to the Trust, to help elect those who support chiropractic. And next year, I will ask you again to come to Olympia, and again to meet with your legislators between sessions back in your home districts. The legislative process is a long one, and at times discouraging. Our lobbyist Lori Grassi is always available to help you facilitate YOUR message with your legislators, both during and between sessions, but it has to be initiated by you. Will YOU? Contact Lori Grassi at 206-878-6055 or by email lgrassi@chirohealth.org.

If you have contributed recently and/or are a regular contributor to the WSCT, it is appreciated and makes a difference. If you haven’t contributed, I urge you to do so today. You will find on our website www.washingtonchirotrust.org an online donation option. Just click on the DONATE button to make either a one-time or recurring donation. Or, if you prefer, fill out and return the enclosed contribution envelope.

Make a one-time contribution: $1000, $500, $250, $100 or sign up for monthly credit card withdrawals: $100, $50, $25 monthly.

— Dr. Dave Butters, DC

Fair pay for chiropractors is within reach – contact your senator now!


Pay parity for spinal manipulation is gaining traction in Olympia, but the fight is far from over.

Washington State Chiropractic Association Executive Director and Lobbyist Lori Grassi and Dr. Austin McMillin testified last week before the Senate Health Care Committee in support of SB 5518, while insurers presented no new arguments against the bill.

Legislators were engaged, and now we need your help to follow up with them. The bill needs to be moved out of the Health Care Committee by 5:00pm on Friday, Feb. 17.

Contact your senator now and tell them to support SB 5518.