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.

Chiropractors turn out for Feb. 2 Legislative Day


Dozens of Washington state chiropractors gathered in Olympia Thursday, Feb. 2 for the 2017 Washington State Chiropractic Trust/Washington State Chiropractic Association Legislative Day.

After receiving a briefing from WSCA Executive Director/Lobbyist Lori Grassi and WSCT President Dave Butters, chiropractors spread across the Capitol campus for individual meetings with their state senators and representatives — and talk about unfair payment to chiropractors for spinal manipulation services. Chiropractors are paid up to 50 percent less than other providers who deliver spinal manipulation. There has been no increase in chiropractic reimbursement for spinal manipulation in more than 13 years.

Miss Legislative Day? You are welcome to come to Olympia at any time and meet separately with lawmakers. If you need help, contact Shaka Forest at the WSCA office at 206-878-6055 or sforest@chirohealth.org. He is ready to help you find your legislator as well as call for appointments for you.

Feb. 2 Legislative Day: Demonstrate the power of chiropractic


Dr. Dave Butters

Our 2017 Chiropractic Legislative Day is Thursday, Feb. 2 in Olympia. We have an aggressive legislative agenda and it’s critical that we demonstrate the power of our profession by showing up Thursday, Feb. 2 to meet with our legislators.

WSCA Lobbyist Lori Grassi has prepared materials exposing the unfair payment to chiropractors for spinal manipulation services. Chiropractors are paid up to 50 percent less than other providers who deliver spinal manipulation. There has been no increase in chiropractic reimbursement for spinal manipulation in more than 13 years.

We’re also working on two other key issues this session: The inclusion of chiropractors in the list of providers who can deliver the already existing spinal manipulation benefit to adult Medicaid recipients, and inclusion of chiropractic on the list of providers defined as “primary care providers” (PCP), within your scope of practice. Being defined as a PCP means that chiropractors would be eligible for student loan forgiveness when working in a rural community; and would be eligible for PCP copayment levels for patients with spinal manipulation (CMT) benefits.

As always we anticipate significant legislative resistance to these issues, both due to a lack of understanding of your education, and perceptions of your scope of practice. Our primary issue – fair pay – is something that insurers claim is a “contract matter”. The contracts available to chiropractors are take it or leave it contracts, we are at a terrible disadvantage as we are unable to negotiate the contracts and/or the fee schedules. Our goal is to “level the playing field”.

It always starts with a briefing, handouts and a question-and-answer session on our legislative status beginning at 8 a.m. inside on the steps under the Capital Dome of the Legislative Building. Plan a carpool with other chiropractic colleagues from your district.

We need you to make appointments with your legislators NOW! If you need help, contact Shaka Forest at the WSCA office at 206-878-6055 or sforest@chirohealth.org. He is ready to help you find your legislator as well as call for appointments for you. You likely will not be able to “select” your appointment time. Legislative staff will work your appointment request into and around the legislative committee hearing schedules. You’ll need to take the time they give you on Thursday Feb. 2nd. Lori Grassi will accompany you to your appointment if her schedule permits. Tell Shaka to add it to her calendar. See the link below to find your legislators!

You can find your legislative district and legislator online at this link: http://app.leg.wa.gov/districtfinder/

Fair pay: We need your help now


Time concept: smartphone with text Time for Action on display. Mobile smart phone on White background, cell phone 3d render

Washington State Chiropractic Association Lobbyist Lori Grassi has prepared materials exposing the unfair payment to chiropractors for spinal manipulation services. Chiropractors are paid up to 50 percent less than other providers who deliver spinal manipulation. There has been no increase in chiropractic reimbursement for spinal manipulation in more than 13 years.
We need your help! We need you to coordinate with Lori Grassi and schedule appointments with your legislators now. Lori will attend your meetings with you to provide the materials explaining the unfair payment practices. Her attendance and involvement will help you avoid potential anti-trust violations in the process. Call Lori at 206-878-6055 or email her at LGrassi@chirohealth.org with the word “Legislation” in the subject line.

To be successful, we have to explain to legislators how the insurance payment processes are:

1. Not following the fair process of payment formulas known as the Resource Based Relative Value Scale (RBRVS); and

2. Not negotiating with individual providers — the contracts are “take it or leave it” unless you are in a group of 20 or more

This process is most effective when a chiropractor from the legislator’s district is involved in the discussion. Again, call Lori at 206-878-6055 or email her at LGrassi@chirohealth.org with the word “Legislation” in the subject line.

Please also note on your calendar that Chiropractic Legislative Day in Olympia will be Thursday, Feb. 2, 2017! It always starts with a briefing on our legislative status beginning at 8 a.m. on the steps of the Legislative Building. Plan a carpool with other chiropractic colleagues from your district to this very important one-day chiropractic legislative event. Get your Legislative Day appointments with your legislators set up now (they get booked up)! Be part of our grassroots efforts.

You can find your legislative district and legislator online at this link: http://app.leg.wa.gov/districtfinder/.

David Butters DC, Chair
Washington State Chiropractic Trust

It’s time to step up and support your profession


Dr. Dave Butters
Dr. Dave Butters

Please, no more procrastination!

It’s not OK that osteopaths and naturopaths get paid twice as much as chiropractors for providing the same service.

It’s not OK that insurance carriers haven’t increased their fee schedules to chiropractors in 13 years.

It’s not acceptable that insurers are allowed to use EviCore or any other mechanism to obstruct a patient’s access to their Chiropractic benefits.

If you agree with the above, the time is NOW to step up and support your profession!

Not tomorrow. Not next week. NOW!

To complete the financial support of our state legislative friends in this election cycle we must raise $20,000 in the next TWO WEEKS. This is what’s necessary if we want a shot at advancing our agenda in Olympia.

DONATE NOW here  or mail a check today to the WSCT, PO Box 2163, Seattle, WA 98111.

— David Butters DC
President WSCT