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.
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 email@example.com. He is ready to help you find your legislator as well as call for appointments for you.
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 firstname.lastname@example.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!
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.
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.
We’re always fighting for you, and one of the issues we continue to tackle is educating legislators on the unfair fee schedule used by insurers to pay chiropractors.
This summer, our lobbyist Lori Grassi has been meeting with state lawmakers, using visuals to show them how insurance company fee schedules for Chiropractic Manipulative Therapy (CMT) is paid at, in many cases, 100 percent less than what is paid to osteopathic and naturopathic doctors using the Osteopathic Manipulative Therapy (OMT) codes. This tool clearly shows how these payments are unfair, especially when the patient copay for chiropractic services is much more than the co-payment required for primary care!
In addition, through these visuals legislators also are learning that carriers have not increased fee schedules to chiropractors in 13 years, clearly unfair financial treatment in a market place where three insurers (Regence and Premera, their subsidiaries and Aetna) hold policies for most of the covered lives in Washington state, and chiropractors have no legal effective way to negotiate fees.
We are also educating legislators about the importance of defining chiropractic as a Primary Care profession, along with physician assistants, nurse practitioners, and naturopathic doctors. This will not only level the playing field when it comes to patient co-payments, it would also allow chiropractors to access the loan re-payment program for newly licensed DCs who choose to practice in a rural setting. And, we continue to challenge unfair prior-authorization practices by encouraging providers and patients to file complaints with the Office of the Insurance Commissioner (OIC). OIC confirms that they are receiving our complaints, are fully aware and concerned about the issue and are considering a market conduct review.
Your support is critical to advance this major agenda. To meet our contribution goals and effectively contribute to State Senate and House campaigns and House and Senate soft money PACs we still need to raise $65,000 over the next 3 months. It’s also important that you spend some 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 have contributed recently and/or are a regular contributor to the WSCT, it is appreciated. If you haven’t contributed, I urge you to do so today. Donate online here to make either a one-time or recurring donation. Or if you prefer, mail your donation 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.
— Dr. Dave Butters, President
Washington State Chiropractic Trust
On June 23, I participated in a meeting that illustrates how the Washington State Chiropractic Association (WSCA) and Washington State Chiropractic Trust (WSCT) are working hard to protect the chiropractic profession in our state.
The WSCA and the WCT, along with State Rep. Eileen Cody, Chair of the House Health Care Committee, met with insurance company representatives to discuss three critical issues affecting our state’s chiropractors:
Copays that exceed the allowed amount paid to a chiropractor.
Fee schedules that have not increased in more than a decade and disparate pay for chiropractic manipulation services vs. osteopaths and naturopaths (paid nearly 100% more in many cases).
Prior authorization requirements with no rational clinical basis that only serve to disrupt or prevent necessary care and burden providers with unmanageable administrative struggles.
While all insurers were invited, those attending included Regence, Premera, Molina, Group Health and Aetna, along with one representative from the Association Health Plans. Our attendees included WSCA President Garry Baldwin, DC; WSCA Executive Director/Lobbyist Lori Grassi; Austin McMillin, DC and myself.
Rep. Cody opened the meeting by asking insurers to consider that their current copay practices may be creating deterrents to patients following their treatment plans and could be adding to the opioid epidemic, forcing patients to turn to drugs when they are in chronic pain.
Lori Grassi prepared materials to illustrate the disparate payments between professions for virtually the same service. The WSCA attendees provided excellent examples of the discriminatory behavior that insurers are applying to chiropractors.
Dr. McMillin led a remarkable conversation about the development of the CPT codes and how the Relative Value Units (RVUs) are intended to apply regardless of provider type to all services described by a CPT code. He delivered a historical perspective that stifled the insurance representatives and left the room silent.
Compelling examples were provided of why the prior authorization process is arbitrary, non-clinical, disrupts and denies care and benefits.
The meeting can be summarized in these bullet points:
The pay to chiropractors is blatantly unfair and discriminatory, and insurers are using arbitrary methods for establishing chiropractor fee schedules.
Between prior authorization requirements and menial payment for manipulation – whether the payment is a copay paid entirely by the patient or the minimal “allowed amount” actually paid by an insurer – it doesn’t cover the cost of the administrative work shifted to the provider along with providing the care.
The WSCA will likely need to run a bill again to overcome this inequity and we will need strong support from the profession to move the issue through the process.
We will also be meeting with the Office of the Insurance Commissioner on June 30, 2016, to discuss detailed issues regarding the prior-authorization processes used to deny access to chiropractic care.
These are just a couple of ways that the WSCA and WSCT are working to protect the chiropractic profession in Washington State. If you are a regular contributor to the WSCT, thank you. If not, I urge you to do so today!
You can click here to make a one-time or recurring donation online. Or you can mail your donation to WSCT, PO Box 2163, Seattle, WA 98111
Consider a one-time contribution: $1000, $500, $250, $100 or sign up for monthly credit card withdrawals: $100, $50, $25 monthly.
— Dr. Dave Butters, President
Washington State Chiropractic Trust
This summer the Office of the Insurance Commissioner (OIC) will be preparing Rules (Washington Administrative Code) for the prior authorization of health care services. Engrossed Second Substitute House Bill 1471 which was passed through the efforts of the Washington State Chiropractic Association (WSCA) and Washington State Chiropractic Trust (WSCT), addresses some aspects of prior authorization and will go into effect January 1, 2017. (Read more about the bill at this link: http://1.usa.gov/20D8IBP)
Washington State Chiropractors and their patients can help guide this policy by making comments to the OIC about the problems associated with prior authorization including the filing of complaints with the state agency (OIC) whether on your own or through your patients.
Many of you have been providing comment and anecdotes to the WSCA directly and we encourage you to continue to do so. This is great and we can use the detail in our meetings with legislators and the OIC. In addition to reporting these issues to the WSCA, we need you and your patients to make complaints to the Office of the Insurance Commissioner directly! The link is: http://1.usa.gov/1WY4Ey5
Write a brief report outlining the patient’s condition, treatment goals, recommendations, complications and consequences of inadequate care; and
Explain that the insurer or its contracted entity (such as Evicore) is denying or delaying benefits that the patient has purchased. Their limits and denials of care cause the patient additional risk of poor health outcomes; and
The insurer or its contracted entity are not using individual clinical information as their basis for authorization or denying care; and
The online system for filing prior authorization requests are inadequate and only allow for one patient diagnosis, which is unrealistic and not clinical. They appear to be computer generated!
When filing complaints REDACT all patient identifying information unless your patient has given you written permission to file the complaint on their behalf.
Be clear in your complaint — if you know that there is a violation of law or rule, make that citation known! It does not require a citation, but if you KNOW there is one, use it to help support your claim.
Example: Issuer (name the insurance company) required my patient to obtain a referral for chiropractic care- RCW 48.43.510 (5) says: “Each carrier shall provide enrollees with direct access to the participating chiropractor of the enrollee’s choice for covered chiropractic health care without the necessity of prior referral. Nothing in this subsection shall prevent carriers from restricting enrollees to seeing only providers who have signed participating provider agreements or from utilizing other managed care and cost containment techniques and processes. For purposes of this subsection, “covered chiropractic health care” means covered benefits and limitations related to chiropractic health services as stated in the plan’s medical coverage agreement, with the exception of any provisions related to prior referral for services.”
Continue to copy the WSCA on your complaints! Email Lori Grass at LGrassi@chirohealth.org or mail to the WSCA, Attn: Lori Grassi, 21400 International Blvd., Ste. 207, SeaTac, WA 98198
Prior Authorization of health care services is interrupting both the doctor-patient relationship and medically necessary care. There are still issues that need to be addressed regarding prior authorization of health care services and your comments on the record will support strong policy for the WSCA and WSCT to work on your behalf.
Finally, we need your ongoing support to continue the work of the WSCT. If you are a regular contributor to the WSCT, THANK YOU! If not, I urge you to do so today!
Just click here to make a one-time or recurring donation. Or you can mail your donation to PO Box 2163, Seattle, WA 98111.
Consider a one-time contribution: $1000, $500, $250, $100 OR sign up for monthly credit card withdrawals: $100, $50, $25.
Memorial Day officially kicks off the summer and some time to relax with family and friends. Aside from this summer’s fun we need you to set aside some time for an important task that will directly impact your profession: networking with your state legislators. Doesn’t Sound Fun? Be Part of the Solution and Do It Anyway!
Invite your lawmakers to coffee or lunch, or to visit your office. It is up to us to educate our legislators about the roadblocks that insurance companies put in our way as we try to care for our patients. Help us to be successful in the 2017 legislative session! Lori Grassi, Executive Director and Lobbyist for the WSCA, is happy to help you coordinate a meeting with your legislators. Don’t hesitate to call her at 206-878-6055 if you need some help or coaching.
This is a major election year, and we have to raise significant $$$$ to effectively contribute to State Senate and House campaigns and House and Senate soft money PACs. Please help us achieve our GOAL OF $120,000 by the November election so we can maintain current legislative relationships and build new ones on both the Democratic and Republican sides of the aisle. Bipartisan support is critical!
The WSCT builds and maintains strong grass roots legislative relationships, and we’ve been doing it for a long time. We support people in both parties who support us. We are the only Chiropractic Political Committee in Washington State.
The WSCA provides our Lobbyist, who coordinates legislative lobby activities and works on state policy and governmental issues affecting the Chiropractic profession in our state.
If you are a regular contributor to the WSCT, THANK YOU! If not, I urge you to do so today! Just click here to make a one-time or recurring donation. Or, mail your contribution to PO Box 2163, Seattle, WA 98111.
Consider a one-time contribution: $1000, $500, $250, $100. Or sign up for monthly credit card withdrawals: $100, $50, $25.
Please help us protect and promote patient access to chiropractic care.
— Dr. Dave Butters, President
Washington State Chiropractic Trust
As many of you have likely noticed, 2016 has been a political season like no other. And although most of the attention has been focused on campaigns for U.S. president, it’s important to remember that as chiropractors, we have very important political business here at home: Elections this fall for Washington State Senate and House seats.
Our hope for success during the 2017 legislative session is directly tied to an abundant continuous flow of resources to effectively contribute to State Senate and House campaigns and House and Senate soft money PACs. We have to maintain our current legislative relationships and build new ones on both the Democratic and Republican sides of the aisle. We must have bipartisan support for our issues!
Your state representatives and senators are making public policy decisions that affect you every day, including access to health care services. We need to ensure that we set the stage now for the 2017 legislative session, by working hard raising money and helping re-elect our chiropractic friends and developing new ones in the November 2016 election.
As I mentioned in my last letter, with the mounting pressure of SICK CARE costs and resulting insurance premium increases. the legislative battles over reimbursement are intense. This creates challenge and opportunity for us. Co-pays often exceed the allowable charge for our services, osteopaths are reimbursed up to 100 percent more for spinal manipulation than we are under a different set of codes that describe the same services, prior authorization requirements that waste time, disrupt care, prevent best practice and best outcomes and ridiculous visit benefit limits. The evidence that we provide best practice, best outcomes, lowest cost and highest patient satisfaction is indisputable (but ignored).
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 can click here to make either a one-time or recurring donation online. Or, if you prefer, you can mail your donation to: WSCT, PO Box 2163, Seattle, WA 98111.
Make a one-time contribution: $1000, $500, $250, $100
Sign up for monthly credit card withdrawals: $100, $50, $25 Monthly