EXECUTIVE DIRECTOR’S MESSAGE Lori Grassi
WSCA Executive Director and Lobbyist Educating the DC
Your focus is on educating your patients about their condition as well as how they can
better maintain good health through an aligned spine. Our focus is on creating an environment that best enables you to do that. One element of that is keeping you informed of how we create that environment. Sometimes, many times, while we are buried in and doing the work, we just don’t have time to tell you about the work we are doing. This message will provide you with a short summary of some of our current projects.
Statement of fact: Chiropractors are the only physician level provider with visit limits in insurance benefits.
WSCA Action 1:
WSCA’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. WSCA wants insurers and legislators to reconsider their approach and send patients to a drugless option first! Remove the barriers to access, which include high copays and visit limits, and encourage patients to engage in a drugless option first.
WSCA Action 2:
Identify chiropractors as primary care providers within their scope of practice. PCPs 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. The Optum study taught us that the most common health conditions presenting in a PCPs office are musculoskeletal. If chiropractors were PCPs the copay would drop and the patient would have a greater incentive to seek their chiropractor first which would reduce exposure to an opioid, and receive the best service for their condition!
DC Action Needed:
MEET WITH YOUR LEGISLATORS AND EDUCATE THEM ON YOUR EDUCATION AND SCOPE OF PRACTICE. USE STUDIES TO SHOW YOUR EFFECTIVENESS. To support you with this effort, we have provided you with your first copy of a brochure to use educating legislators and policy-makers about how chiropractors can assist in ending the opioid epidemic.
Statement of fact: Chiropractors are paid 50% less for chiropractic manipulative therapy (CMT) than naturopaths and osteopaths.
WSCA Action:
The WSCA will run, for the second year, 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 over pay some provider types and under pay chiropractors for CMT. Why aren’t they following the national standards instead of paying others more than the formula and chiropractors less?
DC Action Needed:
MEET WITH YOUR LEGISLATORS AND EDUCATE THEM ON YOUR EDUCATION AND SCOPE OF PRACTICE. USE STUDIES TO SHOW YOUR EFFECTIVENESS. EXPLAIN HOW THIS LOW REIMBURSEMENT LIMITS YOUR ABILITY TO HIRE AND KEEP GOOD STAFF!
Statement of fact: Chiropractic prior authorization is limiting patient access to your care and creating an administrative burden on your practice while interrupting effective patient care!
WSCA Action:
In 2015 WSCA passed a bill regulating some parts of the prior- authorization process. That bill is now RCW 48.43.016. The WSCA intends to argue for expansion of that law to allow up to 12 visits per episode of care to a chiropractor or physical medicine provider (PT/OT/LAc/LMT) without asking for permission from an issuer (insurance company) or third party (benefits manager such as eviCore or ASH) for additional care.
DC Action Needed:
MEET WITH YOUR LEGISLATORS AND EDUCATE THEM ON YOUR EDUCATION AND SCOPE OF PRACTICE. USE STUDIES TO SHOW YOUR EFFECTIVENESS. EXPLAIN TO THEM THAT IF THE PATIENT IS PAYING FOR THE ENTIRE VISIT ANYWAY, HOW IS IT COSTING THE INSURER MONEY? EXPLAIN HOW THIS BURDEN EFFECTS YOUR SMALL BUSINESS OPERATION!
Statement of fact: Regence BlueShield and Premera Blue Cross both use eviCore as their physical medicine benefits manager causing terrible interruption to care and access to benefits.
WSCA Action:
WSCA’s Insurance Committee has been working with a lawyer in consideration of a possible class-action effort with other professions. We will be selecting providers to share with us some key authorization issues in the next several weeks to support moving a case forward.
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www.chirohealth.org
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