Board of Directors
Minutes
The meeting was called to
order at
Motion: Moved by McMahon,
seconded by Baker to approve the minutes of the
Applicants seeking regular membership:
Stacy
M. Bula, DC Antigo
Mark
E. Erb, DC Menomonie
Warren
Silbaugh, DC
Angela
Tenniswood, DC
Steven
Tenniswood, DC
Applicants seeking student membership:
Todd J. Bauer Palmer
Angela K. Hall Northwestern
Joseph W. Ryan Palmer
Motion carried.
Motion: Moved by McMahon,
seconded by Baker to approve the following:
Members seeking change in status
James L. Greenwald, DC From
retired to resignation
Motion carried.
Five: Moved by McMahon,
seconded by Henrichs to approve the following:
Financial Report
The board requested staff to review
the potential for re-offering the vaccine program.
The Fall Convention was
previewed with the centerpiece being the opportunity for chiropractors to earn
up to 24 hours of continuing education. Dr. Rakowski will conduct a nutrition
seminar on Thursday and Friday, Dr. Lipton a program on the Science of Innate
Intelligence on Friday and Saturday, and Dr. Curl a rehab program Saturday and
Sunday. In addition the WCA will have the potential to provide CPR
certification for up to 300 doctors as part of their program.
The board reviewed a proposal
from the Foot & Spine Research Institute regarding their educational
offerings. This was referred to staff for research and recommendations.
Government Affairs:
A detailed review of the
physical therapy bill was conducted focusing on the following points.
To our knowledge, this is the
first bill in the
The bill states:
A
physical therapist may not claim that any manipulation service that he or she
provides is in any manner a chiropractic adjustment that is employed to
correct a spinal subluxation.
This language is something
that the profession has wanted for a very long time. Those physical therapists
that want to tell their patients that their manipulations are the same as an
adjustment will no longer be allowed to do so. The words “in any manner” are
important because it covers all types of communication – with no exceptions. If
this bill does not pass, chiropractors will lose this important protection
Other protections in this
bill
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The physical
therapists were seeking the right to direct access for all patients. We
defeated this attempt. The referral laws are still in place.
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The physical
therapists were seeking the potential to use x-rays in their practices. We
defeated this attempt. Without this very important diagnostic tool, it
reinforces the limited nature of a physical therapist’s work.
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The physical
therapists were seeking the use of the term “diagnosis” in a manner that was
equivalent to the term “differential diagnosis”. We defeated this attempt. The
use of the term “diagnosis” has been strictly limited to their training and
education as a physical therapist. We added specific language that so that the
definition does not include “the making of a chiropractic or medical
diagnosis”.
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The physical
therapists wanted to retain current law that prohibits doctors from advertising
that they provide physical therapy services unless they advertised physical
therapy before 1995. This currently impacts hundreds of chiropractors and would
have eventually shut out the entire profession. We saved this important right
that can have a significant economic impact on the profession. All
chiropractors, without limitation, will be able to advertise that they provide
modality based physical therapy services.
Physical therapists have been
manipulating patients for more than 30 years. This bill does not give them a
right they did not already have.
Contrary to what some people
have been told, the state statutes only provide general guidelines as to a
profession’s scope of practice. One of the primary functions of each examining
board is to interpret the training and education of their providers to
see if it fits into their general scope of practice.
Physical therapists receive a
broad range of training in manipulation. It is part of their core education and
training. It is the height of arrogance to assume that the chiropractic
profession can tell another health care profession that they must discontinue
providing a service for which they are licensed, trained, and reimbursed.
The federal government,
through the CPT process, is the 800 pound gorilla that ultimately determines
the services for which a provider group is reimbursed. Physical therapists are
reimbursed for CPT code 97140, which includes manipulation, millions of
times each year.
Chiropractors adjust
patients, we do not manipulate.
Imagine a circle. Now cover
that circle with a much bigger circle. The small circle represents a
manipulation. The circle that covers it represents the much more encompassing
work of an adjustment. The adjustment represents our underlying philosophy, our
comprehensive diagnosis and on-going assessment of the patient’s condition, and
our well defined adjusting techniques.
The ACA made a mistake by
settling for the nomenclature of
“Chiropractic Manipulative Treatment” instead of “Chiropractic Adjustment
Treatment”. Just because the ACA made a strategic mistake in the naming of our
codes, does not mean that suddenly 100+ years of our history have evaporated.
While other health care professions touch a patient’s body with their hands for
the purpose of moving tissue, muscle, and or bone (manipulation), the
adjustment a chiropractor provides is unique because of its comprehensiveness.
The ACA lawsuit against the
physical therapists.
Under federal law only
chiropractors may provides manipulation services to treat spinal
subluxations. The physical therapists claimed that since they have a right
to be reimbursed for manipulative
services, this should include manipulations for spinal subluxations. The ACA
disagreed and sued the physical therapists. The WCA supported this lawsuit
financially.
CMS recently ruled in the
chiropractic profession’s favor – but the ruling was limited. We have won a big
victory in Medicare which ruled that services to treat a spinal subluxation
must be provided by a chiropractor. This did not put the physical therapists
out of business. While they lost the right to reimbursement for spinal
manipulations, they are still being reimbursed by Medicare each year for the millions and millions of other
manipulation services they provide to their patients.
Insurance Bill
The insurance bill was
reviewed with emphasis on the importance that the disclosures requirements for
IRO were retained. Without these disclosure requirements patients would not
have been informed of their right to seek an independent review. Should this
have occurred it would have gutted the intent of the bill and greatly reduced
its effectiveness.
It was also announced that the Office of the
Commissioner of Insurance (OCI) has certified the first two companies that have
qualified to conduct external appeals from patients. The two companies are
Permedion of Westerville, Ohio, and Medical Review Institute of America of
The process will be available beginning
Unfortunately, external review is not
available to patients whose employer is self insured unless the employer makes
the process available to their employees on a voluntary basis.
Past issues of the Wisconsin Chiropractor has described the IRO process, in detail,
along with the rules for the independent review organizations. The complete IRO
application process will be taught as part of the new Paying for Chiropractic Care Program).
Emergency Health Powers Act
In the discussion of the Emergency Health
Powers Act it was noted that the bill retains an individual’s right to reject
required vaccinations for reasons of religion or conscience. To insure that
those that object are treated fairly the WCA will investigate the quarantine
provisions and inform our members of the potential for legislative action.
Internet Education
Sherry ‘
Philosophy Credit for CE
Sherry Walker, DC also
presented a summary of the public hearing that discussed the potential of
offering CE for philosophy courses. Dr. Walker presented the following as the
WCA’s position on this issue:
Philosophy is one of the
cornerstones of a chiropractor’s education. In fact, it is the philosophy of
chiropractic that serves as a bedrock principle for our clinical approach to a
patient – to look beyond the symptomotology of a patient to find and treat the
cause of a patient’s problem. Our philosophy has allowed us to develop a true
doctor-patient relationship where we can focus on helping patients improve the
quality of their life and health.
However, the intent of the
legislature in requiring continuing education is to provide for the ongoing
improvement in the clinical skills of a chiropractor. Based on the current
literature, it is not possible to document the many positive clinical benefits
of applied chiropractic philosophy in the clinical setting. As further research
occurs, we expect these benefits will be validated as a clinical skill.
The examining board was also
presented with a number of examples in which the so called philosophy seminars
were nothing more than disguised personal opinion programs designed to sell a
product service, or business strategy.
Since philosophy cannot be
directly related to improving a chiropractor’s clinical skills at this time, the board requests that
the examining board withdraw this rule.
Since the examining board
indicated that it is inclined to move ahead with this rule, the board approved
the following motion.
Motion Six: Moved by Varish,
seconded by McMahon to request that the staff write to the chiropractic
examining board and state that the WCA will use all possible legislative means
to defeat the proposal to allow continuing education hours for philosophy
courses. Motion carried unanimously.
Member Suggestions
The board discussed several
suggestions it received from its members. Based on these suggestions,
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The WCA will,
once again, strongly encourage its members to contribute their time to grass
roots campaign activity and will coordinate the interest of members with
various campaigns.
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The WCA will
continue to review the agenda of the National Chiropractic Legislative
Conference to determine if the agenda warrants sending representatives to
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The WCA is
considering the most effective way to impact the WIAAs decision to require
physicals by physicians only. The WCA is currently conducting “listening
sessions” based on the “Future of Chiropractic” article that appeared in the
January edition of the Wisconsin
Chiropractor.
WI Data Base Requirements
The staff briefed the board
on a member complaint that dealt with an insurance company’s perceived failure
to update their data base as required under
The content of Dr. Wilk’s discussion with
a number of WCA board members was discussed. The following is a summary of his
ideas/proposal:
The Alliance of State Chiropractic
Spokespersons (ASCS) has been formed to bring together the "best of the
best," handpicked from every state, with its prime mission being to
contact virtually every radio station, TV station, newspaper and legislator in
America to effectively communicate the chiropractic message. The book that will
guide this process is Dr. Wilk’s text Medicine, Monopolies, and Malice
(MMM)..
By consensus, the board had
no inclination to support this proposal. The board reiterated that:
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The President and
Executive Director serve as the official spokespersons for the WCA and their
work is supplemented by the board of directors.
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The WCA does not
endorse organizations or products.
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While the WCA has
great respect for the work of Dr. Wilk and believes he deserve s the admiration
of the profession, his book represents a strategy of confrontation with the
medical profession at a time when the WCA believes it is in the best interests
of our members to promote interdisciplinary cooperation while maintaining the
uniqueness of chiropractic.
Attorney Generals Opinion on
Point of Service
The board was given a copy of
the opinion of the Attorney General requested by the insurance commissioner
that confirmed that the point of service requirements required under Wi Stat. 609.10
do not apply to self insured employers. The WCA had already disseminated that
information to our members.
Insurance Review of 97140
The board was briefed that
CMS has announced changes in its national coding initiative that will allow
chiropractors to use the 97140 code on the same day as a CMT code. When the CMS
decision is announced the WCA will provides its members with full details on
its correct use. Most important will be that the procedure has an expected use
time of 15 minutes which is far less than the average chiropractor performs the
procedure.
CranioSacral Therapy
The board held a clinical
discussion on their current knowledge of the use of CranioSacral Therapy among
a broad range of health care profession. In view of the fact that not a great
deal is known about this therapy the staff was requested to gather information
for a more complete discussion at the next board meeting.
Accident Marketing
The WCA receives a number of
complaints about what is perceived to be unethical marketing of chiropractic
services to accident victims. The board was shown a current example of this
type of marketing. The board did not take action because unless the
chiropractor is breaking a law the first amendment protects their right to
publish any form of advertising – even that which is offensive to the
profession.
The meeting was adjourned at
approximately