Health Insights Today
By Daniel Redwood, DC
Among the important changes in the recently passed health reform law is Section 2706, which makes it illegal for insurance companies to discriminate against providers acting within the scope of their state licenses. Predictably, medical physicians who have benefited from many decades of discrimination now seek to turn back the clock and reinstate the pro-discrimination policies that have served them so well for so long.
Meeting in Chicago in mid-June (as reported in the “Contain and Eliminate” post below) , the House of Delegates of the American Medical Association (AMA) passed a resolution sponsored by the American Academy of Ophthalmology and the American Society of Anesthesiologists. This new AMA policy directs the organization to use its considerable firepower to overturn the provider nondiscrimination clause, citing its “troubling language” that upsets the “dynamic balance” under which insurers were free to discriminate against a long list of non-MD providers, including optometrists, chiropractors, podiatrists, nurse anesthetists, nurse midwives, psychologists, clinical social workers, acupuncturists, and other groups of licensed health practitioners.
If you have been wondering whether the nondiscrimination language in the health reform law packs real power, wonder no more. Just look at the seriousness with which the AMA is approaching it.
Toward a Level Playing Field
While the AMA and its specialty groups frame their pro-discrimination campaign in terms of protecting public health, saving taxpayer and patient dollars, helping the public avoid “massive confusion,” and supporting the highest possible standards of health care quality, the underlying motivation is transparently self-serving. Why, for example, are the ophthalmologists and anesthesiologists leading the charge? As noted by John Weeks on The Integrator Blog, ophthalmologists fear that a level playing field will weaken their competitive position vis-à-vis optometrists, while anesthesiologists have similar concerns about nurse anesthetists.
Let’s pause for a fact-check.
The Patient Protection and Affordable Care Act of 2010 in no way expands the scope of practice for optometrists, nurse anesthetists, chiropractors, or any other non-MD profession. Optometrists will not be performing eye surgeries; nurse anesthetists will not suddenly be permitted to determine the dosage of prescription medications. Chiropractors and acupuncturists will not be prescribing pain medications or performing back, neck or brain surgeries. Nor will clinical social workers be prescribing antidepressants.
But for those diagnostic and therapeutic procedures permitted these practitioners by state licensure laws, insurers will no longer be allowed to discriminate in favor of medical doctors simply because they are medical doctors. For example, the law specifically allows insurers to reimburse practitioners at higher rates when higher quality and performance have been demonstrated.
Check our Cost-Effectiveness of Chiropractic Page for more information about why this passage makes medicine nervous.
If this law is properly enforced, simply having the letters “M.D.” after one’s name will no longer qualify as a demonstration of high quality care.
This is the heart of the matter. This is the level playing field that the medical profession (along with pharmaceutical and device manufacturers) urgently wishes to avoid.
Comparative effectiveness research, along with rigorous evaluation of quality healthcare delivery, can make a major long-term difference. Both are significantly expanded by the health reform law. Chiropractors should welcome, not fear, fairly applied evaluations of quality and effectiveness.
An Opening for Chiropractic
Chiropractors have historically been among the groups discriminated against by private insurance companies and federal health plans. In the past (and in some cases, the present), this has often taken the form of spinal manipulation being covered only when performed by a medical or osteopathic physician.
More frequently in recent years, annual caps have been applied to chiropractic care but not to the same services when delivered by practitioners such as medical doctors and physical therapists. Today, perhaps the most insidious form of discrimination is tiered reimbursement, in which spinal manipulation delivered by chiropractors is reimbursed at rates significantly lower than the same service performed by other practitioners, who in many cases are far less qualified to deliver it.
This also applies in varying degrees to other services provided by chiropractors. Such unjust discrimination must end, and the nondiscrimination policy that is now the law of the land has the potential to end it.