|
TESTIMONY OF DR. REED PHILLIPS, PRESIDENT, LOS ANGELES CHIROPRACTIC COLLEGE, AND DR. GEORGE GOODMAN, PRESIDENT,
LOGAN CHIROPRACTIC COLLEGE ON
BEHALF OF THE
ASSOCIATION OF CHIROPRACTIC COLLEGES BEFORE
THE SUBCOMMITTEE ON HEALTH COMMITTEE ON VETERANS’ AFFAIRS U.S. HOUSE OF REPRESENTATIVES TUESDAY,
OCTOBER 3, 2000
MR. CHAIRMAN, REPRESENTATIVE GUTIERREZ, MEMBERS OF THE
SUBCOMMITTEE, on behalf of the Association of Chiropractic Colleges
(ACC) we thank you for calling this hearing to discuss, among other
things, our proposal for
establishing direct
access, ‘full scope of practice’ chiropractic health care services
for our Nation’s veterans through the Department of Veterans Affairs
(DVA). Your leadership
last year to include a directive in the Veterans’ Millennium Health
Care Act (Public Law 106-117 ) for the DVA to establish a chiropractic
health care policy, further demonstrates your commitment and the
Committee’s commitment to chiropractic health care for veterans.
We also thank you and the Members of the full Committee on
Veterans’ Affairs for your strong support over the years for
chiropractic health care generally, and for our profession in
particular.
MR. CHAIRMAN, this Subcommittee, perhaps more so than any other
panel in the entire Congress, faces the humbling challenge of
authorizing vital health care programs for our Nation’s veterans and
making sure that they have access to the same high quality care that
most Americans already enjoy. By
any measure, this Subcommittee has met this challenge and done so in a
way that was fair to our veterans and to the taxpayers who support
veterans programs.
MR. CHAIRMAN, the chiropractic health care profession is seeking the same health care ‘opportunity’ for our
veterans that is available in the private sector; all fifty States;
and soon, within the
Department of Defense. More
specifically, we want our Nation’s veterans to have the same direct
access, ‘full scope of practice’ chiropractic health care that is
authorized under State law, and available to the millions of
Americans who utilize chiropractic care every year to address a
whole host of neuromusculoskeletal and related health care problems.
According to data from the NIH Consortial Center for
Chiropractic Research, a center located at Palmer College of
Chiropractic and established under the auspices of the National Center
for Complementary and Alternative Medicine, chiropractic is used by
approximately ten percent of the population annually, representing
about 192 million patient visits per year.
We want our Nation’s veterans to have direct access to this
fastest growing segment of the so-called complementary and alternative
medicine practice in the United States. Furthermore,
the legislative proposal that we have prepared and which was addressed
briefly in your September 13th full Committee markup on
H.R. 5109, is modeled after the chiropractic health care development
plan that was contained in Section 737 of the National Defense
Authorization bill for fiscal year 2001—a plan that passed the full
House and which we believe will be approved in conference. Here
is what the major chiropractic health care profession organizations
are proposing to be included in the next available veterans health
care bill. Our
legislative proposal for chiropractic in the DVA is modeled after the
well-vetted, well-crafted provision that was approved by the House
Armed Services Committee and by the full House as part of the fiscal
year 2001 National Defense Authorization bill, H.R. 4205.
More specifically, our proposal calls for the development of a
plan by the Secretary of Veterans Affairs to provide chiropractic
health care services as permanent
part of the DVA health care system, beginning at the end of calendar
year 2001. Our proposal would require that the plan include two critical
components that have also been addressed in the DoD chiropractic plan
proposal: direct access to chiropractic care, without requirement
for a medical doctor gatekeeper; and full scope of practice of
chiropractic health care services to our veterans.
The plan would also call for an examination of projected costs
of fully integrating chiropractic into the DVA health care system and
a review of facilities; in-house v.s. ‘contract’
doctors of chiropractic; and the personnel structure required
to effectively carry out this new health care program within the DVA. Our
plan also calls for making the appropriate statutory changes to
address the issue of pay for chiropractors who become employees of the
DVA and calls for the establishment of an advisory oversight
committee, analogous to the one utilized by the Department of Defense,
to ensure that the Secretary has the requisite outside assistance with
which to fully comply with the statutory guidelines and carry out the
proposed plan for integrating chiropractic into the DVA. Again,
this proposal mirrors the proposal that was marked up in the Senate
Armed Services Committee and approved by the full House of
Representatives this year, and in our view, is the most effective way
to allow the Department to phase in the development and implementation
of a direct access, full scope of practice chiropractic health care
benefit for our Nation’s veterans. In
short, MR. CHAIRMAN, we believe that our proposal is good health care
policy for our veterans, as the House obviously felt it was for our
active duty military personnel, and we believe that it will make a
significant contribution to improving the health and well-being of our
Nation’s veterans who deserve the very best.
MR. CHAIRMAN, we wish that the Department of Veterans Affairs
and the Department of Defense were in full agreement with us on both
the need and the methodology for implementing a new, comprehensive
chiropractic health care benefit in the two Departments.
Unfortunately, new health
care policy changes for
our veterans and our armed forces are often met with resistance by the
bureaucrats and proponents of the status quo in those Departments.
Therefore, let me attempt to briefly outline why the ACC is
offering its unqualified support
to the joint ACA-ICA-ACC legislative proposal for direct access, full
scope of practice chiropractic care for our veterans and why we firmly
believe that it constitutes a good health care policy change for the
country.
First, and perhaps of paramount importance, chiropractic health
care has been shown to be efficacious in addressing the $40-50 billion
per year back pain problem that confronts the Nation, and, with the
support of the Congress and Executive Branch health care agencies, has
moved into the so-called ‘mainstream’ of the health care arena.
Doctors of Chiropractic are the product of one of the most rigorous
academic, medical, and
clinical education and training formats in the entire health care
arena and their success with their patients is impressive. Each of the 19 chiropractic training institutions in North
America are accredited by the Council on Chiropractic Education, an
agency certified by the U.S. Department of Education since 1974.
Most importantly, each college requires at least three years of
intense undergraduate medical training and education, plus an
additional four years at an accredited college of chiropractic, before
students can qualify for licensure examinations conducted by the
National Board of Chiropractic Examiners. Chiropractic is licensed in
all 50 states in the U.S. and has been established in 70 other
countries around the world. Your
own Committee, in last year’s Committee Report on the Veterans’
Millennium Health Care Act (H. Rept. 106-237; pp. 54-55) cited a 1997 Agency for Health Care Policy Research study that
said: “There is as much or more evidence for the effectiveness of
spinal manipulation as for other non-surgical treatments for back
pain”, and a New England Journal of Medicine report that the effectiveness
of spinal manipulation for certain types of acute pain maladies is no
longer in dispute. Your
report goes on to cite studies indicating that ‘patient satisfaction
in the relief of low back pain is as great or greater with
chiropractic than with other approaches, even when volunteer patients
are randomly assigned to a treatment approach.’ Finally, the
Committee report laments that, despite the positive results of
research on chiropractic, the Department of Veterans Affairs has made
only the most limited use of chiropractic care.
MR. CHAIRMAN, we could spend this entire hearing going over the
myriad of research studies, randomized
clinical trials, and analyses that have been carried out on the
effectiveness of chiropractic over the past century.
For example, the
results of the largest randomized clinical trial ever conducted on
chiropractic, confirmed, among other things, that ‘when chiropractic
or hospital therapists treat patients with low back pain as they would
in day to day practice, those treated by chiropractic derive more
benefit and long term satisfaction than those treated by hospitals’
(T.W. Meade, Director, Medical Research Council Epidemiology and
Medical Care Unit, Wolfson Institute of preventive Medicine, medical
College of St. Bartholomew’s Hospital, London, England, 1995).
But I hope that we can all agree that the age-long debate over the
efficacy of chiropractic is over; that it is universally accepted as
‘mainstream’ health care for our citizens; and that
it should be available to our Nation’s veterans through the
Department of Veterans Affairs as it is to the rest of us outside of
the DVA.
In this regard, MR. CHAIRMAN, the second compelling reason why
our proposed chiropractic health care policy plan should be approved
and included in the next available veterans health care bill, is based
on the overwhelming success of the recently completed Department of
Defense Chiropractic Health Care Demonstration Project.
After a five-year pilot program at thirteen military health
care facilities across the country and in the Washington, D.C.
metropolitan area, the
Department of Defense reported its findings to the Congress—findings
that, by DoD’s own admission, were overwhelmingly positive.
The DoD reported that the problem of spinal maladies among our
Armed Forces was major and that the military health care system was
not adequately addressing this health care problem.
The Department concluded that military personnel who used
chiropractic care for the treatment of lower back pain experienced
superior outcomes in every one of five different measures of health status,
compared to patients who received care from so-called traditional
medical providers. MR.
CHAIRMAN, I have prepared a chart for the consideration of the
Subcommittee, that reflects the patient outcomes results of the
Chiropractic Health Care Demonstration Program.
(Chart A). Furthermore,
a higher proportion of chiropractic patients in the military reported
that they felt better, had less pain, and had fewer
restrictions/physical limitations than patients receiving traditional
medical care, and reported fewer days away from work or on restricted
duty due to their condition. Chart B reflects workdays saved as a
result of chiropractic care being provided to our military men and
women during the CHCDP. The
report went on to quantify that chiropractic patients were more
satisfied with their care than patients who received traditional
medical treatments and a higher proportion of patients seen by Doctors
of Chiropractic reported greater satisfaction with their improvement and
their providers, than patients treated by traditional medical
providers. Chart C
reflects patient satisfaction results of the CHCDP and has been
prepared for your review and consideration. And
finally, the DoD’s own report, acknowledged that integrating
chiropractic care into the military health care system will result in
improved access to health care services for military personnel and
will lead to the recovery of between 111,000 and 331,000 additional
duty days per year.
In short, MR. CHAIRMAN, the Department of Defense, in perhaps
the most comprehensive demonstration of chiropractic health care
services in the history of the country, found that chiropractic
improved patient outcomes; had overwhelming patient satisfaction; and
improved readiness among those men and women of the Armed Forces who
sought the care of a Doctor of Chiropractic.
By any measure, the DoD Chiropractic Health Care Demonstration
Program proved beyond any doubt that chiropractic works for our
military and we believe it will work equally well for our Nation’s
veterans who are eligible for DVA health care benefits.
The plan that we are proposing takes the lessons learned from
the comprehensive DoD chiropractic
health care demonstration program and the legislative response
contained in Section 737 of H.R. 4205 as passed the House, and
provides the Committee with a proven ‘model’ that should be used
to begin the process of integrating a comprehensive, direct access,
full scope of practice chiropractic health care benefit into the DVA
health care system. It
worked for DoD and it will work for the DVA.
Finally, MR. CHAIRMAN, the reason that we are actively seeking
your support for our proposal is because of the inadequate response of
the Department of Veterans Affairs to your legislative directive
contained in Section 303 of the Veterans’ Millennium Health Care
Act. Although
technically, the Department did respond in accordance to the
instructions contained in Section 303, their proposed policy was
woefully inadequate in several key respects.
First, aside from one meeting in February with representatives
of the chiropractic organizations, there was no other substantive
input sought by the DVA from our organization or any of the other
groups that are testifying before you today.
Language contained in House Report 106-237 made it crystal
clear that the VA should consult with Doctors of Chiropractic to
assist the VHA in the development and implementation of its
chiropractic treatment policy’.
Again, after February 24th, there was essentially no
role whatsoever played by any of our organizations or our Members in
the development or implementation of the flawed DVA policy presented
to the Congress on May 5, 2000.
Second, the clear message in your Committee report accompanying
the Veterans’ Millennium Health Care Act was that chiropractic was
efficacious and the time had come to develop a comprehensive
chiropractic health care/treatment policy for our veterans that was
different and better than the inadequate existing policy at the DVA.
Unfortunately, the DVA spent the first half of its written
policy document debating the efficacy of chiropractic rather than
proposing a real, substantive policy that would enhance—not
retract—chiropractic health care treatment for our Nation’s
veterans whom are eligible for VA health care.
Third, the proposed policy itself completely ignores the
prospect of a direct access chiropractic health care benefit that is
available elsewhere in health care plans and merely dusts off it’s
existing ‘referral only’ approach to providing medical gatekeepers
to screen whether or not a veteran should have the opportunity to see
a Doctor of Chiropractic. In
a health care setting where chiropractic health care services lay
dormant and where DVA health care providers are biased against
chiropractic, a gatekeeper/ referral system would effectively shut
most veterans out from obtaining this valuable health care treatment
at DVA facilities or anywhere else.
Fourth, the Committee clearly stated that it wanted the DVA to
give great weight to a policy that would provide greater access to
chiropractic care in rural and medically underserved areas.
Nothing that we can find in the May 5, 2000 DVA policy document
addresses providing access to chiropractic care for veterans residing
in rural or medically underserved areas.
Our legislative proposal will address the role of Doctors of
Chiropractic in rural and medically under-served areas.
Finally, the flawed DVA policy clearly makes chiropractic
health care available at the discretion of individual DVA medical
doctors and significantly limits the scope of practice for Doctors of
Chiropractic whom would be providing services to our veterans.
Again, we believe that a full scope of practice as authorized
under State law, should be the minimum criteria utilized in providing
chiropractic health care to our veterans at DVA facilities.
We also believe that the clear intent of the Committee on
Veterans Affairs and ultimately the House-Senate conferees was that
the policy of providing chiropractic health care services to veterans
was to be ‘mandatory’ and not
subject to the individual whim or discretion of existing DVA
doctors who largely oppose chiropractic in the DVA.
For these reasons, MR. CHAIRMAN, we would hope that the
Subcommittee would revisit our proposal for the development and
implementation of a chiropractic health care plan as one of the first
agenda items for the Committee next year.
Chiropractic care is good for our active duty forces in the
military and it is good for our Nation’s veterans who deserve the
very best in health care services.
Chiropractic is effective and should be available to our
veterans as it is to most every other American.
We hope that you concur and will support our reasoned approach
to providing quality chiropractic health care services to our
Nation’s veterans, beginning in the 107th Congress. Back to Witness List |