Letters to the Editor Crain’s New York Business 711 Third Ave. New York, NY 10017-4036 Re: Samantha Marshall: More chiropractic visits put strain on employers File: P - 1 Dear Editor; The article by Samantha Marshall, “More chiropractic visits put strain on employers,” carried in the November 10, 2003 issue of Crain’s New York Business, is factually wrong and is more worthy of the kind of tabloid journalism one might expect to find at grocery market checkout counters. Mashall squarely puts the onus for any pending increases in Workers’ Compensation premiums on increased utilization of chiropractic care. Although as an absolute number, chiropractic utilization may have increased over the last few years, in terms of cost, the total amount spent on chiropractic is still a mere fraction of a percent of the $4.27 billion employers paid in workers' compensation premiums of under the Workers’ Compensation system. If there is any increase in Workers’ Compensation premiums, it likely parallels the escalating costs of health care in general, none of which have been attributed to chiropractic care. As studies conducted by forecasting firms, Hewitt Associaties1, Kaiser Family Foundation2, the California Healthcare Foundation3, Price Waterhouse Coopers4 and others illustrate over the last four or five years, health care costs have spiraled upward reaching the double digit stratospheres reminiscent of the early 1990s. However, forecasters place the blame for most of the increases squarely on rising cost of hospitalization and drugs,5 not chiropractic. Ms. Marshall’s statement that, “Costs have begun to rise recently in New York, where blanket coverage of chiropractic care is relatively new” is factually wrong. While chiropractic care has been covered service under the Workers’ Compensation system since 1975, the coverage Marshall refers to is not “blanket” or “new.” In fact, in New York, chiropractors are probably the lowest paid of all providers in the entire Workers’ Compensation Reimbursement system. In contrast to other providers, under the Workers’ Compensation fee schedule, chiropractic rates are capped at a reimbursement level equivalent to fifty percent (50%) of ninety-five percent (95%), or roughly 47.5% overall of the rate paid to a general practitioner, and significantly lower than the rate paid to medical specialists, a situation that has prevailed in New York since 1975. In addition, pursuant to the Workers’ Compensation fee schedule chiropractors are not reimbursed at all for many treatments and procedures they are entitled to perform by law. In addition, any cases controverted by insurers and employers are sent to a Workers’ Compensation Practice Panel for adjudication, as they are for other classes of provider. Ms. Marshall’s contention that “a bill introduced into the Assembly this summer, which has a good chance of passing in the next legislative session, would allow chiropractors to expand their fee schedules,” misses the mark. Bills have been introduced for several years that have had as their intent making the reimbursement of chiropractors equitable with other providers in the Workers’ Compensation system. This is a question of equity and fairness, and given the fact that the Legislature has thus far been unmoved, Ms. Marshall’s intimation that this bill “has a good chance of passing in the next legislative session” and “would allow chiropractors to expand their fee schedules” smacks of an appeal to emotional sensationalism, and is not genuine, professional, journalistic reporting. Ms. Marshall also has her facts wrong concerning the impact of the 1997 chiropractic Insurance Equality Law (effective 1998). Marshall states that, “The 1997 Chiropractic Care Act mandated that injured workers eligible for workers' compensation could receive almost unlimited chiropractic care.” (underlining added). Had Ms. Marshall actually bothered to take the time to read the Insurance Equality Statute she would have discovered that the Insurance Equality Law was an equity statute designed to give patients the same access to and equivalent coverage for chiropractic care in health insurance plans as they would receive for medical care provided to physicians. The 1997 Insurance Equality Law had nothing to do with and had no impact whatsoever on Workers’ Compensation Law, Workers’ Comp carriers or plans or employers. To suggest that the 1997 Insurance Equality Law allowed “the New York workers' compensation system [to] create the perfect climate for excessive use of chiropractic services,” is patently false. It calls into question Ms. Marshall’s ability to be fair, objective and balanced in her reporting. Likewise, Marshall incorrectly states that “chiropractors successfully sued several major insurers two years ago for more equitable coverage.” Had Ms. Marshall actually done any sort of investigation she would have learned that the courts had dismissed the suit holding that chiropractors had “no private right of action” to assume the responsibility for enforcing a law that was completely within the ambit of the State Insurance Department. Finally, Marshall and Crain’s reference to Dr. Daniel Quatro, President of the New York State Chiropractic Association as “Mr. Quatro” is an insult. The Federal government and State governments nationwide extend the courtesy of referring to doctors of chiropractic as “Dr.” in recognition of their extensive educational attainment, which studies show, is on par with other health care providers, including physicians.6 This disrespect is antediluvian and reflects, perhaps, part of the “lingering effects” a federal court found when it held organized medicine guilty in 1987 of a “long-term,7 systematic,8 successful,9 and unlawful”10 attempt to “contain and eliminate”11 the “chiropractic profession”12 by any means, legal and unlawful. In 1987, the Federal Court concluded a permanent injunction against organized medicine was necessary because “[t]here are lingering effects of the conspiracy”; because organized medicine “never acknowledged the lawlessness of its past conduct . . . ”13; and because the 'lingering effects' [of organized medicine’s campaign] still threatened plaintiffs with current injury.”14 Unwittingly perhaps, Crain’s contributes to that legacy. Crain’s does its readers a disservice by communicating information in this article that is just plain factually wrong. This type of shoddy reporting leaves the impression that Crain’s plays fast and lose with the facts and that its attitude is decidedly cavalier, perhaps intentionally so. Crain’s would do well to make sure that its reporters and writers have a firm grasp of the facts before putting any article to press. If this sort of shoddy reporting and editing one can expect from Crain’s, it certainly does not reflect well upon Crain’s, its reporters, editors or its other publications. Sincerely, Karl C. Kranz, DC, Esq. Executive Director New York State Chiropractic Association 1. Hewitt Associates. “Health Care Costs Continue Double-Digit Pace, But May Start Moderating in 2004,” Lincolnshire, IL, October 13, 2003. 2. Kaiser Family Foundation and Health Reserach and Educational Trust. Employer Health Benefits, 2003 Summary of Findings, September 2003. 3. California Healthcare Foundation. Trends & Analysis: Insurance Markets – Health Benefit Costs: Employers Share the Pain, July 2003. 4. Price Waterhouse Coopers. The Factors Fueling Rising Health Care Costs. April 2002. 5. Ibid. 6. Cherkin DC, Mootz RD. Chiropractic in the United States: Training, Practice, and Research. Agency for Health Care Policy and Research (AHCPR), Department of Health and Human Services (DHHS), Publication No. 98-N002, December 1997. Grant number HS07915 AHCPR. 7. Wilk v. AMA, 671 F.Supp. 1465, 1488 (Dist. Ct. N.D. Ill. 1987) 8. Id. 9. Id. 10. Wilk v. AMA, 895 F.2d 352, 357 (7th Cir. 1990) 11. Wilk v. AMA, 671 F.Supp. 1465, 1473 (N.D. Ill. 1987) 12. Wilk v. AMA,895 F.2d 352 (7th Cir. 1990), cert denied, 496 U.S. 927, 110 S.Ct. 2621 (1990). 13. Wilk v. AMA, 671 F.Supp. 1465, 1488 (Dist. Ct. N.D. Ill. 1987). 14. Wilk v. AMA, 895 F.2d 352, 357 (7th Cir. 1990))
