Sep 24, 2002 4 min read

WASHINGTON (AP) – After years of being treated as second-class providers in the medical profession, chiropractors are lobbying hard to shape the Department of Veterans Affairs’ new coverage of chiropractic treatment in hopes of winning broader access to patients nationally. The effort will determine what services chiropractors will provide to the 70 million Americans – veterans and their relatives – eligible for VA care and whether veterans will be permitted to seek chiropractic treatment without having to get a medical doctor’s permission first.

Many chiropractors also want the right to coordinate patients’ care. That idea has earned a powerful opponent – the main doctors’ lobby, which argues that coordinating patients’ health care should remain with physicians and not with chiropractors, who do not attend medical school.

Health insurers are also watching. All sides are aware of the high stakes.

“What happens in the VA will set the tone for all future involvement with chiropractic in the federal government,” said Terry Rondberg, a chiropractor and president of the World Chiropractic Alliance.

The intensity of the lobbying has been affected by disagreement among chiropractic groups.

The American Chiropractic Association wants chiropractors to be able to serve as primary care providers, diagnosing illness. In addition, the association wants chiropractic treatment to focus beyond the spine to muscles, bones and nerves.

The World Chiropractic Alliance argues chiropractors should focus on their specialty – the spine and nervous system – rather than mirroring the work of physicians. The alliance wants the VA to let patients see chiropractors for preventive care in addition to existing problems.

Both groups are pushing for the common goal of expanded access to patients – without physicians as gatekeepers.

To make their pitch, chiropractors jockeyed hard to win spots on the 11-member VA advisory committee shaping the policy. The panel includes seven chiropractors, two medical doctors, one physical therapist and one osteopath.

Whether the panel reaches consensus or not, it’s a chance for people to get their views on the table, said Sara McVicker, clinical program manager at Veterans Affairs and manager of the advisory committee. “There are some very clear divisions of opinion,” McVicker said. “There may not be as many divisions of opinion as they think. You never know, until they start talking to each other.”

Chiropractors also have pressed Congress, sending letters and making personal visits to Capitol Hill. One of the chiropractor lobby groups even offered free spinal screenings to lawmakers.

The American Medical Association, the main doctor’s lobby, is pushing back with its own political clout. It wants to keep chiropractors from winning a “massive expansion of their scope of practice in order to be declared primary care physicians,” said Dr. Richard Corlin, a physician and former association president.

“The bottom line is you don’t get to be a primary care physician by the action of a committee,” Corlin said. “You get it by going to medical school.”

The AMA is much larger and better financed than the chiropractic lobbies. It spent about $7.3 million on lobbying last year, compared with about $60,000 by the American Chiropractic Association and $15,000 for the World Chiropractic Alliance.

The AMA also dwarfs chiropractic groups in campaign contributions. It and its members gave more than $1.1 million in the 2000 election, compared with about $140,000 from the American Chiropractic Association and its members.

Insurers are also keeping a watchful eye on the VA debate for its implications to their coverage.

A spokesman for Kaiser Permanente, the giant not-for-profit health maintenance organization, said it’s too soon to gauge the impact of the VA’s decisions. “But obviously, given the size and scope of someone like the VA or Medicare, if they were to change their practices obviously people would have to look at that,” Matthew Schiffgens said.

Until recently, the only federal program that chiropractors were allowed to participate in was Medicare. The Defense Department is now adding chiropractors to its health system.

Each advance in government coverage helps chiropractors make their case to the larger audience of patients.

“When we got into Medicare, we tried to tell everybody we could afford to tell that now we were in a major government program,” the American Chiropractic Association’s Jerome McAndrews said. “This is a sign of further establishment of our services to the country.”

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On the Net:

Department of Veterans Affairs: http://www.va.gov/

American Chiropractic Association: http://www.amerchiro.org/

World Chiropractic Alliance: http://www.worldchiropracticalliance.org/