The new medicare fee schedule and its effect on you

Article Abstract:

Medicare is the governmental program that provides health care payments for the elderly. Major changes in the way that Medicare reimburses health professionals for services go into effect in 1992. These changes will have important effects on chiropractic as well as the other health professions. Under the old guidelines, providers charged patients according to whatever fee schedule they used and Medicare paid the costs, with some limitations. This system led to a wide range of charges for the same service and an over valuation of high-technology and specialty services. The new guidelines set a basic fee for each Medicare service provided. The standardized fees are adjusted geographically. Presently, the only chiropractic service that Medicare pays for is spinal manipulation. This service was performed for Medicare patients 9.2 million times in 1989, representing a significant amount of Medicare funds. Although the government was receptive to using input from the American Chiropractic Association (ACA) in setting reimbursement fees for chiropractic procedures, the spinal manipulation procedure was recognized by Medicare as a single service with one fee. This procedure is complex and the range of services required to provide it can vary considerably. Of further significance to chiropractic is the fact that insurance companies and other third party payers may adopt this model of reimbursement. Talk of a national health care system using the Medicare model is also being heard. The ACA, with the support of much documentation, has submitted to the government a proposal to replace the single fee for spinal manipulation with a coding system that more accurately describes the variety of spinal manipulation services that chiropractors provide. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Medical care, Cost of, Health care costs

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An assessment of recent economic and policy developments affecting chiropractic

Article Abstract:

The author, an economist who specializes in health economics and finance, provided statistical evidence in the antitrust case of Wilk v. AMA (American Medical Association). The statistics revealed the economic impact of the AMA boycott of the chiropractic profession. The effects of this boycott are discussed. The growing recognition that most medical and surgical procedures and other therapies have never been properly evaluated has ignited the government's concern with technology assessment and outcome evaluation. The medical profession (as represented by the AMA) has traditionally nurtured the belief that its members were the only truly scientific health practitioners, but closer inspection reveals that their methods are often neither effective nor cost-effective. New federal programs encourage substantiated research that evaluates alternative treatments for numerous conditions, especially those which are expensive in terms of both heavy health care expenditures and lost productivity. The chiropractic profession must be committed to providing this quality of research, as the benefits of convincingly demonstrating the advantage of chiropractic over other health care services for various disease conditions will greatly benefit both the profession and health care consumers. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cases, American Medical Association

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Amending the Medicare Act to allow for the reimbursement of a greater range of chiropractic services

Article Abstract:

To acquire additional reimbursement benefits from Medicare for chiropractic services, legislation must be enacted to amend Medicare's definition of physician. Legislation has been drafted to amend the Social Security Act to authorize reimbursement to doctors of chiropractic (DCs) for physical and X-ray examinations, along with spinal adjustments. At the present time, Medicare limits reimbursement of chiropractors to 'spinal manipulations performed to treat subluxations shown to exist on X-ray'. Chiropractors are opposed to the requirement that an X-ray be taken before and after each treatment because of the radiation exposure to patients. They feel that federal requirements are trying to influence the chiropractor's diagnostic and treatment protocol, and are especially opposed to federal requirements that are not reimbursable. These requirements interfere with the practice of freedom of choice guaranteed in the Social Security Act under the 'Freedom by Patient Guaranteed' section by creating an economic barrier. A senator from South Dakota, Tom Daschle, is willing to introduce the proposed new legislation to Congress as a member of the Subcommittee on Medicare & Long-Term Care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health insurance

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