Dr. Wolfson, ACA NYS Metro Delegate addresses the NYS Chiropractic Board

Tarrytown, NY - “The NYS Board of Chiropractic and the Education Department are committed to the protection of the public and to the highest standards of professional services.” Cynthia Laks, Executive Secretary State Board of Chiropractic April 2004. On October 21, 2005, Dr H. William Wolfson, ACA NYS Metro Delegate addressed the Board regarding the abuses managed care companies have been perpetrating on the public and chiropractors in New York State. The American Chiropractic Association, the countries largest chiropractic organization has been taking managed care companies to task. The ACA has received numerous complaints from D.C.’s here and around the country about the abuses of managed care companies. The following is the text Dr. Wolfson read to the NYS Board. PRESENTATION TO THE NYSBC Mr. Chairman, Ms. Executive Secretary and Ladies and Gentleman of the Board, my name is Dr. H. William Wolfson. I have been a practicing doctor of chiropractic for the past 23 years and currently serve as the New York Metropolitan Delegate for the American Chiropractic Association. I am also President of the New York State Chiropractic Association, Suffolk County Chapter. I thank you for your time today and the opportunity to present what I believe are serious issues facing patients of chiropractors in New York State. Doctors of chiropractic in this state and doctors of chiropractic everywhere have an ethical obligation to practice in the best interest of their patients. I also realize this Board takes its responsibility to protect patients in this state very seriously. Permit me then to draw your attention to the activities of the ACN Group and other managed care companies. I request that this Board act and question the practices of this and other companies, as they directly affect patient care in this state. Over the course of the past several months, I have received repeated complaints and concerns from ACA and NYSCA members to the effect that ACN policies and procedures severely impact the doctors ability to provide quality patient care. I present to you the following: a letter of September 6, 2005 from the American Chiropractic Association to the New York State Department of Health outlining in specific terms the concerns and problems reported to the ACA in connection with ACN’s policies and practices. I would direct your specific attention to a copy of an August 3, 2005 letter sent to ACA’s General Counsel from the New York Chiropractic College. The College reviewed the criteria utilized by ACN in its administration of chiropractic services in New York. The startling conclusion of the College stated in part that “If NYCC were to use the ACN material above as a cornerstone for our educational process, we would need to significantly alter our curriculum, protocols, and practices and would expect to see a significant decline in positive patient outcomes”. Also included in ACA’s correspondence is a very detailed statistical analysis prepared by Dr. Jeffrey Simonoff-a professor of statistics at New York University. Dr. Simonoff, in commenting on his analysis, stated: “the [ACN] summary statistics certainly suggest that such [cost and visit-limiting controls] could be affecting practice by [in effect] truncating the number of visits from above.” In our opinion, Dr. Simonoff’s analysis supports the view that chiropractic services are artificially being reduced by ACN’s statistical maneuvering. Consequently, chiropractic benefits that have otherwise been promoted and paid for by employers-are being denied to the detriment of patient health and well being. I have personally spoken with case managers from ACN regarding patient treatment parameters and was told the average was less than seven visits per patient per year. It appears ACN has shifted the bell curve over time, consistently terminating those providers who don’t fall within their arbitrary statistics. As noted, my members have complained to the ACA, NYSCA and to my office stating that ACN has prevented patients from receiving needed chiropractic care by placing arbitrary numbers on allowed visits. My members have told me that they have written the same exact information on the required ACN forms for different patients and have received totally different authorizations for allowable visits. In my opinion and in the opinion of the ACA, utilization and treatment parameters as well as other criteria utilized by ACN are arbitrary, not based on the chiropractic principles taught by New York Chiropractic College and are not consistent with commonly accepted standards of care practiced in this State. Therefore, in our view, such parameters and criteria pose an improper interference with the doctor patient relationship and restrict necessary patient care. I would also like to submit for your consideration a letter of September 29, 2005 from the Federation of Chiropractic Licensing Boards to all Federation member boards. I would imagine that this Board may have already received this communication. But with your indulgence, I would like to make reference to several statements contained in the letter. In its letter, Dr. N. Edwin Weathersby writes on behalf of a unanimous Board of Directors, that managed care organization utilization criteria or payment policies “which interfere (or attempt to interfere) in a doctor’s ethical obligation to use sound chiropractic case management in the treatment of his or her patient, or otherwise seek to limit or to restrict the provision of needed chiropractic services, may constitute an inappropriate interference in the doctor patient relationship and pose a threat to safe, quality patient care.” The FCLB letter goes on to cite the previously mentioned conclusion of New York Chiropractic College and states: “If MCO guidelines require and/or restrict doctors to incorporate standards of care which are below those which are accepted in the profession and taught in our chiropractic colleges, then corrective actions should be undertaken”. Ladies and Gentleman of the Board and fellow colleagues, I would respectfully implore you to take that recommendation under consideration and continue to insure that the publics right to chiropractic care remains unimpeded. I urge the Board to assist the appropriate state regulatory authorities in protecting the publics right to access chiropractic care. I thank you for your time and thank you for continuing to protect the rights and best interests of chiropractic patients in the great State of New York.


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