In the ongoing professional debate about the CCGPP Best Practice Initiative CCGPP Executive Committee, presented the fallowing views. The opinions of CCGPP do not reflect the views of New York State Chiropractic Association and are solely presented here for informational purpose. The following observations are submitted to challenge those who believe the CCGPP Best Practice Initiative will limit chiropractic care. We have a differing opinion. Please consider the following: Observation…Chronic care: The CCGPP Best Practice low back draft recommends treatment beyond every guideline in existence today. Given that reality, how could this document be used to limit chiropractic? This is the ONLY document we’ve seen supporting chiropractic treatment of chronic conditions. (see pages 5-19) Show us any others. Observation…Literature ratings: "B" and "C" ratings in the scientific community are not all bad, in fact, with nearly every category of low back condition, no treatments are rated higher than spinal manipulation. (see pages 27-30) Therefore how could this document be used to limit care? “B” and “C” are the equivalent of hitting a triple (using a baseball analogy) in the world of science. There are few home runs in the scientific literature, but manipulation for acute, subacute, and chronic care are rated at the highest levels in the CCGPP Best Practice document, thus improving our chances of expanding benefits. (see pages 27-30) Observation…Passive Modalities: Given that the insurance industry is fully aware of the low rating on passive modalities present in every guideline with which we are aware (ODG, ACOEM, AHCPR, Milliman and Robertson, etc.), what proof do the critics have that this will lead to a 30-40% reduction in income? This issue represents fear mongering at the lowest levels. Observation…X-ray: Given that the CCGPP x-ray recommendations have set the bar as low as "pain and/or limitation of motion" (see page 69), how could this document be used against us, unless you are one of the 1.9% of the DC population who believes in x-raying every patient no matter how uncomplicated the case? Again, why would this lead to a 30-40% drop income? Is there any proof? Answer: NO. Observation…Website as a Resource: Consider the incredible potential every DC will have by having access to reams of data supporting care at the click of a mouse using the website. We also will have the ability to share that information with those who would deny care using a cookbook guideline like ODG, Milliman and Robertson, and ACOEM. Observation…Best Practice vs. Guidelines: The Best Practice Initiative represents an important shift from cookbook guidelines to the "process of care", educating the payors that medical necessity must be based upon clinical decision-making, patient values, risk factors, and documentation, i.e., the uniqueness of each case, versus a guideline cookbook. Encouraging the “process of care” may be the main benefit of CCGPP’s Best Practice Initiative. Observation…Pragmatic viewpoint: To summarize, if the treatment recommendations for the core of what we do, manipulation and active care, expand from acute and subacute into the chronic pain patient population, and the x-ray and PT recommendations are basically no different from what we've been living with for the past 10 years, what is the real problem with this document? This document increases the support for chiropractic management of acute to chronic care in the third party reimbursement world. This document will enhance patient care. (again, please read pages 5-19, What Constitutes Evidence for Best Practice?”