Governor Jay Inslee has signed into law the Chiropractic Fair Pay Bill ESB 5518, the Prior Authorization Bill ESSB 6157 and HB 2313 which gives the Chiropractic Quality Assurance Commission greater authority and independence in its budget and operational activities. Thanks to the skillful hard work and dedication of our lobbyist, Lori Grassi, the unwavering commitment and testimony of Dr. Austin McMillan, and others who took time from their practices and families to attend Legislative Day – including additional trips to Olympia to work this legislation through the process – we were able to prevail over 12 highly paid health insurance company lobbyists.

The Fair Pay Bill ESB 5518 ensures that chiropractors are paid no less than 90% of what osteopaths and naturopaths are paid for spinal manipulation services. Currently, they are paid up to 2 times, or 100% more, for the same services. A 10% variation in reimbursement between the chiropractic and osteopathic codes is due to the Resource Based Relative Value Scale (RBRVS) methodology. This methodology, which is used by Medicare, establishes fair fees for services and procedures on an annual basis and allows the 10% variation in pay for the difference in the facility overhead and malpractice insurance costs between the provider types. This calculation is known as the Relative Value Unit, or RVU. The initial Fair Pay Bill, passed by the WSCA nearly 10 years ago required that insurers pay chiropractors the same for Evaluation and Management and Physical Medicine/Rehabilitation services as paid to other medical providers. Following its passage, reimbursement to chiropractors for these services increased by up to 100% (doubled). When we passed the initial Fair Pay Bill we were not able to include spinal manipulation because the chiropractic and osteopathic spinal manipulation codes are different, even though the first three codes of both are substantially similar in their service descriptions. In the case of E&M and Rehab, all providers use the exact same codes.

After many years of persistence in educating legislators and building relationships (grass roots politics) we finally got a strong majority to see the disparity and unfairness in our reimbursement for spinal manipulation. In addition, we were able to prove that we have not had a fee increase for our core service (spinal manipulation) in 15 years and that our provider contracts are take-it-or-leave-it: there is no opportunity for negotiation! ESSB 5518 takes effect January 1, 2019.

The obvious question: How will the insurers respond to the Fair Pay Bill come January 1, 2019? We don’t know! They could reduce the osteopaths and naturopaths to what they pay us, they could increase us to what they pay them, they could move us both towards the middle (all within the 10% variation) or they could use the RBRVS formula which factors in the variation and is federally recognized by CMS/Medicare. Legislators were moved by the disparity in pay and no cost of living increase in 15 years. I would suggest there was legislative intent behind the passage of ESSB 5518 and I would hope the insurers respond in good faith. We’ll just have to see!

The Prior Authorization Bill ESSB 6157 allows for up to 6 consecutive visits within an episode of care before prior authorization can be required. If the patient has not received treatment for the same or similar condition for a period of 90 days or longer it is, by definition, a new episode of care. Initially we had legislative support for 12 visits prior to requiring authorization for additional care but to move the bill out of the Senate and keep it alive we ultimately had to accept 6 visits. Those 12 health insurance lobbyists fought us aggressively every inch of the way. This legislation improves on our current situation but is still not a resolution that satisfies most of us. It’s an incremental process that never ends, I’ve come to learn and accept that challenge over 44 years of practice and political/legislative involvement nearly that long. ESSB 6157 takes effect June 6, 2018 (this year).

HB 2313 is the bill that allows our regulatory commission, the Chiropractic Quality Assurance Commission, to manage our licensing funds efficiently and independent of the Department of Health. It also allows the Commission to manage its staff and be more responsive to the needs of the public and the profession.

These are historic achievements for the Washington State Chiropractic Association, the Washington State Chiropractic Trust and chiropractic as a whole. To our knowledge, no other state in the USA has passed Fair Pay or Prior Authorization legislation of this nature. However, it’s important to remember that it takes persistence over years to educate 98 House members and 49 Senators.

As you can imagine, we have expended enormous political capital and much will be expected of us. The midterm elections are this November. It’s critical that we be there for those that were there for us. The Goal: re-elect our supporters – those willing to fight for your issues.

We need individual chiropractors to host meetings with other chiropractors from their area, inviting their legislators to attend. Lori Grassi is willing to help you set that up, and invite the legislators. Contact Lori at 206-878-6055 or by email lgrassi@chirohealth.org.

I am calling on you again to donate to the Trust, to help elect those who support chiropractic.

If you have contributed recently and/or are a regular contributor to the WSCT, it is appreciated and makes a difference.

If you haven’t contributed, I urge you to do so today.

You can make a one-time or recurring donation online here. Or, if you prefer, you can mail a check to P.O. Box 2163,
Seattle, WA 98111

Make a one-time contribution: $1000, $500, $250, $100 or sign up for monthly credit card withdrawals: $100, $50, $25.

 — By Dr. Dave Butters, President

Washington State Chiropractic Trust

We are almost at Thanksgiving, and I want to express my gratitude to those of you who have given so much to our profession. You volunteer for committees. You donate time and money. You engage in our mission of protecting and promoting patient access to chiropractic care.

The holiday season also means that we are getting closer to the start of yet another session of the Washington State Legislature, and our Legislative Day, set this year for Thursday, Jan. 25, 2018 in Olympia. It’s your opportunity to meet legislators who represent you, and to advocate for your profession and your patients. We are counting on a large chiropractic turn out for our Legislative Day to ensure that legislators are focused on our issues.

Your participation in the legislative process is critical to our outcomes and truly makes a difference. If you cannot attend the legislative day, you can still come any day during the session. Just schedule your time in advance with our lobbyist Lori Grassi, and she will make sure that you get a chance to share your issues.

Here is the 2018 Legislative Agenda as approved by the Washington State Chiropractic Association Board:

1) Reinforce the importance of chiropractic’s drugless approach to address the opioid crisis

The WSCT, in partnership with the Washington State Chiropractic Association’s Insurance Committee, has been working with legislators and insurers to educate them on how chiropractic can save money assisting in the decrease of opioids for pain management. Patients can see their MD as many times as they want in any health plan and their first plan of attack on pain is an opioid. We want insurers and legislators to encourage patients to engage in a drugless option first, by reconsidering their approach and removing the barriers to access, which include high copays and visit limits. Another concept we’re pursuing is no prior authorization for the initial 12 visits.

2) Identify chiropractors as primary care providers within their scope of practice.

Our message to legislators: Primary care providers aren’t expected to manage and treat every condition that enters their office, but they are expected to triage and work within their scope of practice and refer when appropriate. We are citing results of the Optum study, which demonstrated that the most common health conditions presenting in a PCP’s office are musculoskeletal. If chiropractors were included by definition as PCPs the insurance specialist classification would go away, copays would drop and the patient would have a greater incentive to seek their chiropractor first – thus reducing exposure to an opioid.

3) Ensure that chiropractors are paid fairly for CMT services

We are again submitting a bill that would require insurers to pay chiropractors fairly for CMT services. The bill also encourages carriers to use the nationally established Relative Value Unite (RVU) system and its conversion factors in paying all providers. Currently, most insurers overpay some provider types and underpay chiropractors for CMT. They should be following the national standards instead of paying others more than the formula and chiropractors less.

4) Secure a manipulation benefit for adult Medicaid recipients-who can only see an osteopath or naturopath for manipulative services.

For the fifth year, we are working to include chiropractors in the list of providers who can deliver manipulation benefits. While we recognize this benefit doesn’t pay well, we believe that under-served communities deserve to have access to drugless services too, and it will save the entire Medicaid system money if they see a chiropractor first. We are also working with the Governor and the State Health Care Authority on a pilot project that would direct Medicaid patients to drugless options for pain management.

5) Remove the sunset provision on the independent pilot for the Chiropractic Quality Assurance Commission.

The Chiropractic Quality Assurance Commission regulates the competency and quality of chiropractors to ensure they are delivering high quality services to state residents. For the past four years, the commission has participated in a pilot project under which it has assumed responsibility for several functions that were previously provided by the Department of Health – including budget, licensing and disciplinary compliance. The pilot is set to expire in mid-2018, and we are advocating that the 2018 legislature grant the commission permanent status as an independent body.

As we prepare for the 2018 legislative session, and for our Jan. 25, 2018 Chiropractic Legislative Day, it is critical that each of you get to know your local legislators. Invite them for coffee or a lunch at your clinic and get 4 or 5 of your colleagues to come as well. You can find your state legislator at this link: http://app.leg.wa.gov/districtfinder. If you would like help setting up meetings with your legislators, contact Lori Grassi, Lobbyist and Executive Director for the WSCA, at LGrassi@chirohealth.org or 206-878-6055.

Finally, I began this letter by expressing my gratitude for those chiropractors who give back to our profession. If you are a regular WSCT contributor, it is appreciated. If you haven’t donated, please do so today. Visit www.washingtonchirotrust.org and click on the DONATE button to make either a one-time or recurring donation. Or, if you prefer, fill out and return the enclosed contribution envelope.

You can make a one-time contribution of $1,000, $500, $250, $100 or you can sign up for monthly credit card withdrawals.

Wishing you and yours a wonderful Thanksgiving holiday.

— Dr. Dave Butters, President
Washington State Chiropractic Trust

This month, as chiropractic turns 122 years old, I have an important question:

Have you turned your back on your profession?

There are 2,000 chiropractors in our state. Yet, when it comes to engaging with our legislators and fighting for what we believe in, most don’t engage. It’s always a small percentage of us working to ensure doctors of chiropractic are compensated fairly — and that our patients have unimpeded access to chiropractic services.

However, thank you to those who did respond to our July 2017 request for help; you got us over half way to where we need to be.

This fall, control of the State Senate will depend on a key race in the 45th District. How we participate financially in both the Democratic and Republican caucuses will not be unnoticed and likely impact our chiropractic issues. It’s critical that we raise another $40,000 in October, mostly for the state House and Senate soft money PACS. When we go to the state Legislature in January 2018 session our support now on both sides of the aisle is what opens the doors to our conversations and concerns.

We continue to have major legislative issues to tackle, including Fair Pay for our services and Prior Authorization obstacles to the care of our patients and the huge administrative burden it’s placing on our offices. Our state and nation are in the midst of an opioid crisis, and our legislators need to know that we are the viable solution. Restricting or impeding access to our services is unacceptable!If you’ve left this work to others in your profession, just couldn’t find the time – now is the time to engage! Do it for your Patients. Do it for your Family. Do it for Yourself.

Click on the DONATE button. Or, if you prefer, mail a check to PO Box 2163, Seattle, WA 98111. Make a one-time contribution: $1000, $500, $250, $100 or sign up for monthly credit card withdrawals of any amount.

— Dr. Dave Butters, President
Washington State Chiropractic Trust