Fw: [PMX:#] ACA EVP Weekly Report

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[PMX:#] ACA EVP Weekly Report

Memorandum

ACA Members, House of Delegates, Board of Governors and Other Interested Parties

From: Cuneo

Re: ACA EVP Weekly Report

Date: November 17, 2003

This week's report includes the following items:

1. ACA PRESENTS PORTIONS OF TRIGON BRIEFS TO JUSTICE DEPARTMENT AND FTC

2. BETHESDA NAVAL HOSPITAL COMMANDER PRAISES BILL MORGAN, DC

3. BREAKTHROUGH COACHING: A REAL STAR

4. FORBES MAGAZINE EXPOSES UNNECESSARY SURGERY, ACA APPLAUDS

5. ACA COOPERATES WITH COCSA ON INSURANCE PROGRAM

6. PENNSYLVANIA CHIROPRACTIC ASSOCIATION STEPS UP FOR NCLAF

7. ERISA OFFICIAL VISITS ACA OFFICE, CONDUCTS CONFERENCE CALL WITH NACA

8. ACA ON THE ROAD

9. SPECIAL PILLOW OFFER FOR ACA MEMBERS ONLY

10. CAN’T ACCESS THESE LINKS?

1. ACA PRESENTS PORTIONS OF TRIGON BRIEFS TO JUSTICE DEPARTMENT AND FTC

As I’ve reported previously, the Federal Trade Commission (FTC) and the Department of Justice have been holding public hearings in Washington, DC, on health care and competition law policy. The hearings have focused particularly on the question of whether managed care has hampered competition within the health care community.

Having initially filed lengthy testimony addressing the abuses of managed care against both doctors and patients, ACA is now preparing a follow-up statement based on a relevant portion of our appeal brief in the Trigon case. The relevant portion (pages 7-30) illustrates the conspiracy that existed during the Wilk days, and demonstrates how the conspiracy continues today in the Trigon Blue Cross Blue Shield case.

If you are interested in reading the sections of our appeal brief referenced above, visit

<http://www.acatoday.com/pdf/trigon_appellants_brief.pdf>

2. BETHESDA NAVAL HOSPITAL COMMANDER PRAISES BILL MORGAN, DC

, DC, who provides chiropractic care to our nation's leaders and military personnel at Bethesda Naval Hospital and the U.S. Capitol, was selected Chiropractor of the Year at this year's ACA House of Delegates meeting. Because Dr. was unable to attend the event, he submitted a video that was played before the gathering at the HOD meeting, in which he express appreciation for the award. In the video, Rear Admiral C. Arthur, MD, PhD, JD, commander at Bethesda Naval Hospital, introduces Dr. , calling him a "consummate professional and a real team player" whose work and research at the hospital has been instrumental in getting injured soldiers from all branches of the military back to active duty. Meanwhile, Dr. thanks his wife and a wide range of people who have supported him in his efforts to bring chiropractic to the highest levels of government and military health care. And after treating some of the brave soldiers who have returned from Iraq--injured but undaunted in their mission--Dr. offers this advice to chiropractors here at home who struggle to advance their profession: "Never weary of the fight…long for the fight…and to not leave the field before the battle is determined."

You can view Dr. 's acceptance speech online at: <http://www.acatoday.com/about/hod2003/morgan_acceptance.shtml>

3. BREAKTHROUGH COACHING: A REAL STAR

Speaking of the HOD meeting in New Mexico -- we were remiss in our previous reports for not mentioning the insurance program put on by Dr. Mark Sanna of Breakthrough Coaching and Pat , ACA’s vice president of professional development and research. The program was very well attended and well received. Once again, Dr. Sanna offered his time at no cost to the ACA. Breakthrough Coaching has been one of ACA's strongest supporters. Dr. Sanna's team teachers are all members of the ACA and monthly contributors to the National Chiropractic Legal Action Fund (NCLAF). Breakthrough Coaching has contributed a total of $70,450 to the NCLAF. Thanks for your help, Dr. Sanna.

4. FORBES MAGAZINE EXPOSES UNNECESSARY SURGERY, ACA APPLAUDS

ACA recently congratulated Forbes magazine for publishing an illuminating article titled "Is Elective Surgery Overdone?" The October 27 article exposes the growing epidemic of unnecessary knee, spine, shoulder and other surgeries, saying, "A silent scandal simmers untended in American Medicine. Every year surgeons perform thousands upon thousands of questionable or unnecessary procedures on unwitting patients…" One observer in the story goes so far as to label the situation "white-coat crime." In a letter from our president, Don Krippendorf, DC, ACA applauded the magazine for its informative article. In the letter, ACA explains that, "Unfortunately, we seem to be trained in this country to seek the most drastic solutions to our health problems first, while utilizing more conservative treatments - such as chiropractic care - as a last resort…As we look for answers to our nation's health care crisis, revealing articles like yours will help draw attention to the need for patients to seek safer, more effective, and less costly options first." To view ACA's letter in its entirety, as well as other recent ACA letters to media outlets, visit: <http://www.acatoday.com/media/record/>

5. ACA COOPERATES WITH COCSA ON INSURANCE PROGRAM

The annual conference of the Congress of Chiropractic State Associations (COCSA) in Las Vegas was the site of another great program and ACA was involved in helping to organize one of the more interesting meetings. At COCSA’s request, Pat contacted a number of national insurance leaders, many of whom have participated on our claims solutions workgroup, to participate on a chiropractic/insurance panel to discuss state level initiatives that can be enacted to help solve reimbursement concerns and other problems on the local level. The panel was facilitated by Mr. Jim Palmer, former chair of the Workers Compensation Research Institute (WCRI). Other panelists included Wisniewski, vice president of Erie Group; Dr. Rich Guttschow from State Farm’s national headquarters in Illinois; Schroeder, vice president of the National Association of Independent Insurers (NAII); Dr. Griffiths of Alabama; Dr. McClelland, representing FCER; and Pat from ACA. It was a fascinating discussion.

Here is some additional information about a couple of the panelists: Mr. Palmer is past chair of WCRI, a group that recently published negative studies on chiropractic in California and Texas (although not on his watch). He is working with their current leadership to get ACA integrated into their process so we can have input in any future reports on the profession. Schroeder of NAII is also involved with the WCRI, and is also encouraging them to engage the ACA in future discussions. She is a strong advocate of improved relations between the two professions, and was responsible for putting together the panel on chiropractic and insurance that was held recently at the NAII legislative conference.

6. PENNSYLVANIA CHIROPRACTIC ASSOCIATION STEPS UP FOR NCLAF

At the COCSA meeting I was given an opportunity to provide state association executives an update on our legislative program and a status report on the lawsuits. Following my presentation, Dr. Madeira, president of the Pennsylvania Chiropractic Association (PCA), and Gene Veno, executive director of the PCA, presented a check for $25,000 to the National Chiropractic Legal Action Fund. This check brings PCA’s total contribution to $47,500.

Other organizations that contributed to the NCLAF last week include:

Arkansas Chiropractic Society: $500, bringing total to $2,850

Florida Chiropractic Association: $1,250, bringing total to $25,000

South Central District of Kansas Chiropractic Association: $1,000, bringing total to $11,000

7. ERISA OFFICIAL VISITS ACA OFFICE, CONDUCTS CONFERENCE CALL WITH NACA

Here is a scary statistic: 80% of the non-government covered lives in health care are governed by the ERISA statutes. The good news is that recent U.S. Supreme Court decisions, and the implementation of new regulations by the U.S. Department of Labor, have begun to dent the stranglehold that ERISA plans have on health care providers and have given us the tools to fight them. As you may know, the ACA Board of Governors directed the establishment of a task force to review the decisions to see how they can be turned to help our doctors. The task force includes representatives from ACA’s departments of Professional Development/Research and Government Relations, as well as ACA’s legal counsel office, with input from Drs. Gentile and Steve Conway. As part of the ongoing effort, ACA invited Handorf, Deputy Associate Solicitor for the Plan Benefits Security Division of the U.S. Department of Labor, to ACA headquarters. As Deputy Associate Solicitor, she is responsible for and participates in all of the legal and administrative functions of the Plan Benefits Security Division, which provides litigation and advisory legal services under ERISA. While at the ACA office, Handorf participated in a conference call with ACA staff, National Association of Chiropractic Attorneys (NACA) reps, and state associations regarding ERISA laws. She outlined the purpose of ERISA, discussed the 2002 and 2003 Supreme Court and Appeals Court rulings, as well as the ERISA regulatory changes. She covered the appeal process, including arbitration and mediation and the penalties to companies that fail to comply. The Kentucky decision and subsequent court decisions appear to be communicating the court's intention to return the powers to the state. It was an outstanding conference. We have invited Handorf to return to ACA to address the attendees at NCLC 2004.

Look to ACA Today and this report for further information and material specifically prepared for ACA members that will help them deal with ERISA issues.

8. ACA ON THE ROAD

Two weeks ago, Dr. Glenn Manceaux, president of ACA’s Council of Delegates, traveled to Cleveland College of Chiropractic-Kansas City to speak the students. The student raved about Dr. Manceaux’s visit.

Last week, ACA national spokesperson Dr. Jerome Mcs and Dr. , ACA’s delegate to Oklahoma, spoke at the Oklahoma Chiropractic Association annual convention. They showed the “Simple Justice” video (narrated by Dr. Carl S. Cleveland, III) and discussed the status of ACA’s lawsuits. Dr. Mcs and Dr. signed up a number of doctors as monthly contributors to the National Chiropractic Legal Action Fund.

This past weekend, Dr. Daryl Wills, ACA’s immediate past president, spoke at the convention of the Ohio State Chiropractic Association, updating the attendees on ACA activities as well as the ACA lawsuits.

9. SPECIAL PILLOW OFFER FOR ACA MEMBERS ONLY

Innovative Choices, manufacturer of the ACA-endorsed Therapeutica pillow, recently hosted ACA president Krippendorf, DC, and Caroline Fuchs, ACA vice president of member services and business development, at their Toronto manufacturing facility. From the efficient manufacturing process to the innovative products currently under development, this trip confirmed the quality that goes into every product the company makes. If you refer patients to sleep products, you should personally evaluate the Therapeutica pillow. To make it easy for members who have never tested the pillow, Innovative Choices offers a free sample pillow. To request one, call 1-800-348-5729. This offer is only available to ACA members.

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[PMX:#] ACA EVP Weekly Report

Memorandum

ACA Members, House of Delegates, Board of Governors and Other Interested Parties

From: Cuneo, Executive Vice President, American Chiropractic Association

Re: ACA EVP Weekly Report

Date: November 25, 2003

This week's report includes the following items:

FINAL SUCCESS IN MEDICARE DOD BILL PASSES OUT OF CONFERENCE COMMITTEE VA CHIROPRACTIC ADVISORY COMMITTEE FIRST CAC CONFERENCE CALL A SUCCESS CAC AND BLUE CHIP REPRESENTATIVES: MARK YOUR CALENDAR ACA DISASTER RELIEF INITIATIVE MOVES FORWARD; VIDEO AVAILABLE CAN’T ACCESS THESE LINKS?

1. FINAL SUCCESS IN MEDICARE

After more than 10 years of effort to expand the chiropractic benefit under Medicare, ACA took a significant step toward this goal recently with the Senate-House conference committee’s agreement on the Medicare Drug Reform Act, which includes a chiropractic demonstration project.

The conference recommendations must now be sent to both the Senate and House for a vote. While it is considered close, most believe that there will be sufficient votes to get the measure out of both houses--particularly with the support of AARP. We should know for sure in the next couple of days.

As an aside, the physical therapists were unsuccessful in including in the Medicare bill either a study of or demonstration project for direct access to physical therapy services--their legislative priority.

Late breaking news: Over the weekend, the Medicare bill passed out of the House of Representatives. And today, it passed the Senate. The President is expected to sign the measure.

The chiropractic demonstration pilot project will be conducted in four sites over a two-year period. The sites have not yet been determined. Under the pilot program, Medicare recipients will now be covered for the full scope of chiropractic practice paid by Medicare. Also to be tested is direct access to chiropractic care under Medicare Part C, where federally approved managed care companies administer Medicare benefits. Now we will have statistics from the government’s own sources to counter the ridiculous projections from the Congressional Budget Office that have hampered our efforts in the past. Pilot programs under DoD made our point about the cost-effectiveness of chiropractic care and led to chiropractic being offered as a permanent benefit for the armed forces. We have the same confidence regarding the outcome of this pilot project.

Also included in the Medicare bill, and backed by Senator Grassley and the ACA, is a provision aimed at ensuring that beneficiaries will continue to have access to chiropractors and other physicians by replacing a 4.5% physician payment cut -- scheduled to take effect on January 1, 2004, if the bill does not pass -- with two years of payment increases.

Getting the chiropractic demonstration pilot project included in the Medicare bill was a very difficult fight, as two of the most powerful members of the House and Senate on health matters—Senate Majority Leader Bill Frist, MD, and Chairman of the House Ways and Means Committee Bill --maintained their opposition to the chiropractic provision to the very end.

But chiropractic had a champion in Sen. Chuck Grassley from Iowa, who is chairman of the Senate Finance Committee. He was a major player in the Medicare drug bill and doggedly fought off both Frist and to achieve this victory.

It is difficult to describe the significance of Grassley’s efforts on our behalf. However, we can get a glimpse of it from comments he made at a press conference broadcast on CNN the day before the conference committee took its final action. In response to a question from a reporter asking about the status of the chiropractic demonstration provision, he read from an e-mail that he had sent to Sen. Frist the day before. In it, he used the strongest language possible to tell Frist to have his staff “back off” its opposition to the provision.

Following is an excerpt from the e-mail: "I hope that this can be handled at the staff level…but your staff have been refusing my chiropractic demo…knock it off. I have been fighting AMA for years to get crumbs off the table for the chiropractors. I got $54 billion for the docs in January. You and they better not object to budgetary asterisks for chiropractors…so back your staff off of this demo."

To listen to Sen. Grassley discuss his strong support for chiropractic and the chiropractic demonstration at this critical time (or read the transcript), please click on this link to the ACA Web site: www.acatoday.com.

While Grassley was clearly the champion, there were others on the conference committee who also helped, including Reps. Tauzin, , Bilirakis and many other members of Congress outside of the conference committee who let the conferees know about their support of the demo. On the Senate side, we had many people who lent their support attempting to convince Frist to back off, including Sens. Norm , Orrin Hatch, , Tom Daschle, Ben , Chuck Hagel and others.

One thing I won't forget is the strong opposition of both and Frist. Our provision was not a budget buster. We were simply trying to demonstrate our cost-effectiveness. Their opposition seemed to me to be mean-spirited. But every dog has its day; perhaps someday we will have an opportunity to express our opposition to both of them…on the campaign trail.

On Sunday, the Washington Post ran a story in its “A” section on the Medicare bill, discussing the chiropractic provision and highlighting ACA’s involvement. Here’s a link to the article: http://www.washingtonpost.com/wp-dyn/articles/A6920-2003Nov22.html

2. DOD BILL PASSES OUT OF CONFERENCE COMMITTEE

We also had success with a recent DOD authorization bill that was passed out of another House/Senate conference committee. A chiropractic provision accelerates the full implementation of chiropractic into the armed services by one year, increases the annual allocation for this implementation and includes report language that strengthens the hand of the chiropractic advisory committee.

3. VA CHIROPRACTIC ADVISORY COMMITTEE

There has been considerable discussion lately about the actions taken by the chiropractic members of the VA advisory committee that recently submitted recommendations to the Veterans Administration (VA) Secretary in implementing the chiropractic health benefit in the (VA). ACA's goal in sponsoring the VA legislation was for veterans to have the opportunity to seek chiropractic care without unreasonable barriers. Our chiropractic representatives understood this goal, but at the same time, they were faced with the problem of being part of an advisory committee appointed by the Secretary of the Veterans Administration whose members weren't all sympathetic to the profession. We want to commend our team for working with the majority on the committee and getting them to agree to recommendations that clearly benefit n! ot only the veterans but also this profession. The Secretary isn't mandated to accept these recommendations. He stated clearly at NCLC that he would do the best he could to support our position without altering the way the Veterans Administration operates. We believe the consensus developed and the program recommended by the Chiropractic Advisory Committee will make it more likely that the Secretary will embrace the proposals.

Two of the representatives, Dr Rick Mc and Dr. Vaughn, recently wrote separate articles regarding their experiences in formatting their recommendations. It is a fascinating account on the art of consensus building. I urge you to read both at:

http://www.acatoday.com/government/va/setrecord_vahcs.shtml and

http://www.acatoday.com/government/va/advisory_recommendation_comments.shtml

4. FIRST CAC CONFERENCE CALL A SUCCESS

Last Tuesday, we held the first in a series of conference calls with the chiropractic representatives of Medicare's carrier advisory committees (CAC) and state associations. This month’s call focused on those states that were covered by the following Medicare carriers: Noridian Mutual Insurance Company, Blue Cross Blue Shield of Kansas, and Blue Cross Blue Shield of Arkansas. Included on the call were representatives from Wyoming, Kentucky, South Dakota, Hawaii, Colorado, Nebraska, Arizona, Washington, Virginia, Alaska, Pennsylvania, Illinois and Arkansas. Dr. Ritch , Chairman of the Medicare Committee, along with McClelland and Tom Daly, facilitated the meeting. The meeting’s goal was to establish a closer dia! logue between ACA and the Medicare carrier advisory committees. The highlight of the call was Ms. McClelland providing her analysis of each of the local medical review policies (LMRP) where they were consistent with the national plan and where they were inconsistent. LMRPs can't be in conflict with the national plan.

Our next CAC call is scheduled for Tuesday, December 9 at 1:00 pm Eastern. CAC and state associations from the following carrier areas will be invited to participate: Cahaba Government Benefits Administrators (GBA); Cigna Medicare; HGS Administrators of Pennsylvania; Palmetto Government Benefits Administrators; Trailblazer Health Enterprises, LLC; and Triple S.

5. CAC AND BLUE CHIP REPRESENTATIVES: MARK YOUR CALENDAR

If you are the chiropractic representative of a carrier advisory committee (CAC) in your state, or the Blue Chip representative in your state, please mark your calendar for Friday, March 5 at the Hyatt Regency Hotel, Capitol Hill. These meetings will be held in conjunction with National Chiropractic Legislative Conference (NCLC) being held at the Hyatt Regency Capitol Hill, March 3-6. The ACA Medicare Committee is putting together the agenda for the CAC meeting, and ACA’s Office of Professional Development and Research is doing the same for the Blue Chip program. The CAC meeting is tentatively scheduled to begin at 8:00 am, and the Blue Chip program at 10:00, providing the Blue Chip representatives an opportunity to sit in on some of the CAC program. A tentative agen! da for both meetings is set forth below:

CAC Meeting:

Seminar on the National Medicare Policy and its significance in determining local medical review policies, followed by a presentation on documentation. (There will be an opportunity for CAC representatives to compare their LMRPs with the national plan.)

This will be followed by a roundtable discussion, which will include CAC representatives discussing how they achieved positive results with their LMRPs.

These discussions will be facilitated by McClelland, ACA Medicare consultant, and Dr. Ritch , chairman of the Medicare Committee.

BCCHIP Meeting:

a. How to deal with benefit limitations

b. Focus on care of pediatrics

c. Focus on extremity care

d. Model State--Invitation is being sent to Medicare Director and Blue Chip liaisons from Model State to present on their relationship.

That afternoon, ACA’s House of Delegates will convene at 3:00 pm ET. At that time, Ms. Handorf, Deputy Associate Solicitor for the Plan Benefits Security Division of the U.S. Department of Labor and an expert on ERISA matters, will discuss the recent regulations and court decisions regarding ERISA. She will be followed by Mr. Mcs, Esq., who will provide an update on the lawsuits. Those attending the CAC and Blue Chip meetings are welcome to attend these programs as well.

6. ACA DISASTER RELIEF INITIATIVE MOVES FORWARD; VIDEO AVAILABLE

I have reported previously on the strides ACA has made in opening avenues for doctors of chiropractic to serve in cases of natural disaster, terrorism or other tragedies, including ACA's passage of an historic resolution that aims to integrate doctors of chiropractic more freely into the disaster relief community. At ACA's recent annual meeting in Albuquerque, NM, ACA's Arkansas delegate Konarski-Hart, DC, reported on the progress of the initiative and distributed-- among other materials--a video titled "First There, First Care: Bystander Care for the Injured." The video, produced by the America Trauma Society and the National Highway and Traffic Safety Administration, instructs viewers on simple steps to take to help injured victims at a trauma/disaster site. To view the video, visit: http://www.acatoday.com/about/hod2003/First_there.wvx

Note: *You will need Windows Media Player to view the video and audio capability from your system to hear it. To test whether you have this software (and download it, if necessary), click: http://www.streampipe.com/test/

7. CAN’T ACCESS THESE LINKS?

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[PMX:#] ACA EVP Weekly Report

Memorandum

ACA Members, House of Delegates, Board of Governors and Other Interested Parties

From: Cuneo

Re: ACA EVP Weekly Report

Date: December 15, 2003

This week's report includes the following items:

1. CHIROPRACTIC ECONOMICS INTERVIEWS WASHINGTON TIMES REPORTER REGARDING HEALTH CARE LOBBYING SURVEY

2. ASSOCIATED PRESS ACKNOWLEDGES ERROR AFTER ACA CHALLENGES ARTICLE

3. NEW ACA LIST SERVE TO HELP YOUR PRACTICE THRIVE

4. ACA’S FREQUENTLY VISITED WEB SITE

5. SECRETARY PRINCIPI CONFIRMS FOR NCLC; COCSA ALSO INVOLVED

6. UPDATE ON THE LAWSUITS: NO WHITE SMOKE YET FROM THE COURTS

7. SUCCESSFUL OREGON CASE RESEMBLES TRIGON CASE

8. ACA PRESENT FOR PRESIDENTIAL SIGNING OF MEDICARE BILL

9. NC BLUE CHIP LIAISON REPORTS GREAT VICTORY FOR STATE EMPLOYEES

10. CCE SEEKS CHEA RECOGNITION

11. NCLAF MONTHLY CONTRIBUTORS ARE INVITED TO JOIN US AT PARKER

12. CAN’T ACCESS THESE LINKS?

1. CHIROPRACTIC ECONOMICS INTERVIEWS WASHINGTON TIMES REPORTER REGARDING HEALTH CARE LOBBYING SURVEY

I reported recently on an op-ed article and an accompanying chart that appeared recently in the Washington Times--authored by Heaney--that ranked the top 25 grassroots lobbying organizations at the Capitol that have interest in health care legislation. ACA made the top 25 list, checking in at number 19. At number 19, ACA tied the United Auto Workers and beat out the American Physical Therapy Association (APTA) and the U.S. Chamber of Commerce. Some of the organizations listed ahead of ACA include the American Hospital Association, AARP, AFL-CIO. Curiously, the American Osteopathic Association (AOA) wasn't even listed. Chiropractic Economics contacted Mr. Heaney to learn more about his study and the methodology that he used in arriving at his conclusions. The interview appears in the December 2003 issue of Chiropractic Economics, and can be found at the following link: <http://w! ww.chiroeco.com/news/aca_grassroots%20lobbying.html>

Allow me to quote a section of the Chiropractic Economics article that addresses the sampling process, which I find very revealing:

"Heaney explained that his list of the top 25 grassroots lobbying organizations was culled from a roll of more than 1,200 associations he initially compiled that have interests in health care legislation. He used several criteria, including recommendations by a panel, mention in previous studies and lobbying efforts, to narrow the list to the top 171 associations. He said that the

International Chiropractors Association and the World Chiropractic Alliance both met the criteria to be among the original 1,200 associations, but did not meet the criteria for the smaller group, from which the top 25 were eventually ranked, based on in-depth interviews with 77 congressional staff."

I understand that one other chiropractic periodical contact Mr. Heaney as well. It will be interesting to learn who that is and what they will say about the interview. We plan to have lunch with Mr. Heaney on Tuesday.

If this interview with Mr. Heaney doesn't make the case that the ACA is the only show in town, nothing else well. But we could accomplish so much more if we had more resources. Can you help? Please print out a copy of the Chiropractic Economics article and a membership application at the link provided below, and recruit one or more non-members. If the non-member still has doubts, I would be pleased to talk with him or her. You have my email address. My phone number is (800) 986-4636. We have a real good product that deserves and needs the support of the profession. Please help us get there. <http://www.acatoday.com/join.shtml>

2. ASSOCIATED PRESS ACKNOWLEDGES ERROR AFTER ACA CHALLENGES ARTICLE

Because the press is generally reluctant to acknowledge a mistake, we are pleased to see that the Association Press (AP) has acknowledged that it committed an error in stating that chiropractors make up 11.3 percent of all Medicare errors. AP issued a correction to their story after ACA sent the news service a letter urging that they run a correction to their mistake. According to the AP correction, "In a Nov. 14 story about error rates in Medicare claims, The Associated Press reported erroneously that physical therapists accounted for 18.2 percent of all health care provider billing errors, internists 11.3 percent and chiropractors 11.3 percent, according to a review by the Centers for Medicare and Medicaid Services." The correction goes on to explain that the Centers for Medicare and Medicaid Services’ review was merely evaluating the percentage of claims within each specialty that were in error, as opposed to the percentage of Medicare errors ov! erall for which each specialty is responsible.

To read ACA’s letter to the Associated Press, visit: <http://www.acatoday.com/media/record/ap.shtml>

3. NEW ACA LIST SERVE TO HELP YOUR PRACTICE THRIVE

ACA supports the success of your practice and is introducing a new practice management resource that is targeted for both experienced and new practitioners. ACABizDoc is a networking forum that includes a practitioner email discussion group and a Web-based resource dedicated to the business of chiropractic.ACABizDoc and its sister Web site resource will facilitate conversations among ACA members looking for practice management information and answers to questions on insurance, starting a chiropractic office, managed care and more! Participants will be able to share knowledge on the management of small but important details related to everyday chiropractic business, and specific practice management challenges. Note: you MUST formally register for the ACABizDoc list serve in order to participate on it. Both the Web site resource and the email discussion group will launch on January 5, 2004, but you can register now by going to: /! FONT><http://ww3.chirolists.com/mailman/listinfo/acabizdoc>

4. ACA’S FREQUENTLY VISITED WEB SITE

Did you know that ACA logs 120,000 visits a month to our Web site, and our "Find-A-Doctor" section registers between 8,000 to 10,000 hits a month? How many more reasons do you need to become a member of the ACA? If you need more, visit: <http://www.acatoday.com/membership/>

5. SECRETARY PRINCIPI CONFIRMS FOR NCLC; COCSA ALSO INVOLVED

Principi, Secretary of the Veterans Administration has confirmed that he will speak at ACA’s National Chiropractic Legislative Conference (NCLC), scheduled for March 3-6, 2004 at the Hyatt Regency Hotel in Washington, D.C. His presentation will be particularly timely as he is currently reviewing the recommendations from the chiropractic advisory committee on implementation of the chiropractic benefit within the VA program.

Additionally, the Congress of Chiropractic State Associations (COCSA) has agreed for the second year in a row to sponsor a state association roundtable discussion. This program provides an opportunity for state association leadership to discuss with each other and ACA staff various issues that they are confronting locally. More details to follow.

Do you need more reasons to attend? Other speakers include: the U.S. Labor Department Attorney responsible for ERISA laws; Mr. Mcs, who will comment upon ACA’s lawsuits; Dr. Korn of National Blue Cross/Blue Shield, who will participate in the Blue Chip meeting and a chiropractic carrier advisory committee meeting, along with presentations by prominent members of congress and the president’s administration, with even more to come.

A downloadable registration form for NCLC will be available on ACA’s Web site soon. For more information on NCLC 2004, visit: <http://www.acatoday.com/about/nclc2004/>

6. UPDATE ON THE LAWSUITS: NO WHITE SMOKE YET FROM THE COURTS

I have no major developments to report from the courts on either of our two lawsuits at this time. While we had anticipated that oral arguments might have been scheduled in the Trigon case by the Appellate Court prior to Christmas, we have not received such notice. Although there is no requirement that oral arguments be taken, we do believe this will be scheduled sometime in January. We will keep you apprised.

7. SUCCESSFUL OREGON CASE RESEMBLES TRIGON CASE

In an Oregon antirust case that resembles a smaller-scale version of our Trigon case, a jury awarded $4.5 million in damages, which, under law, is tripled to $16.2 million. The plaintiff will also be eligible to collect attorney fees of up to $4 million. The case involves a hospital system that used its monopoly power to negotiate exclusive agreements with Regency Blue Cross Blue Cross of Oregon to establish pricing schemes that charged patients more for services received from the plaintiff hospital than those charged to the defendant hospital system. A hearing has been set on the motion of the defendant to have the court set aside the jury verdict.

8. ACA PRESENT FOR PRESIDENTIAL SIGNING OF MEDICARE BILL

As you probably read in the paper or saw on television, President Bush signed last Monday the Medicare Drug Reform Bill. I was joined at the signing by ACA vice president of government relations Jon Hymes and PAC manager Kim Krocker in viewing the impressive ceremony. Most of the major players in Congress and the lobbying community were present. Tommy introduced President Bush, who gave a pretty good speech. The signing took place at the DAR Constitution Hall instead of the White House in order to accommodate the obvious interest in the ceremony. The gallery and main floor were packed. We had fairly good seats--about 15 rows from the president. It was an impressive and moving ceremony, particularly when you know that our provision was included in the bill.

9. NC BLUE CHIP LIAISON REPORTS GREAT VICTORY FOR STATE EMPLOYEES

ACA Blue Chip liaison Dr. sharp recently reported a change in the State Employee Medical Plan, which covers teachers and state employees in North Carolina and is administered by Blue Cross Blue Shield of North Carolina (BCBSNC). An ACA member contacted ACA in April of this year stating that the state employee coverage would only pay for one Evaluation and Management (E/M) Code in a patient's lifetime. When ACA took this problem to Dr. Sharp, he was able to contact the State Employee Medical Director through his meetings with BCBSNC as the liaison. He was then able to educate her about the necessity of having more than one E/M code covered for doctors of chiropractic. Thanks to Dr. Sharp's efforts, an ACA member bringing this problem to our attention, and the open-mindedness of the State Employee medical director in North Carolina, doctors of chiropractic can now bill and be reimbursed for at least one (1) E/M code per month under the state employee ! plan.

10. CCE SEEKS CHEA RECOGNITION

Two weeks ago I attended a public hearing in Washington, D.C., sponsored by the Council for Higher Education Accreditation (CHEA). The council is a private accrediting agency that extends recognition status to the accrediting agencies of the major professions in the country that meet CHEA standards. On the agenda this day were applications from the following accrediting agencies: American Council of Pharmaceutical Education; National Association of Schools of

Public Affairs and Administration Commission on Peer Review and Accreditation; the Accreditation Review Commission on Education for the Physician Assistant; and the Council on Chiropractic Education (CCE).

The CCE was represented at the hearing by Dr. Weeks, chair of the CCE Commission on Accreditation and vice president for academic affairs at Sherman College; Dr. Craig Little, president of the CCE and Martha O’Conner, PhD, executive vice president of the CCE. All three did an excellent job in responding to questions about the extensive self-study application submitted by the CCE. It's a pretty extensive process and the CCE will not know for a while whether they received the status or need to make further changes. I would guess that more work will need to be done, but the good news is they are now in the pipeline.

CHEA is a very prestigious private agency that is well respected in higher education. The 12-member committee that reviewed CCE’s application included the editor of Gannet News services; president of Oakton Community College; the provost and vice president for academic affairs at SUNY-Binghamton; and the vice president of academic affairs at Alcorn State University.

11. NCLAF MONTHLY CONTRIBUTORS ARE INVITED TO JOIN US AT PARKER

If you are a monthly contributor to National Chiropractic Legal Action Fund (NCLAF), we invite you to join ACA’s board of governors and others attending the program in Las Vegas, where we will enjoy an outstanding program and raise money for the lawsuits. We are preparing a special recognition ribbon for you and ask that you come to the NCLAF booths at the program and get your recognition. We are also hopeful that during the major programs that will occur on Thursday evening and Saturday, you will again be recognized for your efforts. For more on the program, visit: <http://www.parkerseminars.com/seminar/seminardetail.asp?locationid=29>

12. CAN’T ACCESS THESE LINKS?

Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com <http://www.adobe.com/>. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@... <mailto:gcuneo@...>.If you do not wish to receive further e-mail promotions, Click Here to be removed. DO NOT REPLY to this message. The e-mail address in which you are subscribed is rcross@.... Copyright 2002. All rights reserved.

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[PMX:#] ACA EVP Weekly Report

Memorandum ACA Members, House of Delegates, Board of Governors and Other Interested PartiesFrom: CuneoRe: ACA EVP Weekly ReportDate: January 20, 2004

This week's report includes the following items:

1. ORAL ARGUMENTS IN TRIGON SUIT SET: WHAT HAPPENS NEXT?2. DECISION IN CANADIAN INQUEST IS PUZZLING3. ACA CONDUCTS SURVEY ON ACUPUNCTURE4. NCLC INCLUDES BLUE CCHIP WORKSHOP 20045. AMERICAN MEDICAL NEWS REPORTS ON VA COMMITTEES RECOMMENDATIONS6. REMINDER TO PARTICIPATE ON CAC CONFERENCE CALL7. EXPANDING CHIROPRACTIC IN THE TRICARE PROGRAM A HIGH LEGISLATIVE PRIORITY8. CAN’T ACCESS THESE LINKS?

1. ORAL ARGUMENTS IN TRIGON SUIT SET: WHAT HAPPENS NEXT?

We have been informed by the 4th Circuit Court of Appeals that our oral arguments are scheduled for Tuesday, February 24th in Richmond, Virginia, before a three-judge panel. We have also learned a little more about the process. One week before the hearing, two copies of all the appeal briefs filed by either side will be given to each of the three panel judges. Each judge will then provide a copy to his/her clerk, and for the next week they will discuss with each other the case and begin to form their individual decisions. Judges will not speak to one another during this period. Following the oral testimony, the judges will meet together for the first time; discuss the case and issue their decisions. The most senior member of the court will decide who will write the majority opinion. We could receive the majority opinion anywhere from one to six months later. The decision could range anywhere from an outrigh! t denial of our appeal, to issuing an order supporting one or all parts of our appeal, including the remanding of the case back to the original judge ordering a jury trial.

2. DECISION IN CANADIAN INQUEST IS PUZZLING

As you are probably aware, an inquest had been ongoing in Ontario, Canada to determine the cause of death of Lana Dale , a woman who had suffered a stroke under a set of controversial circumstances. On January 16, 2004, the five-member jury involved in the inquest reported a finding of "accidental," In delivering its finding, the jury also made a series of recommendations based on the proceedings.

While the inquest found no evidence that chiropractic care caused the stroke death of Ms. , ACA feels that many of the jury’s recommendations are incompatible with the “accidental” ruling in the case.

According to ACA’s official statement on the decision, “The American Chiropractic Association is not surprised that the jury in a recent Canadian inquest into the death of Lana Dale was unable to find any evidence that chiropractic manipulation caused her stroke. In ruling that ' death was ‘accidental,’ the jury effectively conceded that it was unable to determine exactly what caused her death…”

For a full listing of the jury’s recommendations, or for a copy of ACA’s official statement, contact Bernat at pbernat@... <mailto:pbernat@...>. In the meantime, the ACA offers the following links to information that may be helpful in dealing with the issue of chiropractic safety, as the topic may generate concern among patients and local media: http://www.acatoday.com/pdf/informed_consent_bullets.pdfhttp://www.acatoday.com/pdf/chiro-risks.pdf

3. ACA CONDUCTS SURVEY ON ACUPUNCTURE

The ACA, in conjunction with three professional associations that represent acupuncturists, will be conducting a survey as part of the AMA CPT process. The survey's purpose is to develop relative values for acupuncture codes. The ACA, who holds a seat on the AMA's Health Care Professional Advisory Committee (HCPAC), will be coordinating the effort. Roughly ten percent of the chiropractic profession performs acupuncture, and the ACA has selected a random sample of these doctors as survey participants. Within the week, these surveys will be sent out. If you receive one of these surveys, please be diligent in completing it and returning it by the assigned deadline, as this is the only means by which to fairly assign relative values to these services.

4. NCLC INCLUDES BLUE CCHIP WORKSHOP 2004

For the third consecutive year, ACA will host a Blue CCHIP (BCCHIP) workshop during its annual National Chiropractic Legislative Conference (NCLC) in Washington, DC. This closed meeting will take place Friday, March 5th from 10:00am-3:00pm. All BCCHIP liaisons, state delegates, and state association representatives are encouraged to attend. Attendees at this year's meeting will learn about the working relationships of a particular model state from the perspective of both the liaison and internal Blue Cross Blue Shield contacts. They’ll also hear about new research and measures ACA is taking on specific problem areas that have arisen over the past few years, such as chiropractic coverage for children. Additionally, the BCCHIP meeting provides a forum for liaisons, delegates, and state associations to exchange strategies and ideas to overcome problems and frustrations inherent in working within the BCCHIP program. ! This is a very important meeting for everyone involved with BCCHIP to attend.

5. AMERICAN MEDICAL NEWS REPORTS ON VA COMMITTEE RECOMMENDATIONS

In its January issue, the American Medical News published a fairly extensive article on the recommendations made by the VA Chiropractic Advisory Committee. The article states in part, "Chiropractic care at the Department of Veterans Affairs could expand dramatically, if the final recommendations of the VA chiropractic advisory committee are followed."

A review of a portion of the 38 recommendations made by the committee to Secretary Principi bears out this statement. The Secretary does not have to adopt the recommendations, and there is already strong pressure on him by the bureaucrats and political medicine to water them down. However, the strong majority vote from the committee and our own discussions with the Secretary give us hope of a favorable outcome. The recommendations include:

(a) Inclusion of doctors of chiropractic under Title 38, along with other health care professions (MD, DO, OD, DPM, and DDS)

( Direct access to chiropractic care for newly discharged veterans who received chiropractic care in the military for service-connected condition(s)

© Inclusion of doctors of chiropractic as full voting members of medical staff

(d) A goal of providing chiropractic care at all major VA health care facilities, consistent with distance and travel standards for access to specialty care

(e) Continuance of fee-for-service chiropractic care in areas where veterans do not have easy access to VA facilities with chiropractic services

(f) Inclusion of chiropractic in VA research projects

(g) Inclusion of chiropractic in VA training programs

(h) Comprehensive educational programs on chiropractic for VA physicians, other health care providers, ancillary personnel and the patient population

For more details regarding these recommendations, please view the following statements from Drs. Bill , Vaughn and Rick Mc: <http://www.acatoday.com/government/va/morgan_response.shtml><http://www.acatoday.com/government/va/advisory_recommendation_comments.shtml><http://www.acatoday.com/government/va/setrecord_vahcs.shtml>

6. REMINDER TO PARTICIPATE ON CAC CONFERENCE CALL

Just a reminder to those CAC/state association leaders in states covered by the Medicare carriers listed below to participate in a conference call with our Medicare experts to review local medical review policies. The call is scheduled for Thursday, January 22nd at 1:00 pm Eastern. Call Brown at the ACA office (800-986-4636) for call-in and pass code numbers…

Administar Federal Inc., Blue Cross Blue Shield of Montana, Blue Cross Blue Shield of Rhode Island, Empire Medicare Services, First Coast Services Options, Inc., Group Health Inc. (GHI Medicare), HealthNow of Upstate New York, Medicare Northwest, National Heritage Insurance Company and Wisconsin Physicians Services.

7. EXPANDING CHIROPRACTIC IN THE TRICARE PROGRAM A HIGH LEGISLATIVE PRIORITY

We continue to solicit cosponsors for Rep. Ed Schrock's bipartisan bill (HR 3476) to extend chiropractic care benefits to military retirees, dependents and survivors through the Department of Defense’s (DoD) TRICARE program. There are currently 27 members of Congress who have signed up as cosponsors. We urge that you contact your member of Congress and request that he become a cosponsor. A summary of the legislation and its deposition is provided below. For more information or to obtain a list of the current cosponsors, contact ACA’s Government Relations office at 800-986-4636 or visit: http://econstituent.votenet.com/(kxzme2vddpzkag55rgic5cm5)/index.aspx/aca/letterwriting.aspx?issueid=538

8. CAN’T ACCESS THESE LINKS?

Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com <http://www.adobe.com/>. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@... <mailto:gcuneo@...>. If you do not wish to receive further e-mail promotions, Click Here to be removed. DO NOT REPLY to this message. The e-mail address in which you are subscribed is rcross@.... Copyright 2002. All rights reserved.

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[PMX:#] ACA EVP Weekly Report

Memorandum

ACA Members, House of Delegates, Board of Governors and Other Interested Parties

From: Cuneo

Re: ACA Executive Vice President Weekly Report

Date: February 9, 2004

* Note - last weeks' report was formatted with hyperlinks within the document so that you could jump from item to item. Some members had difficulty with this format so this weeks' report will be in the old format. We will let you know when we have worked out the bugs.

This week’s report includes the following items:

1. CHANGES IN ACA MEMBERSHIP CATEGORIES AND DUES STRUCTURE

2. LEGISLATIVE ISSUE BRIEFS FOR NCLC PARTICIPANTS

3. COCSA TO SPONSOR ROUNDTABLE DISCUSSION AT NCLC

4. CCE APPOINTS ACA DELEGATE TO COMMISSION ON ACCREDITATION

5. ACA RESPONDS TO FLAWED ARTICLE IN UC-BERKELEY WELLNESS LETTER

6. THANKS TO OUR ORGANIZATIONAL CONTRIBUTORS TO THE NATIONAL CHIROPRACTIC LEGAL ACTION FUND OF THE PAST TWO WEEKS

7. ANTITRUST LAWS CAN HELP IN OBTAINING FAIR REIMBURSEMENT

8. NEW ACA DELEGATE, ALTERNATE DELEGATES

9. LIVE ACA TELESEMINAR: LEARN CODING FROM AN EXPERT

10. CAN’T ACCESS THESE LINKS?

1. CHANGES IN ACA MEMBERSHIP CATEGORIES AND DUES STRUCTURE

I’m very pleased to announce that after several months of working on improving ACA’s membership renewal process, we now have a more efficient, equitable and user-friendly system in place. As a result, you will notice that your next renewal statement will have a new look-making it much easier to read and understand.

As work on this project evolved, it became obvious that consolidating the various membership categories and dues amounts would make the categories less confusing and more manageable. With this in mind, the system was streamlined from 32 membership categories down to only 12. At the same time, some of the dues levels were modified in order to be consistent and equitable under the new system.

One of the most significant changes is in the New Graduate membership category. ACA’s Board of Governors has approved a reduced rate of $120.00 per year for the second, third and fourth years of New Graduate membership - a total reduction of $330.00 from the previous rates for the same period.

The new system will also allow ACA to serve you better by providing more efficient dues processing and enhanced customer service. Once fully implemented, this effort will make the process of joining and renewing membership easier and more efficient for all members.

Approximately 2,000 members received the new renewal notice in February. This process will be introduced throughout the year as each member comes up for renewal. If you have questions now or upon receiving your renewal notice, please don’t hesitate to call ACA staff at 800-986-4636. Thank you for your support and patience as ACA works to improve every aspect of membership.

2. LEGISLATIVE ISSUE BRIEFS FOR NCLC PARTICIPANTS

If you are planning to meet with members of Congress at NCLC or at home in their respective districts, here are the issue briefs for ACA’s Legislative Agenda for 2004. This information is also helpful as you set up your appointments on Capitol Hill, as the staffs of members of Congress will want to know in advance the programs you will be discussing. Attendees at NCLC will be given copies of this as well.

Medicare - Urge prompt implementation of chiropractic demonstration project:

http://www.acatoday.com/pdf/2004_issue_briefs/Medicare_Discrimination.pdf

Military Health Care System - Co-sponsor HR 3476 to extend chiropractic care to military retirees, beneficiaries and survivors:

http://www.acatoday.com/pdf/2004_issue_briefs/HR3476_2.pdf

Military Health Care System - Restore the Department of Defense’s Chiropractic Advisory Panel:

http://www.acatoday.com/pdf/2004_issue_briefs/ChiroCareBenefit.pdf

Veterans Health Care - Implement the chiropractic care benefit for veterans approved by Congress:

http://www.acatoday.com/pdf/2004_issue_briefs/VA.pdf

Public Health Service - Include DCs in the Commissioned Corps of the U.S. Public Health Service:

http://www.acatoday.com/pdf/2004_issue_briefs/PHS.pdf

ERISA / AHPs / Managed Care - Halt federal preemption of state patient and provider protection laws and unfair practices within managed care:

http://www.acatoday.com/pdf/2004_issue_briefs/AHP_ERISA.pdf

3. COCSA TO SPONSOR ROUNDTABLE DISCUSSION AT NCLC

COCSA officers Dr. Donovan (President) and Dr. Walt Engle (Treasurer) will lead a roundtable discussion for state association leaders during NCLC on Saturday morning between 9:30 and 11:30 am. Topics to be discussed are ERISA, an actuarial study on the impact of chiropractic care on insurance premiums, and the development of best practices for the profession. Each of these issues has a direct impact on state associations and their members, so it is imperative for state leaders to be informed. Bobby Gibson and Page of ACA will be on hand to discuss ERISA and the actuarial study, and Dr. Eugene of CCGPP will be available to discuss best practices. All three individuals are integrally involved in these respective projects and will expose participant! s to the most accurate and updated information. Other topics to be addressed as time permits are Workers’ Compensation and PACE.

For additional information on NCLC, visit http://www.acatoday.com/about/nclc2004/. To hear testimonials about NCLC from Dr. Fabrizio Mancini, President of College of Chiropractic, and Gene Veno, Executive Director of the Pennsylvania Chiropractic Association, visit http://www.acatoday.com/about/nclc2004/videos/mancini1.wvx (Dr. Mancini) and http://www.acatoday.com/about/nclc2004/videos/veno.wvx (Gene Veno).

For written transcripts of these comments, visit http://www.acatoday.com/about/nclc2004/transcripts.shtml#mancini and http://www.acatoday.com/about/nclc2004/transcripts.shtml#veno.

4. CCE APPOINTS ACA DELEGATE TO COMMISSION ON ACCREDITATION

I am pleased to announced that ACA’s Arkansas delegate, Dr. Konarski Hart, has been selected as a doctor member of the Council on Chiropractic Education’s Commission on Accreditation (COA). Appointed for a second term to the COA were:

COA Chair Weeks, DC, Sherman College of Straight Chiropractic; COA Vice Chair Lester Lamm, DC, Western States

Chiropractic College; COA Secretary DuMonthier, Palmer College of Chiropractic West.

The COA certifies the quality and integrity of Doctors of Chiropractic Programs (DCPs) by interpreting the criteria for and conducting the process of accreditation. This includes that DCPs (a) have clearly defined and educationally appropriate objectives;

( maintain conditions under which the achievement of these objectives can reasonably be expected;

© are in fact achieving these objectives substantially; and

(d) can be expected to continue to achieve these objectives in the future.

5. ACA RESPONDS TO FLAWED ARTICLE IN UC-BERKELEY WELLNESS LETTER

ACA has responded with a pointed letter to a misleading article published in the February 2004 issue of the University of California-Berkeley Wellness Letter. The unfortunate article, titled "Should You Consult a Chiropractor," attempted to minimize the effectiveness of chiropractic care while espousing outdated, irrelevant stereotypes about the profession. The article also claimed that for low back pain, one should first see his or her "regular physician first for a diagnosis and possible treatment," and to then ask for a referral to a chiropractor "if you want to try one." To view ACA's response to the UC-Berkeley Wellness Letter, visit: http://www.acatoday.com/media/record/uc_berkeley.shtml.

6. THANKS TO OUR ORGANIZATIONAL CONTRIBUTORS TO THE NATIONAL CHIROPRACTIC LEGAL ACTION FUND OF THE PAST TWO WEEKS

Ward Success Systems: $100 ($1,600 to date)

The Master's Circle: $500 ($12,000 to date)

Performance Health $100 ($1,600 to date)

Missouri Chiropractic Association $100 ($2,200 to date)

Missouri Chiropractic Association, District 1: $100 ($7,000 to date)

New York Chiropractic Association, District 9: $1,000

Illinois Chiropractic Assistants Association: $750 ($1,250 to date)

Tennessee Chiropractic Association: $1,000 ($6,700 to date)

Chiropractic Services Management, LLC: $1,000

Rubicon Sales, LLC: $100

Florida Chiropractic Association: $1250 ($26,250 to date)

Iowa Chiropractic Physicians Clinic: $513.55 ($2,513.55 to date)

Special thanks to the National Council of Jewish Women (Burlington County Section: New Jersey) for a contribution to NCLAF, which the group made in recognition of a presentation by Dr. Longo of New Jersey.

7. ANTITRUST LAWS CAN HELP IN OBTAINING FAIR REIMBURSEMENT

Since 1992, doctors in the Northern Kentucky/Greater Cincinnati area have experienced unusually low reimbursement rates from area insurance companies including Humana, Aetna Health Inc., Anthem Blue Cross Blue Shield, and United HealthCare of Ohio. These low reimbursement rates have been alleged to be the product of a collaboration of these four insurance companies, which represent 90 percent of that local market. These companies have been accused of working in tandem to determine the reimbursement rates for doctors in the area and to set them below the market value.

In response to the perceived unfair business practices by the above-mentioned insurance companies, attorney Stan Chesley filed an antitrust lawsuit in Boone County (Kentucky) and Hamilton County (Ohio) in 2002. In December 2003 the lawsuit was settled, and Humana Healthcare agreed to make a $20 million increase in reimbursement for doctors by 2004, an additional $35 million by 2005 and another $45 million by 2006. These reimbursement increases will affect more than 2,000 area doctors.

The ACA believes much can be learned from this lawsuit and subsequent settlement. The recent settlement agreement with Humana demonstrates the value of effective antitrust litigation in areas dealing with reimbursement issues and problems. The chiropractic profession is currently using the antitrust laws dealing with similar issues in the ongoing Trigon litigation. It has also filed comments with the Federal Trade Commission and U.S. Justice Department, Antitrust Division, on the impact of the antitrust laws on competition in the health care marketplace. Remedies under the antitrust statues and other federal and state laws should, and can, be considered when all other reasonable options for settlement are exhausted.

8. NEW ACA DELEGATES, ALTERNATE DELEGATES

Congratulations to Dr. , who has been elected ACA’s new delegate to Georgia, and to Dr. Denmark, who was elected alternate delegate to Georgia. Congratulations also to Dr. Servais, ACA’s newly elected delegate to Wisconsin, and to Dr. Leo Bronston, who has been elected alternate delegate to Wisconsin.

9.. LIVE ACA TELESEMINAR: LEARN CODING FROM AN EXPERT

ACA's convenient new live teleseminar series is a cost-effective way to educate yourself and your staff on chiropractic hot topics without having to leave your office. Register today for the February teleseminar Coding Solutions, presented by Dr. Hamm. Dr. Hamm is the chairman of ACA’s Coding Reimbursement Committee and the ACA representative to the AMA/RUC/HCPAC Committee, on which coding positions are formulated. Dr. Hamm will cover Chiropractic Manipulative Treatment (CMT), Physical Medicine, Modifiers, and other chiropractic-related services and will answer your specific coding questions.

Date: Tuesday, February 17, 2004

Time: 1:30 p.m. - 3:00 p.m. ET

Registration Fee Per Seminar: $69 for ACA Members, $99 for Non-ACA Members. Upon registration, each participant will receive conference materials and speaker handouts--great for planning and goal setting. For more information or to register, visit ACA's website at www.acatoday.com or call the ACA Member Services Department at 1-800-986-INFO (4636)

10. CAN’T ACCESS THESE LINKS?

Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@....

If you do not wish to receive further e-mail promotions, Click Here to be removed. DO NOT REPLY to this message. The e-mail address in which you are subscribed is rcross@.... Copyright 2002. All rights reserved.

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[PMX:#] ACA EVP Weekly Report

Memorandum ACA Members, House of Delegates, Board of Governors and Other Interested PartiesFrom: CuneoRe: ACA Executive Vice President’s Weekly ReportDate: February 16, 2004

This week’s report includes the following items:

1. JUST BECAUSE YOU READ IT IN A NEWSPAPER DOESN'T MEAN IT’S TRUE2. SACA's NCLAF 1000 CAMPAIGN AIMS TO GET “SIMPLE JUSTICE” FOR THE PROFESSION3. ACA PRESIDENT INVITED TO PRESENT AT IASIU’S 19th ANNUAL SEMINAR AND EXPO ON INSURANCE FRAUD4. ORAL ARGUMENTS IN TRIGON SUIT JUST AROUND THE CORNER5. MEMBERS OF CONGRESS CONFIRM FOR NCLC6. INSURANCE JOURNAL COVERS ACA'S CLAIMS SOLUTIONS WORK GROUP7. LOSACK: A REAL AMERICAN HERO8. LONG TERM CARE INSURANCE FOR ACA MEMBERS9. NCLC FEATURED SEMINAR: TRANSFORM YOURSELF INTO A CODING PRO AS YOU NAVIGATE THE INSURANCE & CODING PROCESS10. CAN’T ACCESS THESE LINKS?

1. JUST BECAUSE YOU READ IT IN A NEWSPAPER DOESN'T MEAN IT’S TRUE

If you happen to be a history buff, you are undoubtedly familiar with the headline that appeared in the Chicago Tribune the day after the 1948 presidential election, announcing the election of Governor Dewey. Clearly, the editors misread the polls and provided the wrong information, as it was in fact Truman who was reelected president. While we perhaps can excuse this error, other national newspapers have not always been responsible in their reporting. In the late 1890s, the Hearst newspapers sensationalized a situation in Cuba, leading America to become involved in the war against Spain. As a result, a new expression entered the world of journalism, as reporting false and/or distorted news became known as “yellow journalism.” Regrettably, our other national organizations with publication in the profession are giving new meaning to the phrase "yellow journalism" as they distort the recommendations of the Chiropractic A! dvisory Committee of the Department of Veterans Affairs. Let’s examine some of the headlines from their recent issues:

A) ICA Fights for Direct Access, ACA Votes for MD ReferralB) Profession Could be locked out of VA: ACA Ignores Promise to Fight for Direct Access

Here is a dose of reality: ACA doesn't have a vote on the advisory committee and neither does ICA. Three of the 12 members are ACA members, but they were appointed by the Secretary of the Department of Veterans Affairs (DVA). We supported their appointment, as did the Association of Chiropractic Colleges (ACC), and support their actions, as does the ACC, as the best hope for our veterans. In fact, only one vote was taken on direct access and the ACA members voted for it, but they were in the minority.

There was no vote on MD referral. The fact is, veterans who wish to seek chiropractic care shall have access to doctor of chiropractic, if the recommended protocols are adopted by the Secretary. This is a key. The Secretary has the final determination on what protocols are adopted, and he is under great pressure from bureaucrats to water them down. It is our hope that the strong majority vote from the committee on the recommendations, and our own discussions with the Secretary, will result in a favorable outcome. If he waters the recommendations down, we are prepared to go back to Congress as we have done with the Department of Defense (DoD) project. The bureaucrats may not want us, but our veterans do, and so do members of Congress.

The AMA also recognizes the significance of the recommendations that were made, which is why they have joined with the bureaucrats in the DVA to lobby AGAINST them. And for good reason, the January issue of American Medical News published a fairly extensive article on the recommendations made by the committee, and stated in part, "Chiropractic care at the Department of Veterans Affairs would expand dramatically if the final recommendations of the VA chiropractic advisory committee are followed."

A review of a portion of the 38 recommendations made by the committee to Secretary Principi bears out this statement:

a) Inclusion of doctors of chiropractic under Title 38, along with other health care professionals (MD,DO,OD,DPM, and DDS) Direct access to chiropractic care for newly discharged veterans who received chiropractic care in the military for service connected condition(s)c) Inclusion of doctors of chiropractic as full voting members of medical staffd) A goal of providing chiropractic care at all major VA health care facilities, consistent with distance and travel standards for access to specialty caree) Continuance of fee-for-service chiropractic care in areas where veterans do not have easy access to VA facilities with chiropractic servicesf) Inclusion of chiropractic in VA research projectsg) Inclusion of chiropractic in VA training programsh) Comprehensive educational programs on chiropractic for VA physicians, other health care providers, ancillary personnel and patient population

For detailed insights from Drs. Bill , Vaughn and Rick Mc into these recommendations, visit http://www.acatoday.com/government/va/truth_va_recommendations.shtml and scroll through these doctors’ analyses.

2. SACA's ‘NCLAF 1,000’ CAMPAIGN AIMS TO GET “SIMPLE JUSTICE” FOR THE PROFESSION

At ACA’s most recent House of Delegates meeting in Albuquerque, NM, our SACA (Student ACA) leadership set a goal of getting 1,000 students to contribute 10 dollars a month to the National Chiropractic Legal Action Fund (NCLAF). That effort is well underway. Students are organizing to give greater exposure to the effort. "The average student spends $10 a week on coffee" they say, adding, "Imagine if you spent a few of those bucks on chiropractic." As part of this effort, Mcs held a conference call on February 12, updating student leaders on the case status. Dr. J. Flynn, Chairman of both the SACA and NCLAF committees, said it best, "Every student who signs on is making a personal commitment that they care. This action will serve them well as they strive to meet personal and professional goals of success. Given our SACA leadership and their dedication, I am betting that they will reach the 1,000 mark.” If ! you are a SACA student and wish to participate, please contact ACA at 800-986-4636 or your local SACA representative: http://www.acatoday.com/about/saca/directory.shtml

3. ACA PRESIDENT INVITED TO PRESENT AT IASIU 19th ANNUAL SEMINAR AND EXPO ON INSURANCE FRAUD

The International Association of Special Investigation Units (IASIU), the largest national association representing Fraud Special Investigation units, has asked ACA President Krippendorf, DC, to present at their 19th Annual Seminar and Expo on Insurance Fraud, on September 12, 2004 in Pittsburgh, PA. Last September at an IASIU presentation in Florida, there was a focus on chiropractic care during some segments of the presentation. In response, ACA’s vice president for professional development and research, , contacted the director of the IASIU and requested an opportunity for ACA officials to present at an upcoming IASIU Seminar. The representation of the ACA at such a seminar would not only afford ACA an opportunity to communicate the association's position against any sort of fraudulent activity, but it would also give seminar attendees the opportunity to receive information from an informed chiropractic professional.! The ACA welcomes this opportunity to work with the IASIU to set the record straight and to oppose fraudulent activities.

4. ORAL ARGUMENTS IN TRIGON SUIT JUST AROUND THE CORNER

Mark your calendar. The oral arguments before the U.S. Court of Appeals, 4th Circuit, are scheduled for February 24th at 9:30 am Eastern in Richmond, Virginia. The location of the hearing is: 1000 East Main Street, US Courthouse, 2nd Floor, Richmond, VA. 5. MEMBERS OF CONGRESS CONFIRM FOR NCLC

We have received confirmation that the following members of Congress will be presenting at ACA’S National Chiropractic Legislative Conference (NCLC) on Thursday morning, March 4: Senators Jim Talent, Norm , Kent Conrad, Jim Bunning, and Representatives English, Xavier Becerra, Dave Weldon, Jim McCrery, Steny Hoyer, Earl Pomeroy and Collin . During the congressional reception in the evening, we are expecting appearances from a number of other senators and representatives, as well as members of the presidential administration. In particular, we are expecting Senator Chuck Grassley, Secretary Principi and Secretary Tommy . If you add-in other prominent speakers from the Federal Trade Commission, Department of Labor and others that have been previously reported to you, this will be one of the best NCLC’s yet. Visit http://www.acatoday.com/about/nclc2004/ for more information.

6. INSURANCE JOURNAL COVERS ACA'S CLAIMS SOLUTIONS WORK GROUP

Prominent industry magazine, Insurance Journal, recently covered the success of ACA's Claims Solutions Work Group--the program developed by the ACA to help build an infrastructure between the insurance industry and the chiropractic profession. The most recent meeting of the Claims Solutions Work Group marked the sixth time the group has convened since its inception in 1999. Insurance Journal is read by members of all major insurance industry associations, including the Independent Insurance Agents of America, the National Association of Independent Insurers, the American Agents Alliance, the Council of Insurance Agents and Brokers and more, with a circulation of over 42,000. To view the article, visit: http://www.insurancejournal.com/news/newswire/national/2004/01/13/35585.! htm

7. LOSACK: A REAL AMERICAN HERO

I believe you have all heard the story of the heroics of Lt. Col. Mark Losack, DC. Dr. Losack closed down his practice, said goodbye to his family and boarded a ship to Iraq along with his suitcase and his adjusting table. While in Iraq, after completing his normal intelligence duties, he treated his fellow solders--particularly helicopter pilots who came out of combat. His actions didn't make the bureaucrats at the Pentagon happy, but the solders on the ground, including his immediate superiors, were more than appreciative of his skills.

Last September we were honored to have Dr. Losack at our annual House of Delegates meeting. We asked him later to participate in a video supporting our lawsuits. He was more than happy to do so, completing in time for us to show the video at the Seminars in January. Our plan was to show the video and have him come on stage before the nearly 5,000 in attendance. I was backstage with him before his presentation. While I would have been nervous in anticipation of addressing such a large crowd, he was as cool as a cucumber. I guess compared to what he has been through, a speaking engagement is small potatoes. When he came on stage in uniform, he got a standing ovation--not once, but many times. The attendees appreciated a real hero. It almost caused me to sign up for the military--but the recruiter wouldn't stop laughing.

Anyway, this was Thursday night. All day Friday and Saturday, he stood at the National Chiropractic Legal Action Fund (NCLAF) booth, taking pictures for a solid eight hours each day. He wouldn't even sit down because he didn't want to wrinkle his uniform. He completed his efforts Saturday afternoon standing among the leaders in the profession.

He is going back to Iraq in a few weeks and will be stationed in an unpleasant area of the country. We really do have a hero among us--and a truly nice person as well.

Speaking of the program, in a previous report I listed a number of ACA members/delegates who helped promote NCLAF at the Las Vegas Program. As I expected, I did leave off a couple of names. Dr. and his son were also very helpful. I regret the oversight.

8. LONG TERM CARE INSURANCE FOR ACA MEMBERS

Marsh Affinity Group has been chosen as ACA's new insurance administrator for the member insurance program effective October 1, 2003. An important new product Marsh has made available to ACA members is Long Term Care insurance. ACA's carrier of choice for this new product is GE Capital Assurance (GECA), the number one Long Term Care provider in the nation. GECA has been the leader in the Long Term Care insurance market for over 25 years, and they have never raised rates on existing policyholders. Their program is now available to ACA members, their parents, and parents-in-law, in all 50 states.

We consistently hear the same positive message about the value of the GECA Long Term Care product. But one in particular stands out. The Military Officers Association of America (MOAA) tells us that they have endorsed GECA's Long Term Care product since 1997, and it has been growing in participation each year since. They state that they "are very pleased with GECA and Marsh's services.”

However, even though they were totally satisfied with GECA's product, a few years later when the federal government introduced a new plan for federal employees, the MOAA considered replacing it. Although they don't generally compete with federal plans, MOAA decided to keep their existing plan because "the benefits were much better under the GECA plan with only a slightly higher premium.”

Comments like these from other associations, especially one that qualifies for a federal plan, are encouraging and reinforce our belief that we made the right choice for our members. http://www.acatoday.com/membership/longterm_insurance.shtml

9. NCLC FEATURED SEMINAR: TRANSFORM YOURSELF INTO A CODING PRO AS YOU NAVIGATE THE INSURANCE & CODING PROCESS

ACA is pleased to present a new educational seminar featuring Dr. Mark Sanna of Breakthrough Coaching at this year's NCLC. Navigate the Insurance & Coding Process is designed to provide chiropractic professionals with the knowledge they need to successfully steer clear of costly coding errors and protect their practice from claim delays, billing review, and fraud investigations. Participants learn about coding fundamentals, resources, billing, guidelines and documentation that can cut insurance administrative time in half. Get the tools you need to negotiate successfully with insurers and avoid bundling and down-coded claims. DATE: Saturday, March 6, 2004 TIME: 1:00 pm - 4:00 pm LOCATION: Valley Forge Meeting Room, Hyatt Regency Washington COST: ! ; $79 members, $99 non-members

Open to ACA members, non-members, students, CAs, and practice managers. State association executive directors and presidents are invited to attend free of charge. For more information or to register contact Janet Ridgely, Director of Education and Meetings, at 1-800-986-INFO (4636), x216 or email jridgely@.... Space is limited; register early.

10. CAN’T ACCESS THESE LINKS?

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[PMX:#] ACA EVP Weekly Report

MEMORANDUM

TO: ACA MEMBERS, HOUSE OF DELEGATES , BOARD OF GOVERNORS AND OTHER INTERESTED PARTIESFROM: GARY CUNEORE: ACA EVP WEEKLY REPORTDATE: March 22, 2004

This week's report includes the following items:

1. ACC SUPPORTS RECOMMENDATIONS OF THE VA ADVISORY COMMITTEE2. SIMPLE JUSTICE II AND LT. COL LOSACK ON WEB PAGE3. WHAT KIND OF IMPACT DID WILK HAVE ON THE PROFESSION?4. CCA TAKES AN IMPORTANT STEP BY SUPPORTING BEST PRACTICES5. TROUBLESOME ISSUE: GROWING MOVEMENT BY INSURERS NOT TO COVER THE TREATMENT OF CHILDREN6. STATE HEALTH PRIVACY LAWS RELATIONS TO HIPAA7. MOVIE CREDITS INCLUDE THE NAME OF A D.C.8. ORDER YOUR CD-ROM OF THE FEBRUARY LIVE TELESEMINAR - "CODING SOLUTIONS" 9. CAN'T ACCESS THESE LINKS?

1. ACC SUPPORTS THE RECOMMENDATIONS OF THE VA ADVISORY COMMITTEE

At its meeting in Las Vegas last weekend, the Board of Directors of the Association of Chiropractic Colleges (ACC) voted unanimously to support the recommendations of the VA Advisory Committee. O'Bryon, executive director of the ACC, stated, "The ACC supports the Chiropractic Advisory Committee recommendations to Secretary Principi, and if the Secretary adopts the recommendations, our veterans will have access to doctors of chiropractic." The ACA is already on record in support of the recommendations.

The ACC board is composed of the presidents of the CCE-approved chiropractic colleges in the United States as well as schools in Canada and England.

The next meeting of the VA Advisory Committee is scheduled for March 30 and 31 in Washington, D.C. Included on the agenda is "Status of Recommendations to Secretary." At NCLC, the chief of staff to the VA Secretary indicated that she expected a decision by the Secretary shortly. My guess is that his views will be learned at the meeting.

For further details on ACA's position regarding this matter please visit ACA's Web site at <http://www.acatoday.com/government/va/>.

2. SIMPLE JUSTICE II AND LT. COL LOSACK ON WEB PAGE

We've set up a new page on our Web site with both Simple Justice films and the new film with Lt. Col. Losack. Check it out at <http://www.acatoday.com/legal/video.shtml>.

Simple Justice II and the Losack film are the newest videos that we first unveiled at in Las Vegas. Simple Justice II continues on the theme from Simple Justice I where Dr. Carl Cleveland discusses the purpose of the lawsuits, what we have accomplished and what we hope to accomplish. The video featuring Dr. Losack is even more inspirational, if that's possible. Dr. Losack is a real American hero, dressed in his Marine uniform he puts a real perspective on the importance of the suits.

3. WHAT KIND OF IMPACT DID WILK HAVE ON THE PROFESSION?

The other day I asked Mcs to dictate to me in two sentences what he believes was the impact of the Wilk decision on the profession. He dictated the statement and then asked to see it for further consideration. He has never done that before, which indicates that this statement received a lot of his consideration:.

"The Wilk vs. AMA case tore away the medical profession's illegal efforts to prevent the public and individual MDs from learning about the superior training, education, and results achieved by chiropractors in significant areas of human health. The resultant interprofessional cooperation, patient acceptance, and billions of dollars of income that then moved to the chiropractic profession enabled the profession to expand its scope and quality of services, engage in research, improve its colleges and universities, gain credibility with legislative bodies, and to continue to challenge other illegal acts flowing from the callous greed and disdain for patients exhibited by certain medical physicians and entities controlled by them such as certain hospitals, insurance companies, HMOs, etc."

I am sure that anyone who has been around the profession for 20 or more years has their own story about the impact of the Wilk decision on the profession. Here is mine: In the early 90s, the CCA had a few bucks in the till and decided to retain a researcher to put together all the documents that existed in public and private sources regarding the cost effectiveness and efficacy of chiropractic. This guy was one of the best in the business and was expensive. After working on the project for a couple of weeks, he came back very discouraged. He said that with a few exceptions prior to the late 80s, there was very little material on chiropractic. It was like we didn't exist. He reduced his fee substantially and provided us with a very thin book. If the boycott had a dramatic effect it was in discouraging organizations from discussing chiropractic. Things changed substantially after the Wilk decision. Court actions do count.

4. CCA TAKES AN IMPORTANT STEP BY SUPPORTING BEST PRACTICES

I think most of us have heard of the problems in California that our doctors have faced with the recently passed workers compensation reform bill, and with legislation that is being proposed. The last set of bills signed by former Governor Gray instituted a hard cap of 24 visits for injured workers. Included in the statute was the requirement that the visits follow the guidelines established by the American Council on Occupational and Environmental Medicine (ACOEM) or its equivalent. These are very tough guidelines and I doubt anyone can come close to 24 visits by following them. If you don't believe me, go to www.acoem.com for further information. What is scary is that carriers may be looking to California in deciding the work comp policy in other states.

The California Chiropractic Association (CCA) is trying to address this problem in part through the Council on Chiropractic Guidelines and Practice Procedures (CCGPP). As I think I have mentioned in previous reports, the ACA, along with the other national chiropractic organizations, has joined with COSCA in organizing the CCGPP. CCGPP was established to review, update and publish information about chiropractic practice for use by all stakeholders who impact or are impacted by chiropractic. They have retained a company to put together a Best Practices document. Most of the national organizations including the ACA are contributing to this effort. At the recent CCA Board of Directors meeting, the CCA stepped forward in a big way, contributing $30,000. Very smart! The CCA believes that the CCGPP best practices guidelines will provide a flexible, patient-specific road map for patient care that will blend the most recent chiropractic research with practi! cing doctor experience. Of particular importance to the CCA is that the lower back guidelines are expected this June and will be presented to the administrative director of the California Division of Workers Compensation for adoption as a substitute to ACOEM..

As an aside, the Association of Chiropractic Colleges have indicated their support for this project by agreeing to contribute $50,000.

5. TROUBLESOME ISSUE: GROWING MOVEMENT BY INSURERS NOT TO COVER THE TREATMENT OF CHILDREN

An issue of growing concern to the ACA is the number of carriers that are not reimbursing for the treatment of children under the age of 12. Over the last couple of years we have attempted to set up meetings with the medical directors from various carriers - particularly among Blue Cross plans - to challenge their conclusions. Finally, we were successful in setting up a meeting with Care First BCBS of land. In January, Drs. Bill Lauretti, delegate from land, Bruce Nordstrom, delegate from the District of Columbia and Pat , ACA vice president of professional development and research, met with the Care First Medical Policy Committee. BCBS had 19 people involved - from the senior medical director to specialists (pediatricians) to health policy analysts, technology assessment experts, fraud investigators and RNs. Some also attended by conference call. By the number and quality of the participants it was clear that the Blues were taking t! his meeting seriously.

We did not get a lot of warm and fuzzy feelings from those in attendance. They asked for research data on the treatment of children. We provided them with some but also noted that studies on medical care are few and far between. When they mentioned safety concerns, we pointed out the report from NCMIC that indicated that only 2 percent of chiropractic malpractice claims concerned the treatment of children, compared to 10 percent among medical providers. They promised to take the issue under advisement.

We are providing additional research information that they requested on colic, ear infections, etc. Dr. Lauretti will be supplying a study on the force/safety of manipulation. The Medical Policy Committee's major focus is quantifying the safety of manipulation for children and infants.. Clearly, they don't understand chiropractic and we will do our best to educate them, assuming that the lack of information is the reason for their skepticism. This isn't going to be easy, but we must maintain the dialogue.

6. STATE HEALTH PRIVACY LAWS RELATIONS TO HIPAA

The Centers for Medicare & Medicaid Services has compiled a summary of information contained in state health privacy statues, which are related to HIPAA. You can learn about your state privacy law by clicking on the following link: <http://www.acatoday.com/government/hipaa/state_laws.shtml>.

7. MOVIE CREDITS INCLUDE THE NAME OF A D.C.

You have probably read a lot about or even seen Mel Gibson's movie, "The Passion of Christ." You probably have an opinion on it as well. But one thing you probably didn't realize is that in the movie credits, there is a doctor of chiropractic listed as "Staff Chiropractor." This is Mel Gibson's personal doctor who we understand was on the set during the entire filming treating Mr. Gibson and other members of the production team.

8. ORDER YOUR CD-ROM OF THE FEBRUARY LIVE TELESEMINAR - "CODING SOLUTIONS"

If you missed the first in the series of ACA's live teleseminars, "Coding Solutions," order your CD-ROM of this educational teleseminar today. Speaker Hamm, DC, Chairman of the ACA Coding and Reimbursement Committee and ACA Representative to the American Medical Association RVU Update Committee (RUC) and Health Care Professionals Advisory Committee (HCPAC) spoke about key coding issues including chiropractic manipulative treatment, physical medicine, modifiers, troubleshooting and other chiropractic related services.

Just read what one participant of this live teleseminar had to say.

"Thank you for the opportunity to participate in the seminar. I learned quite a bit of information and would love to participate in future teleconferences, or actual seminars related to insurance/billing/motivational as well." - Kathy ez, Sylvia Chiropractic Center

*Price: ACA Member: $39.00; Non-member: $69.00To order your CD-ROM version of "Coding Solutions" call 800-368-3083. Order Item Audio 32.

*Includes conference materials and speaker handouts

9. CAN'T ACCESS THESE LINKS?

Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@....

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[PMX:#] ACA EVP Weekly Report

Memorandum ACA Members, House of Delegates, Board of Governors and Other Interested PartiesFrom: CuneoRe: ACA EVP Weekly ReportDate: April 6, 2004

This week's report includes the following items:

1. OBSERVATIONS FROM THE MEETING OF THE VA CHIROPRACTIC ADVISORY COMMITTEE2. CONGRESSMAN FILNER COMMENTS ON ACA-SPONSORED DIRECT ACCESS BILL3. APRIL 5-11 IS NATIONAL PUBLIC HEALTH WEEK4. CLAIMS SOLUTIONS WORKGROUP: ANOTHER SUCCESS5. CAN'T ACCESS THESE LINKS?

1. OBSERVATIONS FROM THE MEETING OF THE VA CHIROPRACTIC ADVISORY COMMITTEE

Sitting in the room last Tuesday morning, waiting for the beginning of the meeting of the Department of Veterans Affairs (VA) Chiropractic Advisory Committee I felt pretty satisfied. Thanks to the efforts of our government relations team, we had not only gotten an advance copy of Secretary Principi's decisions on the VA committee's recommendations for implementing the chiropractic benefit into the VA, but we had also gotten a commitment from Congressman Bob Filner (CA) to introduce a direct access bill. Filner was in fact planning to present the bill that afternoon. (Hey, you don't get listed in the Washington Times as the 19th most effective lobbying group by sitting on your hands.) And thanks to our Communications department, we had already distributed a press release to the general public and to the chiropractic media on our observations regarding the recommendations, and another press release was ready and waiting to go out that aft! ernoon regarding the Filner bill.

I was really pleased that we were able to compliment what the ACA members on the Chiropractic Advisory Committee had already accomplished. Anyway, the meeting began with the advisory committee members receiving for the first time a copy of the Secretary's decisions on the recommendations. Sara McVicker, the program manager of the committee who all members of the committee have praised for her fairness, efficiency and frankness, began the meeting with an overview of the recommendations.

If you wish to view the recommendations of the Secretary, please visit: <http://www.acatoday.com/membersonly/frameset.cfm?FIND=va_responses.pdf>. You will need your ACA member ID and password to access the document. The document sets forth each of the VA committee's 38 recommendations and indicates the Secretary's position and rationale for each. It's really an exceptional document. I am not going to spend a lot of time reviewing these as previous reports and press releases have already accomplished that. What I want to do is to provide you with the observations I made while the recommendations were being reviewed.

1. Sara McVicker mentioned a couple of times during the presentation the exceptional involvement of the Secretary in reviewing and deciding on these recommendations. Ordinarily he relies on his subordinates to make the decisions on such recommendations, but in this instance, he took particular personal interest, reading every word and making revisions to what his staff had prepared.

2. There was concern that the VA facilities may have too much leeway in implementing some of the recommendations. Sara noted that the Secretary's strong words in the recommendation would make clear that this attitude would not be ignored (the Filner bill also provides insurance in this regard).

3. This week or next the Secretary will send a directive to the VISN Chief Medical Officers in each of the 21 VA regions, urging them to identify one or more sites (VA Hospitals). In the Secretary's comments to Recommendation # 21 on site selection gives an indication of his intentions: "The VA concurs that the VISN Chief Medical Officers should identify sites that they believe will be most successful in integrating chiropractic care. While VA understands the desire of the Committee to eventually see chiropractic care available at all major VHA facilities, VA will need to evaluate and learn from the initial placement of doctors of chiropractic in order to facilitate later expansion of the program, evaluate demand in relation to VHA distance and time standards for specialty care, and determine the resources required to initiate and maintain chiropractic care at additional sites."

4. The Secretary's comments on Recommendation #21 were significant in another respect. His opening statement was, "It would appear that the intent of this recommendation is to ensure that chiropractic care is ultimately available and accessible to veterans who need it through the VA health system. VA agrees with the intent of this recommendation." The statute only required that the VA set up at least one site per region.

We believed that pressure for chiropractic care from the veterans community would force the VA to expand these sites, and we believe this will happen. However, the Secretary of the VA having the intention of making this program work is icing on the cake.

5. One of the medical doctors on the committee indicated that he was already in consultation with the chief of staff of a VA hospital about designating this hospital as one of the hospital sites. He expressed frustration that certain things needed to be done before this could happen. We should expect bumps in the road even when there is an interest in doing this, but the good news is there is definite interest. However, I must repeat this won't happen overnight.

6. Two of the chiropractic members of the committee, Drs. and Rick Mc, were also on the Department of Defense (DoD) Advisory Committee. Dr. Mc commented on the different atmosphere that existed in working with the VA staff from the DoD experience, which may account for the more successful outcome. Everything in DoD was close to the vest -- their staff wasn't overly cooperative and didn't make an effort to share information with the chiropractic community. We have had to go back to Congress to push the DoD to get as far as we have. Of course, it also helps that the chairman of the VA advisory committee was Dr. .

7. There was one awkward moment for at least one member of the advisory committee. After Sara presented the recommendations, she passed out an email from the President of the WCA, sent to Secretary Principi, complaining that the recommendations had no provision on direct access and stating that, "...I would rather see chiropractors excluded from the entire program rather than included for the wrong reasons..." After the Secretary adopted most of the recommendations, which placed DCs squarely in the VA system, everyone in the room including the WCA representatives shook their heads in amazement.

We still have a long way to go, but clearly we have come a long way.

2. CONGRESSMAN FILNER COMMENTS ON ACA-SPONSORED DIRECT ACCESS BILL

The dueling press releases from various organizations regarding Bob Filner's introduction of a direct access bill created some confusion (probably intentionally) as to who the sponsor of the bill was. I think if you read our press release and compare it with one other association, you would see some similarities. In case there is still any confusion as to the instigator of this bill, Congressman Bob Filner clears it up in his statement published in the March 31st issue of the Congressional Record, which details the purpose of the bill. It states in part, "I have worked closely with the patients, our veterans, who know the benefits of chiropractic care. I was also pleased to work with the American Chiropractic Association (ACA), the nation's voice of doctors of chiropractic and their patients..." Filner continues:

"I understand that the VA Secretary Principi has just released some new policy directives regarding chiropractic care and that, at last, we may be on our way to seeing the true and fill integration of chiropractic care into the DVA. But Mr. Speaker, if the past is any guide to the future, then I must remain concerned until I see these new policies firmly in place and working well in all DVA treatment facilities. To help ensure that in the future, barriers to veterans who want and need chiropractic care are fully removed, I am pleased to introduce legislation that require the DVA to make chiropractic care available on a direct access basis to our veterans. If the previous legislation had actually been implemented, my legislation would not be necessary-because referrals to doctors of chiropractic would actually be taking place with the encouragement and support of DVA leadership. I hope this is what happens under Secretary Pri! ncipi's new guidance-but as insurance, Mr. Speaker, in case the Department loses their newfound enlightenment somewhere along the way-perhaps under a less supportive Secretary-then the enactment of the legislation I propose would guarantee the right of a veteran to obtain this important service without the cost and stumbling blocks of going through potentially hostile gatekeepers..."

Visit the following link for a copy of the Congressional Record and the article by Congressman Filner: http://frwebgate.access.gpo.gov/cgi-bin/getpage.cgi?dbname=2004_record & page=E489 & position=all

3. APRIL 5-11 IS NATIONAL PUBLIC HEALTH WEEK

ACA has once again signed on as an official partner in National Public Health Week, sponsored by the American Public Health Association. The theme for National Public Health Week 2004 is Eliminating Health Disparities: Communities Moving from Statistics to Solutions. As concern grows about increasing health disparities across the country, APHA and its partners will hold a series of town hall meetings around the country from April 5 -11 to highlight community programs and creative solutions to eliminate health disparities. Doctors of chiropractic play a critical role in the public health of their own communities, as we protect, promote, and restore people's health. To learn more about National Public Health Week Activities, visit: <http://www.apha.org/NPHW/>. And for a complete lis! t of National Public Health Week national partners, visit: <http://www.apha.org/NPHW/sponsors/national.cfm> 4. CLAIMS SOLUTIONS WORKGROUP: ANOTHER SUCCESS

The 7th Claims Solutions Workgroup (CSWG), held at ACA's National Chiropractic Legislative Conference (NCLC), was prompted by insurers' request to collaborate on ways to deal with fraud within health care. The ACA came together with nearly 20 of the nation's top insurers. A list of the carriers and organizations is provided below.

The morning session included opening comments from Pat , ACA's vice president for professional development and research, Dr. Eugene of the Council on Chiropractic Guidelines and Practice Parameters, and Mr. Phil Denniston, who presented on the development of chiropractic "best practices." I also addressed the group. There was a spirited discussion on payer methodology used to determine fraud related to chiropractic claims, with the ACA doing its part in educating the insurers about routine chiropractic treatments. The next CSWG meeting is tentatively scheduled for Fall, 2004. Many of the insurers agreed to serve on CSWG subcommittees, which have been set up to help adjusters in understanding what actually constitutes fraud, as opposed to what they believe to be abusive or fraudulent.

Pat and Dr. Gentile provided information on ACA action steps to date, addressing many of the issues raised during the meeting, including: ACA's Fraud and Abuse Policy, development of a draft clinical documentation manual, ACA Coding Talking Points, and development of an chiropractic education series for claims adjusters.

We also got an ear-full from the representatives about the abuses in the profession. I was the executive secretary of the state board in California for seven years, so I thought I had heard all the horror stories. Well, there are a number of new ones. As much as we need to be concerned about the abuses by the insurance carriers, we also need to be concerned about the abuses in our own profession.

Overall, ACA leadership was very pleased with the number of CSWG VII attendees, their willingness to engage in an open discussion on a difficult topic, and interest in working with the ACA in the future to address these and other payer issues.

Attendees:

AAHP-HIAAAIG Claim Services, Inc.AMI InsuranceAmerican Family InsuranceAllstate Blue Cross/Blue Shield AssociationBlue Cross/Blue Shield of South CarolinaBlue Cross/Blue Shield of IllinoisEmployers Mutual Casualty of Des MoinesErie Insurance GroupGeneral CasualtyHarleysville InsuranceHighmark InsuranceLiberty Mutual Insurance Co.Met Life Auto and HomeNationwide InsuranceProperty Casualty Insurers Association of AmericaShelter InsuranceState Farm InsuranceTennessee Farm BureauWork Loss Data Institute

5. CAN'T ACCESS THESE LINKS?

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[PMX:#] ACA EVP Weekly Report

Memorandum ACA Members, Board of Governors, Delegates and Other Interested PartiesFrom: CuneoRe: ACA EVP Weekly ReportDate: April 19, 2004

This week's report includes the following items: 1. ERISA PRACTITIONER EDUCATION MATERIALS AVAILABLE2. MAY IS CORRECT POSTURE MONTH: A NATIONAL OBSERVANCE SPONSORED BY THE ACA3. ACA RESPONDS TO WALL STREET JOURNAL EDITORIAL4. ANTHEM (TRIGON) AWARDS THEIR EXECUTIVES5. CONGRESS IS A CLICK AWAY WITH ACA's LEGISLATIVE ACTION CENTER6. VA UPDATES ITS WEB SITE7. GR BRIEFING MEMBERS OF CONGRESS REGARDING SECRETARY'S RECOMMENDATIONS8. ACA ENDORSES ACC STATEMENT REGARDING THE COUNCIL ON CHIROPRACTIC EDUCATION9. SUMMARY OF COMMENTS ON NCQA's HEDIS 2005 MEASURE: USE OF IMAGING STUDIES FOR LOW BACK PAIN10. ! SPECIAL OFFER TO STATE ASSOCIATIONS: ACA EDUCATIONAL CODING PROGRAMS ARE UNDERWAY!11. CAN'T ACCESS THESE LINKS?

1. ERISA PRACTITIONER EDUCATION MATERIALS AVAILABLE

ACA's ERISA (Employee Retirement Income Security Act) Task Force has worked over the last few months to develop ACA ERISA practitioner education materials. These materials serve two main purposes: (1) to educate practitioners on favorable ERISA regulations and (2) to provide information on how to file an appeal in the case of an adverse decision (denied claim, denied benefits, etc.). The materials can be accessed on ACA's Web site at: http://www.acatoday.com/pdf/GeneralPublicERISA.pdf According to ERISA, the "Introduction to New Regulations" section of the materials is an example of the important information available in the education materials.

ERISA's regulations only cover plans provided by private employers; therefore, non-private employer-provided plans are not covered under ERISA regulations. ERISA regulations apply to private employer plans that are self- and fully-insured.

The ERISA Task Force also developed a second, more in-depth article, titled ERISA: 2003 Rulings and Impact on Chiropractic. It includes specific instructions on how to file an appeal in the case of a denied claim or benefits. Available to ACA members only, this document can be accessed on ACA's Web site here: http://www.acatoday.com/membersonly/frameset.cfm?FIND=/MembersOnlyERISA.pdf. Both of the documents mentioned above include an important list of states that may be affected by the 2003 ERISA pre-emption rulings.

Most practitioners should learn more about ERISA regulations, obtaining a basic understanding including knowledge of the recent court rulings, and ERISA's possible impact on your practice. While the rulings do not mandate chiropractic benefits, from a legislative perspective, these rulings provide a new opportunity for states to revisit indirect regulation of ERISA plans and a real opportunity to ensure ERISA plans are administering chiropractic benefits fairly.

The next mission of ACA's ERISA Task Force will be to address state association education materials, model state legislation, and materials to support state associations in promoting chiropractic to ERISA employers. 2. MAY IS CORRECT POSTURE MONTH: A NATIONAL OBSERVANCE SPONSORED BY THE ACA

This May, during Correct Posture Month, the American Chiropractic Association (ACA) and its members are raising awareness of the hidden risk factors our children face each day at school. Heavy backpacks, poorly designed computer workstations and physical inactivity are all contributing to childhood health problems rarely seen in years past. ACA members can access their official, FREE 2004 Correct Posture Month project kit by simply visiting the homepage of ACA's Web site at www.acatoday.com. Once there, you will just need to have your ACA membership ID and password handy. Your Correct Posture Month kit provides you with all the tools you'll need to make Correct Posture Month a success in your own community. May is Correct Posture Month & the success of this event is limited only by your own creativity and initiative!

3. ACA RESPONDS TO WALL STREET JOURNAL EDITORIAL

This past Friday's edition of the Wall Street Journal included an editorial on the recent workers' compensation package that was negotiated in California between the governor and the democratic legislature. In discussing the results of the workers' compensation package, the author of the editorial threw in the following sarcastic comments about chiropractic:

"This week's bill rewrites the way the system works. The biggest change is that workers initially will be required to choose doctors from a poll that is approved by employers, rather than run to any chiropractor who'll prescribe years of massages. It tightens up standards for defining work related injuries and better ensures that treatments are appropriate."

Over the weekend, ACA sent a letter to the editor of the Wall Street Journal in response to this obviously biased piece, highlighting the real value of our profession in dealing with the injured worker. To view ACA's response, visit: http://www.acatoday.com/media/record/wsj_6.shtml

4. ANTHEM (TRIGON) AWARDS THEIR EXECUTIVES

I've been accused before of being a little slow on the uptake, but this time I think I get it. A recent article in the Dow Business News talked about the bonuses and salary increases of the executives from Anthem BlueCross/BlueShield Inc., including a bonus for the anticipated merger between Anthem and WellPoint Health Networks, Inc. According to the article, the top executive at Anthem is set to receive a $42 million stock and cash incentive package as a reward for the health insurer's rapid growth over the past three years. "The incentive award to Larry Glasscock, the President of Anthem and its chair is in addition to the $1.04 million salary he received last year, a $2.3 million bonus and other 2003 compensation of $273,000. The incentive package will grant Glasscock a cash bonus of $21 million this year, plus a restricted stock award totaling $21.2 million." The article goes on and on about other parts of the package and the bonuse! s/salaries being received by other Anthem executives.

Now I understand why Trigon -- now a part of Anthem -- has fought so hard with our lawsuit. There is just not enough money to go around.

5. CONGRESS IS A CLICK AWAY WITH ACA's LEGISLATIVE ACTION CENTER

The ACA offers a state-of-the-art Web site to further strengthen its aggressive and effective grassroots lobbying capabilities. ACA's Legislative Action Center -- accessible at http://econstituent.votenet.com/(w15dvc452osreo2rciioz2br)/index.aspx/aca/home.aspx -- will provide the nation's 60,000 doctors and 20 million chiropractic patients with the latest information on key health policy issues being considered by Congress and allow for instant contact with elected officials through e-mails and faxes in support of the chiropractic profession's priority issues. If you have any trouble accessing the above link, simply visit www.acatoday.com and look for the Legislative Action Center icon on the top left-hand corner o! f the page.

The ACA Legislative Action Center offers a variety of legislative resources, including ACA campaign letters, a take-action center to write directly to congressmen/women, and a "find your representative" database. It also monitors the congressional floor schedule.

6. VA UPDATES ITS WEB SITE

If you want to look at the Department of Veterans Affair's Web site, which has been updated to include recent information regarding the chiropractic benefit, go to at www.va.gov/primary under the Chiropractic Advisory Committee heading on the left-hand side of the page. The committee's recommendations document is posted in 2 parts -- Recommendations of CAC Nov. 2003, and Summary of Public Comments (which is Appendix D). You will have to scroll down to see both the main heading for the committee and then the recommendations and response. It provides the most up-to-date information from the VA perspective.

7. GR BRIEFING MEMBERS OF CONGRESS ON SECRETARY'S RECOMMENDATIONS

With the recommendations of Veterans Secretary Principi regarding the implementation of the chiropractic benefit in the VA system, your Government Relations staff has been briefing key members and staff of the Senate and House committees with jurisdiction over the veterans administration regarding the key provisions. Like ACA, they have an interest to assure that the recommendations are implemented in a complete and timely manner. Visit ACA's Web site for a complete copy of the Secretary's recommendations: http://www.acatoday.com/pdf/va_responses.pdf

8. ACA ENDORSES ACC STATEMENT REGARDING THE COUNCIL ON CHIROPRACTIC EDUCATION

The ACA Board of Governors elected last Tuesday to endorse the following statement from the Association of Chiropractic Colleges regarding the Council on Chiropractic Education:

"The Association of Chiropractic Colleges supports the Council on Chiropractic Education and the Commission on Accreditation as the accrediting body of the chiropractic profession. Consistent and high quality standards are expected of accredited institutions to ensure the safety of the public. These standards guide accredited institutions by ensuring their graduates are well prepared to serve the public.

Because CCE is recognized by the United States Department of Education, chiropractic colleges are:

Recognized by the U.S. government and thus federal loans are available to our students;

Standards of curriculum have national recognition thus allowing our graduates to apply for licensure to all states (consistent with state requirements);

Graduates are admitted to federal programs as were other health care providers;

Chiropractic availability in federal programs has grown because of the recognition of the CCE by the federal government."

9. SUMMARY OF COMMENTS ON NCQA's HEDIS 2005 MEASURE: USE OF IMAGING STUDIES FOR LOW BACK PAIN

The ACA recently provided comments to the National Committee on Quality Assurance (NCQA) on NCQA's revised 2005 health plan accreditation standards, known as HEDIS® (Health Plan Employer Data and Information Set). ACA comments, provided in response to NCQA's request for public comment, addressed the HEDIS standard on Use of Imaging Studies for Low Back Pain (LBP). ACA's response promoted ACA's involvement in an advisory conference call with NCQA representatives in 09/03; recommended inclusion of CPT Codes 98940 - 42 (Chiropractic Manipulation Treatment) in determining the patient sample population; recommended deletion of references to a six-week waiting period for patients with LBP and no indicators of serious pathology; recommended the plan's patient sample population included chiropractic benefits; and clarified that x-ray studies that show structural degenerative changes, in symptomatic patients, should be given clinical significance.

HEDIS is NCQA's tool used by health plans to collect data about the quality of care and service they provide. HEDIS consists of a set of performance measures that tell how well health plans perform in key areas: quality of care, access to care and member satisfaction with the health plan and doctors. HEDIS requires health plans to collect data in a standardized way so that comparisons are fair and valid. Health plans can arrange to have their HEDIS results verified by an independent auditor.

10. SPECIAL OFFER TO STATE ASSOCIATIONS: ACA EDUCATIONAL CODING PROGRAMS ARE UNDERWAY!

Don't wait to sign your state association up for the ACA's new coding seminar, "Navigate the Insurance & Coding Process" Dates are going fast! Three states have signed on and six more are in line to take part in this exciting new program! This new educational program, now available for your state association through the ACA, provides chiropractic professionals with the tools needed to negotiate successfully with insurers and steer clear of costly coding errors, while protecting your practice from claim delays, billing review and fraud investigations. Participants will master coding clarification for evaluation and management (E & M), chiropractic manipulative treatment (CMT), manual therapy, massage, CPT modifiers, and other chiropractic related services such as writing a diagnosis, x-rays, and hot/cold packs. Generate Revenue For Your State Association: This seminar can be customized for a full or half day formats at the sugges! ted seminar rates and can generate significant revenue. Once your state association sets your date, ACA secures the speaker, and provides presentation materials suitable for duplication and marketing.

Navigate the Insurance & Coding Process is a must for DCs, billing/coding professionals, students, and practice managers! For more information contact: Janet Ridgely, ACA Director of Education and Meetings at Telephone: 1-800-986-INFO (4636), x216 or Email: jridgely@....

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