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House Committee on Veterans' Affairs
Subcommittee on Health

Hearing on Chiropractic Services
in the Department of Veterans Affairs
October 3, 2000

Testimony of Dr. Reed Phillips, President,
Los Angeles Chiropractic College, and
Dr. George Goodman, President, Logan Chiropractic College
on Behalf of the Association of Chiropractic Colleges

Mr. Chairman, Representative Gutierrez, Members of the Subcommittee, on behalf of the Association of Chiropractic Colleges (ACC) we thank you for calling this hearing to discuss, among other things, our proposal for establishing direct access, 'full scope of practice' chiropractic health care services for our Nation's veterans through the Department of Veterans Affairs (DVA). Your leadership last year to include a directive in the Veterans' Millennium Health Care Act (Public Law 106-117 ) for the DVA to establish a chiropractic health care policy, further demonstrates your commitment and the Committee's commitment to chiropractic health care for veterans. We also thank you and the Members of the full Committee on Veterans' Affairs for your strong support over the years for chiropractic health care generally, and for our profession in particular.

Mr. Chairman, this Subcommittee, perhaps more so than any other panel in the entire Congress, faces the humbling challenge of authorizing vital health care programs for our Nation's veterans and making sure that they have access to the same high quality care that most Americans already enjoy. By any measure, this Subcommittee has met this challenge and done so in a way that was fair to our veterans and to the taxpayers who support veterans programs.

Mr. Chairman, the chiropractic health care profession is seeking the same health care 'opportunity' for our veterans that is available in the private sector; all fifty States; and soon, within the Department of Defense. More specifically, we want our Nation's veterans to have the same direct access, 'full scope of practice' chiropractic health care that is authorized under State law, and available to the millions of Americans who utilize chiropractic care every year to address a whole host of neuromusculoskeletal and related health care problems. According to data from the NIH Consortial Center for Chiropractic Research, a center located at Palmer College of Chiropractic and established under the auspices of the National Center for Complementary and Alternative Medicine, chiropractic is used by approximately ten percent of the population annually, representing about 192 million patient visits per year. We want our Nation's veterans to have direct access to this fastest growing segment of the so-called complementary and alternative medicine practice in the United States.

Furthermore, the legislative proposal that we have prepared and which was addressed briefly in your September 13th full Committee markup on H.R. 5109, is modeled after the chiropractic health care development plan that was contained in Section 737 of the National Defense Authorization bill for fiscal year 2001-a plan that passed the full House and which we believe will be approved in conference.

Here is what the major chiropractic health care profession organizations are proposing to be included in the next available veterans health care bill.

Our legislative proposal for chiropractic in the DVA is modeled after the well-vetted, well-crafted provision that was approved by the House Armed Services Committee and by the full House as part of the fiscal year 2001 National Defense Authorization bill, H.R. 4205. More specifically, our proposal calls for the development of a plan by the Secretary of Veterans Affairs to provide chiropractic health care services as permanent part of the DVA health care system, beginning at the end of calendar year 2001. Our proposal would require that the plan include two critical components that have also been addressed in the DoD chiropractic plan proposal: direct access to chiropractic care, without requirement for a medical doctor gatekeeper; and full scope of practice of chiropractic health care services to our veterans. The plan would also call for an examination of projected costs of fully integrating chiropractic into the DVA health care system and a review of facilities; in-house v.s. 'contract' doctors of chiropractic; and the personnel structure required to effectively carry out this new health care program within the DVA.

Our plan also calls for making the appropriate statutory changes to address the issue of pay for chiropractors who become employees of the DVA and calls for the establishment of an advisory oversight committee, analogous to the one utilized by the Department of Defense, to ensure that the Secretary has the requisite outside assistance with which to fully comply with the statutory guidelines and carry out the proposed plan for integrating chiropractic into the DVA.

Again, this proposal mirrors the proposal that was marked up in the Senate Armed Services Committee and approved by the full House of Representatives this year, and in our view, is the most effective way to allow the Department to phase in the development and implementation of a direct access, full scope of practice chiropractic health care benefit for our Nation's veterans.

In short, MR. CHAIRMAN, we believe that our proposal is good health care policy for our veterans, as the House obviously felt it was for our active duty military personnel, and we believe that it will make a significant contribution to improving the health and well-being of our Nation's veterans who deserve the very best.

MR. CHAIRMAN, we wish that the Department of Veterans Affairs and the Department of Defense were in full agreement with us on both the need and the methodology for implementing a new, comprehensive chiropractic health care benefit in the two Departments. Unfortunately, new health care policy changes for our veterans and our armed forces are often met with resistance by the bureaucrats and proponents of the status quo in those Departments. Therefore, let me attempt to briefly outline why the ACC is offering its unqualified support to the joint ACA-ICA-ACC legislative proposal for direct access, full scope of practice chiropractic care for our veterans and why we firmly believe that it constitutes a good health care policy change for the country.

First, and perhaps of paramount importance, chiropractic health care has been shown to be efficacious in addressing the $40-50 billion per year back pain problem that confronts the Nation, and, with the support of the Congress and Executive Branch health care agencies, has moved into the so-called 'mainstream' of the health care arena. Doctors of Chiropractic are the product of one of the most rigorous academic, medical, and clinical education and training formats in the entire health care arena and their success with their patients is impressive. Each of the 19 chiropractic training institutions in North America are accredited by the Council on Chiropractic Education, an agency certified by the U.S. Department of Education since 1974. Most importantly, each college requires at least three years of intense undergraduate medical training and education, plus an additional four years at an accredited college of chiropractic, before students can qualify for licensure examinations conducted by the National Board of Chiropractic Examiners. Chiropractic is licensed in all 50 states in the U.S. and has been established in 70 other countries around the world.

Your own Committee, in last year's Committee Report on the Veterans' Millennium Health Care Act (H. Rept. 106-237; pp. 54-55) cited a 1997 Agency for Health Care Policy Research study that said: "There is as much or more evidence for the effectiveness of spinal manipulation as for other non-surgical treatments for back pain", and a New England Journal of Medicine report that the effectiveness of spinal manipulation for certain types of acute pain maladies is no longer in dispute. Your report goes on to cite studies indicating that 'patient satisfaction in the relief of low back pain is as great or greater with chiropractic than with other approaches, even when volunteer patients are randomly assigned to a treatment approach.' Finally, the Committee report laments that, despite the positive results of research on chiropractic, the Department of Veterans Affairs has made only the most limited use of chiropractic care.

MR. CHAIRMAN, we could spend this entire hearing going over the myriad of research studies, randomized clinical trials, and analyses that have been carried out on the effectiveness of chiropractic over the past century. For example, the results of the largest randomized clinical trial ever conducted on chiropractic, confirmed, among other things, that 'when chiropractic or hospital therapists treat patients with low back pain as they would in day to day practice, those treated by chiropractic derive more benefit and long term satisfaction than those treated by hospitals' (T.W. Meade, Director, Medical Research Council Epidemiology and Medical Care Unit, Wolfson Institute of preventive Medicine, medical College of St. Bartholomew's Hospital, London, England, 1995). But I hope that we can all agree that the age-long debate over the efficacy of chiropractic is over; that it is universally accepted as 'mainstream' health care for our citizens; and that it should be available to our Nation's veterans through the Department of Veterans Affairs as it is to the rest of us outside of the DVA.

In this regard, MR. CHAIRMAN, the second compelling reason why our proposed chiropractic health care policy plan should be approved and included in the next available veterans health care bill, is based on the overwhelming success of the recently completed Department of Defense Chiropractic Health Care Demonstration Project. After a five-year pilot program at thirteen military health care facilities across the country and in the Washington, D.C. metropolitan area, the Department of Defense reported its findings to the Congress-findings that, by DoD's own admission, were overwhelmingly positive.

The DoD reported that the problem of spinal maladies among our Armed Forces was major and that the military health care system was not adequately addressing this health care problem. The Department concluded that military personnel who used chiropractic care for the treatment of lower back pain experienced superior outcomes in every one of five different measures of health status, compared to patients who received care from so-called traditional medical providers. MR. CHAIRMAN, I have prepared a chart for the consideration of the Subcommittee, that reflects the patient outcomes results of the Chiropractic Health Care Demonstration Program. (Chart A).

Furthermore, a higher proportion of chiropractic patients in the military reported that they felt better, had less pain, and had fewer restrictions/physical limitations than patients receiving traditional medical care, and reported fewer days away from work or on restricted duty due to their condition. Chart B reflects workdays saved as a result of chiropractic care being provided to our military men and women during the CHCDP.

The report went on to quantify that chiropractic patients were more satisfied with their care than patients who received traditional medical treatments and a higher proportion of patients seen by Doctors of Chiropractic reported greater satisfaction with their improvement and their providers, than patients treated by traditional medical providers. Chart C reflects patient satisfaction results of the CHCDP and has been prepared for your review and consideration.

And finally, the DoD's own report, acknowledged that integrating chiropractic care into the military health care system will result in improved access to health care services for military personnel and will lead to the recovery of between 111,000 and 331,000 additional duty days per year.

In short, MR. CHAIRMAN, the Department of Defense, in perhaps the most comprehensive demonstration of chiropractic health care services in the history of the country, found that chiropractic improved patient outcomes; had overwhelming patient satisfaction; and improved readiness among those men and women of the Armed Forces who sought the care of a Doctor of Chiropractic. By any measure, the DoD Chiropractic Health Care Demonstration Program proved beyond any doubt that chiropractic works for our military and we believe it will work equally well for our Nation's veterans who are eligible for DVA health care benefits.

The plan that we are proposing takes the lessons learned from the comprehensive DoD chiropractic health care demonstration program and the legislative response contained in Section 737 of H.R. 4205 as passed the House, and provides the Committee with a proven 'model' that should be used to begin the process of integrating a comprehensive, direct access, full scope of practice chiropractic health care benefit into the DVA health care system. It worked for DoD and it will work for the DVA.

Finally, MR. CHAIRMAN, the reason that we are actively seeking your support for our proposal is because of the inadequate response of the Department of Veterans Affairs to your legislative directive contained in Section 303 of the Veterans' Millennium Health Care Act. Although technically, the Department did respond in accordance to the instructions contained in Section 303, their proposed policy was woefully inadequate in several key respects.

First, aside from one meeting in February with representatives of the chiropractic organizations, there was no other substantive input sought by the DVA from our organization or any of the other groups that are testifying before you today. Language contained in House Report 106-237 made it crystal clear that the VA should consult with Doctors of Chiropractic to assist the VHA in the development and implementation of its chiropractic treatment policy'. Again, after February 24th, there was essentially no role whatsoever played by any of our organizations or our Members in the development or implementation of the flawed DVA policy presented to the Congress on May 5, 2000.

Second, the clear message in your Committee report accompanying the Veterans' Millennium Health Care Act was that chiropractic was efficacious and the time had come to develop a comprehensive chiropractic health care/treatment policy for our veterans that was different and better than the inadequate existing policy at the DVA. Unfortunately, the DVA spent the first half of its written policy document debating the efficacy of chiropractic rather than proposing a real, substantive policy that would enhance-not retract-chiropractic health care treatment for our Nation's veterans whom are eligible for VA health care.

Third, the proposed policy itself completely ignores the prospect of a direct access chiropractic health care benefit that is available elsewhere in health care plans and merely dusts off it's existing 'referral only' approach to providing medical gatekeepers to screen whether or not a veteran should have the opportunity to see a Doctor of Chiropractic. In a health care setting where chiropractic health care services lay dormant and where DVA health care providers are biased against chiropractic, a gatekeeper/ referral system would effectively shut most veterans out from obtaining this valuable health care treatment at DVA facilities or anywhere else.

Fourth, the Committee clearly stated that it wanted the DVA to give great weight to a policy that would provide greater access to chiropractic care in rural and medically underserved areas. Nothing that we can find in the May 5, 2000 DVA policy document addresses providing access to chiropractic care for veterans residing in rural or medically underserved areas. Our legislative proposal will address the role of Doctors of Chiropractic in rural and medically under-served areas.

Finally, the flawed DVA policy clearly makes chiropractic health care available at the discretion of individual DVA medical doctors and significantly limits the scope of practice for Doctors of Chiropractic whom would be providing services to our veterans. Again, we believe that a full scope of practice as authorized under State law, should be the minimum criteria utilized in providing chiropractic health care to our veterans at DVA facilities. We also believe that the clear intent of the Committee on Veterans Affairs and ultimately the House-Senate conferees was that the policy of providing chiropractic health care services to veterans was to be 'mandatory' and not subject to the individual whim or discretion of existing DVA doctors who largely oppose chiropractic in the DVA.

For these reasons, MR. CHAIRMAN, we would hope that the Subcommittee would revisit our proposal for the development and implementation of a chiropractic health care plan as one of the first agenda items for the Committee next year. Chiropractic care is good for our active duty forces in the military and it is good for our Nation's veterans who deserve the very best in health care services. Chiropractic is effective and should be available to our veterans as it is to most every other American. We hope that you concur and will support our reasoned approach to providing quality chiropractic health care services to our Nation's veterans, beginning in the 107th Congress.

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This page was posted on October 18, 2000.