South Dakota Chiropractors Associationp

SDCA’s Mission:T E h ETo Enhance, Empower,Promote and Protect theChiropractic Profession.

How Will Health Care Be Delivered In The Future?In The Future?

Who will decide what benefits the citizens of South Dakota will receive?

By 2014 the Patient Protection and Aff d bl C A t (PPACA)Affordable Care Act (PPACA) dictates that Health insurance exchanges will commence goperation in each state. If one is not in place by 2014, the federal government will designate angovernment will designate an exchange.

How Will Health Care Be Delivered In The Future?In The Future?

In the PPACA; Establishment of Exchanges and Qualified Health Plans Proposed Rule, the Department of Health and p , pHuman Services urges state legislative bodies to broadly define the providers eligible to perform primary care services.

“Consistent with the goals and policies of the Affordable Care A i i i i bli hi idAct in supporting primary care, in establishing provider networks that ensure broad access to care, we encourage States, Exchanges and health insurance issuers to consider , gbroadly defining the types of providers that furnish primary care services.”

What is a Health Exchange?g

Health Insurance Exchangesg

• The broad intent of a Health Insurance E h i t l t hilExchange is to lower costs while providing for increased competition and f d f h i Thi t bfreedom of choice. This cannot be achieved without ensuring increased

t i t f h lthaccess to a variety of health care providers as intended.

PPACA Sec. 2706 Non-Discrimination in Health CareNon-Discrimination in Health Care

“(a) PROVIDERS. - A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under theshall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State la This section shall not req ire that a gro papplicable State law. This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishinghealth insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures.

Where Does Chiropractic Fit In?

(1) IN GENERAL- Subject to paragraph (2), the Secretary shall define the essential health benefits except that suchshall define the essential health benefits, except that such benefits shall include at least the following general categories and the items and services covered within the categories:(A) Ambulatory patient services.(B) Emergency services.(C) Hospitalization.(C) Hospitalization.(D) Maternity and newborn care.(E) Mental health and substance use disorder services, including behavioral health treatmentincluding behavioral health treatment.

Where Does Chiropractic Fit In?p

(F) Prescription drugs.(G) Rehabilitative and habilitative services and devices.(H) Laboratory services.(I) Preventive and wellness services and chronic disease management.management.(J) Pediatric services, including oral and vision care.(2) LIMITATION-(A) IN GENERAL The Secretary shall ensure that the scope(A) IN GENERAL- The Secretary shall ensure that the scope of the essential health benefits under paragraph (1) is equal to the scope of benefits provided under a typical employer plan, as determined by the Secretary.

Where Does Chiropractic Fit In?p

• IN GENERAL The Secretary shall ensure that the scope• IN GENERAL. - The Secretary shall ensure that the scope of the essential health benefits under paragraph (1) is equal to the scope of benefits provided under a typical employer plan, as determined by the Secretary.

The largest employer in the state of South Dakota is the state g p yof South Dakota. Currently there are over 10,000 employees and over 20,000 insured lives. All state employees have chiropractic benefits in their planschiropractic benefits in their plans.

What Does Primary Care/Portal of Entry Mean?Portal of Entry Mean?

According to the National Committee for Quality Assurance y(NCQA) “Primary care is a foundation of the health care system The NCQA standardssystem. The NCQA standards reflect elements that make primary care successful. Primary

li i i f h ficare clinicians are often the first point of contact for an individual; thus patient access to care is an pimportant issue.

What Does Primary Care/Portal of Entry Mean?Portal of Entry Mean?

Clinicians must have a broad knowledge of many health care conditions and often follow their patients over the years; thus, the quality of the clinician/patient relationship and thethe quality of the clinician/patient relationship and the clinician’s ability to track care over time are also important.

Many primary care clinicians need to refer patients toMany primary care clinicians need to refer patients to specialists, making communication among providers important - and often challenging.”

1. First point of contact.2. Follow patients for years.p y3. Refer to specialists.

What is Chiropractic?p

Doctors of Chiropractic (DC) are a generalist rather than a specialist. As generalists, we are p g ,concerned with the whole person.

As primary health care providers, DC’s serve as portals of entry into the health service system qualified to diagnose, treat, and refer when indicated.

Does a Chiropractor Have the Training to be a Primary Care/Portal of Entry Provider?be a Primary Care/Portal of Entry Provider?

Yes!In South Dakota: SDCL 36-5-8In South Dakota: SDCL 36-5-8 The minimum requirements for licensure of any person graduating on or after January 1 2011 shallperson graduating on or after January 1, 2011 shall be a baccalaureate degree in addition to a doctor of chiropractic degree. The baccalaureate degree may p g g ybe granted by an accredited undergraduate program or by a chiropractic college or university that can offer

d l da dual degree.

The courses of study are approved by an accrediting agency which are fully recognized by the U.S. Department of Education.

Thi h b th f th 25This has been the case for more than 25 years.

Does a Chiropractor Have the Training to be a Primary Care/Portal of Entry Provider?be a Primary Care/Portal of Entry Provider?

In total, the curriculum includes a minimum of 4,200 h f lhours of classroom, laboratory and clinical experience Chiropractorsexperience. Chiropractors have the ability to differentially diagnose, order y g ,labs, MRI’s, CT’s and X-ray’s They are considered primary care doctors in the state of South Dakota

Can A Chiropractor Be A Primary Care/Portal of Entry Provider?

All Doctors of Chiropractic t i d t f

Care/Portal of Entry Provider?

Like other primary health care doctors, DC’s training

are trained to perform and read X-Rays in South Dakota.

care doctors, DC s training includes subjects related to evaluating and caring for patients as well as completion of a minimum of

li i b da one year clinic based program dealing with front line patient care fromline patient care from pediatrics to geriatrics.

Can A Chiropractor Be A Primary Care/Portal of Entry Provider?Care/Portal of Entry Provider?

Yes! According to the Joint Commission and Medicare, Chiropractors are Primary Care/Portal of p yEntry Providers.The Joint Commission, the largest credentialing body for g g yhospitals and health care organizations in North America, has recently changed its stance on the recognition of chiropractors This organization now recognizes chiropractorschiropractors. This organization now recognizes chiropractors as physicians. This is a major policy change from decades ago, when the commission published an article entitled “The Ri ht d D t f H it l t E l d D t fRight and Duty of Hospitals to Exclude Doctors of Chiropractic.”

Can A Chiropractor Be A Primary Care/Portal of Entry Provider?Care/Portal of Entry Provider?

Glossary of Physician Credentialsy yCH – Chiropractor DDM – Doctor of Dental Medicine DO – Doctor of Osteopathy OD – Doctor of Optometry DPM – Podiatrist MD – Medical Doctor DDS – Doctor of Dental Surgery

How Do Chiropractors Function as Primary Care in South DakotaPrimary Care in South Dakota

Doctors of Chiropractic can perform sports physicals, DOT physicals, and last year Senate billphysicals, DOT physicals, and last year Senate bill SB 149 included Chiropractors as Primary Care/Portal of Entry Providers:Section 5. For the purposes of this Act, a licensed health care provider is a person who is: (1)Registered, certified, li d th i i d i l b th St t flicensed, or otherwise recognized in law by the State of South Dakota to provide medical treatment; and (2)Trained and experienced in the evaluation, management, and care p gof concussions.

Chiropractic Is Distributed Where Primary Care/Portal of Entry Provider Is NeededCare/Portal of Entry Provider Is Needed

• Often in medically underserved areas such

l S th D k tas rural South Dakota, Chiropractors act as usual source providersusual source providers delivering portal of entry care.

• South Dakota has one of the highest usage rate of Chiropractic care in theChiropractic care in the United States.

Chiropractic Is Distributed Where Primary Care/Portal of Entry Provider Is NeededCare/Portal of Entry Provider Is Needed

Dr. Rebecca Bear - Beresford, SDDr. Morgan Dorsett - Webster, SDDr. Stephen Gullikson - Faith, SDDr. Brandon Heck - Isabel & Eagle Butte SDDr Valere Beeck - Alcester SDDr. Valere Beeck Alcester, SDDr. Marvin Braun - Gregory, SDDr. Jeff & Dr. Terry Kramer - Tripp, SDD S d C d C t SDDr. Sandra Conard - Custer, SDDr. Paul & Dr. Leah Thielen - Sisseton, SDDr. Stuart Johnson - Buffalo, SDCarr Chiropractic Clinics - Miller, Faulkton, Kimball & Redfield Ortman Clinic - Canistota, SD

Chiropractic: A Low Cost Solution to High Cost Health CareHigh Cost Health Care

Physical Medicine Pilot on Quality

Th 2008 il t i lit The 2008 pilot, an ongoing quality improvement program for Iowa and South Dakota physical medicine providers analyzed Dakota physical medicine providers, analyzed data on care provided by 238 chiropractors, physical therapists and occupational therapists p y p p pto 5,500 Wellmark members with musculoskeletal disorders.

Chiropractic: A Low Cost Solution to High Cost Health CareHigh Cost Health Care

Physical Medicine Pilot on Quality: First Year Results

Patients who received chiropractic or physical therapy hadPatients who received chiropractic or physical therapy hadlower total health care costs and were less likely to havesurgery than demographically similar Wellmark members whodid not receive such services, and overall, 89 percent of allpatients receiving physical medicine services reportedimprovement of at least 30 percent within 30 days.p p y

• The total healthcare costs of Wellmark BCBS members were significantly lower than medical costs for a similar membersignificantly lower than medical costs for a similar member population who did not receive such services.

Chiropractic: A Low Cost Solution to High Cost Health CareHigh Cost Health Care

“Wellmark is very pleased with the clinical outcomesWellmark is very pleased with the clinical outcomes demonstrated by these practitioners, and will continue working with providers to design programs that help evaluate the value of physical medicine services for members.”

Pamela A. Duffy, PT, PhD, OCSWellmark’s physical medicine director

Chiropractic: A Low Cost Solution to High Cost Health CareHigh Cost Health Care

The AMI Study

• This data was collected from patients who chose their Doctor of Chiropractic as their primary carep p yprovider.• This study focused on the years 1999-2002, and this y yis what they found:

Chiropractic: A Low Cost Solution to High Cost Health CareHigh Cost Health Care

• Decrease of 43% in-hospital admissions per 1,000• Decrease of 58.4% in hospital days per 1,000 • Decrease of 43.2% in outpatient surgeries and

procedures per 1,000• Decrease of 51.8% in pharmaceutical costs.

Chiropractic: A Low Cost Solution to High Cost Health CareHigh Cost Health Care

Stano Cost Comparison StudyStano Cost Comparison Study

Chiropractic: A Low Cost Solution to High Cost Health CareHigh Cost Health Care

• There are currently hundres of studies• There are currently hundres of studies on the cost effectiveness of chiropractic care Please visit www chiro org to viewcare. Please visit www.chiro.org to view more of these studies.

Questions?

In Summary:• Chiropractors are primary care providers.• Chiropractic is cost effective.• Chiropractic is already included in the National Healthcare Plan.