R.M. Masteller, DC
The Civilian Health and Medical Program United Services (CHAMPUS) Chiropractic Demonstration Project was originally mandated by Congress in 1985 but did not get fully underway in Colorado and Washington state until May of 1990. Now, nearly 11 months into the study, there are ongoing allegations and rumors of abuse. In both Colorado and Washington, participating doctors are increasingly frustrated by the CHAMPUS claims handling process.
The demonstration project was designed based on data gleaned from a specially commissioned study done by the Midwest Research Institute in 1985. This study, heavily based on Medicare, formed the basis of CHAMPUS chiropractic treatment parameters.
In May of 1989, the Office of Civilian Health and Medical Program United Services (OCHAMPUS) held an introduction/advisory meeting with representatives of the American Chiropractic Association (ACA), International Chiropractors Association (ICA), Colorado Chiropractic Association (CCA), Colorado State Chiropractic Society (CSCS has since merged with CCA), Washington Chiropractic Association (WCA), United Chiropractors of Washington (UCW), Washington Chiropractic Society (WCS), the Departments of Labor, and the examining boards of both states. At this point, the basic study design had been completed. Originally contemplated as a two year "cost shift" study, the demonstration project was designed to, "Test the hypothesis that chiropractic care is as efficient and effective a method of delivery of care as allopathic or osteopathic medicine for certain conditions." After this meeting there were still a number of unresolved issues, including the provision for covered services to children under the age of 16 and the application of utilization review guidelines.
A comparison of three patient populations was contemplated: beneficiaries who use only a chiropractor; beneficiaries who use a traditional physician as well as a chiropractor; and beneficiaries who use only traditional medicine for certain conditions. All care analyzed will be provided under the CHAMPUS program. The basic data collection instrument is the Diagnosis and Treatment Summary Sheet (DATSS) form which relates appropriate ICD-9 codes & corresponding costs.
Prior to the care start date, the CCA submitted a position paper to OCHAMPUS regarding the importance of the inclusion of minors for chiropractic care. The CCA also spoke with OCHAMPUS regarding the selection and appointment of the peer review organization (PRO) and the mechanism for utilization review. Neither our recommendation for coverage of minors nor our offer of local peer review were accepted by OCHAMPUS.
After a series of training seminars in both Washington and Colorado the demonstration project began May 1, 1990. To date, over 340 Colorado doctors have agreed to participate. In the state of Washington, over 500 doctors are participating. About six months after the care start date, we received indications from the CHAMPUS utilization review coordinator, Richard Mooneyham, D.C., that there was concern on the part of the ACA about overutilization and abuse. No figures were forthcoming from either the ACA or OCHAMPUS to document this.
Realizing the critical importance of the study, the CCA contacted Dr. Mooneyham with the intention of arranging another series of seminars for CHAMPUS providers that would focus on the necessity of proper reporting and documentation of care rendered to CHAMPUS patients. We then received word from the ACA and OCHAMPUS that seminars of this nature could not be conducted as there was a potential of skewing data. In addition, we were informed that OCHAMPUS was working hand in hand with the ACA to redesign the DATSS form to more accurately assign the distribution of costs to related diagnoses.
During this period we attempted to interview Dr. Mooneyham and Dr. Howard Balduc of the ACA about the progress of the demonstration project and the concerns which had been expressed earlier. These interviews were declined based on the need to preserve the integrity of the study.
Ensuing discussions between ACA and CHAMPUS finally resulted in a redesign of the DATSS form. The final form has not yet been approved, although the study itself is nearly a year old. OCHAMPUS has indicated that the care start date can possibly be redefined to 10/1/90 or 11/1/90 to more accurately reflect correct data. To date, no final determination has been made on that issue.
In concert with the redesign of the DATSS form, the CCA submitted a detailed list of concerns which had been expressed by participating doctors. Representatives of the ACA and OCHAMPUS met in December to review the new DATSS form design. They also addressed problems that had arisen on the providers' end, which ranged from inept claims processing to the comparatively high cost of handling CHAMPUS patients due to the overwhelming volume of paperwork, much of which had to be repeatedly resubmitted. While OCHAMPUS has assured both the ACA and the CCA that they are working to resolve these problems, the doctor in the field has seen little change. In order to get the project back on track, CHAMPUS has tentatively scheduled a series of seminars to introduce the new DATSS form and to answer doctors' questions on claims handling for late April.
The CCA is very well aware of the ramifications of this study -- for future federal programs as well as for chiropractic's place in the future health care delivery system. Throughout the planning and implementation stages of the demonstration project, the CCA has made a point of keeping Colorado doctors informed of all developments and aware of the national importance of the study. An article about CHAMPUS has appeared in nearly every issue of the monthly CCA Update and in many issues of the Journal.
R.M. Masteller, D.C.
President, Colorado Chiropractic Association
