Dynamic Chiropractic – March 15, 1991, Vol. 09, Issue 06

A Fresh Bowl of Alphabet Soup

By Donald M. Petersen Jr., BS, HCD(hc), FICC(h), Publisher
As the health care world changes with incredible velocity, it is critical that everyone within the chiropractic profession not only stay abreast of the events that shape our future, but who is making the decisions that drive those events.
If you don't know who to direct your efforts towards, you may find yourself trying to use yesterday's methods to solve today's problems without the advantage of addressing the real decision makers.

Most of the agencies and programs that are shaping our future on a national basis (within the United States) have been reduced to a group of initials. While these initials cause the organization or program to appear small, the impact that they will have on you and your practice in the next ten years cannot be overstated.

It is our intention to provide you with full details of how the chiropractic profession is being (and will be) affected by these groups and programs. Two articles are in this issue; AHCPR and RBRVS. A detailed article on those remaining will be forthcoming.

NIH - National Institute of Health. Until recently (please see AHCPR), this was the primary agency deciding what health care research will be funded federally. Research grants are made by a process of rating the scientific merit of a study as well as its necessity. While this organization is medically dominated, John Triano, M.A., D.C., is frequently called to be a member of special study sections to review grant proposals from all areas of health care that do not fall into the usual study categories.

The chiropractic research community has worked long and hard to in an attempt to break through the barriers that keep chiropractic research from receiving NIH funds (thus far, only a very few research grants have funded for chiropractic). It is hoped that in the future, the chiropractic profession can begin to receive research funding from the NIH. The profession will need to do a better job of funding its own research in order to make this hope a reality.

HCFA - Health Care Financing Administration. Created in 1977, HCFA was established to manage Medicare and Medicaid as well as medical care quality control. Medicare is a federal health insurance program primarily for Americans who are age 65 or over. Medicaid provides financial assistance to individual states which run their own health care assistance programs. Medicaid provides between 50% and 80% of all state program costs.

Policies established by HCFA will many times set standards for other third party payers (please see RBRVS). Medicare and Medicaid programs effect approximately one out of every four Americans.

HHS - Department of Health and Human Services. The HHS is headed by Louis W. Sullivan, M.D. It is referred to as "the federal government's principle agency for furthering the good health of Americans and providing essential health services." The HHS budget, the largest of all federal agencies, accounts for almost 38% of all federal spending.

Social Security, HCFA, Medicare, NIH, Food and Drug Administration (FDA) and AHCPR are but some of the programs belonging to the HHS. The department's services and support affect the lives of one in every five Americans.

AHCPR - Agency for Health Care Policy and Research. This agency was created by Congress within the Department of health and Human Services (HHS) in December, 1989. Its mission is to "enhance the quality of patient care services through improved knowledge that can be used in meeting society's health care needs." For more information please see "Chiropractic Cost Comparison Presented at AHCPR Conference" on page ##.

RBRVS - Resource Based Relative Value Scale. The system of determining the amount of reimbursement that _all_ health care (including chiropractic) will receive. This system will be phased into Medicare from 1992 through 1996. Some form of this system will probably be adopted by many, if not most, third party payers and workers' compensation systems. It would not be unrealistic to say that this system could replace "usual and customary" for every health care service by the end of the decade. For more information, please see "RBRVS - What Is It? How Will It Effect You?" on page #### of this issue.

IAIABC - International Association of Industrial Accident Boards and Commissions. This is an association which includes representatives from every state workers' compensation board as well as representatives from the largest insurance companies, labor concerns, business communities, national agencies and international organizations. If there is ever an action taken on a national basis that will severely affect the chiropractic company, it will be through this organization and its medical committee.

Fortunately, Charles Herring, D.C., is not only representing the ACA and the chiropractic profession as a member of this organization, but he is also a member of the medical committee. For more information on his role and the most recent actions of this committee, please see "The Future of Chiropractic Within Workers' Compensation" in the August 18, 1990 issue and "IAIABC Presents Paper on 'The Role of Managed Care in Workers' Compensation'" in the November 7, 1990 issue.

Congress - that group of chefs in Washington D.C. who include alphabet soup as one of the house specialties.

DMP Jr., BS, HCD(hc)

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