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Dynamic Chiropractic – March 26, 2009, Vol. 27, Issue 07

Flexing Muscle in Pennsylvania

PCA steps in when hospitals prohibit DCs from ordering outpatient X-ray services.

By Gene G. Veno

Three years ago, two members of the Pennsylvania Chiropractic Association (PCA) contacted me, complaining that a local hospital in western Pennsylvania was no longer accepting scripts for X rays from doctors of chiropractic. The hospital told the DCs they could only accept scripts from hospital staff doctors. When I contacted the president and medical director of the hospital, they commented that indeed their "new" policy was to no longer accept scripts from chiropractors. That answer was not what the PCA wanted to hear, so we contacted the Pennsylvania Department of Health.

We uncovered a specific hospital regulation (127.32) that clearly and unequivocally states that a doctor of chiropractic (or any health care provider, for that matter) needs to have hospital privileges if they want to send their patients to a hospital for diagnostic tests (X ray, MRI, CT, etc.). Apparently the hospital was relying on this regulation to deny chiropractors (but apparently not other health care providers) the ability to write scripts. Ironically, chiropractors could still get their patient scripts processed at a free-standing, independent facility, but not at a hospital.

Although we were encouraged by numerous parties to basically let this issue slide (the concern was that we could end up creating an even larger issue), the PCA could not ignore the new policy and the inequities it created for our members We felt our profession was being singled out and did not understand why, especially considering we have educational training and certification to take X-rays.

From September 2005 through January 2006, we had countless meetings before the legislative assembly and regulators, to no avail. The then-secretary of health would not issue an order or memorandum clarifying/correcting the regulation, which was now being followed by other hospitals across the state. What once had been standard procedure for hospitals (accepting scripts from chiropractors) had effectively been prohibited statewide.

Then the Department of Health took the matter to another level. The secretary of health issued a letter to every hospital CEO, advising them that hospitals could only accept scripts from health care providers who were members of the medical staff or who had clinical privileges at the hospital. Hospitals could not accept a script from a DC or any health care provider not affiliated with the hospital - even though state law authorized these professionals to write orders for diagnostic radiology tests.

We continued to pursue this issue by every imaginable means. Legislators began writing and our members began calling hospital CEOs. (Surprisingly, many hospital CEOs contacted the PCA seeking our help in getting the regulation amended.)

Finally, in January 2008, we brought the issue before the director of the Governor's Office of Health Care Reform and explained how it was deterring patient access, something directly contrary to the governor's "Patient Access Legislation." We explained that our position was not about reimbursement; our only concern was quality patient care. We emphasized that forbidding hospitals to accept scripts from a DC or any other unaffiliated health care provider was counterintuitive and against the central tenets of expanding access to quality care.

We finally got our meeting before the Department of Health's acting deputy secretary for quality assurance and her staff, who listened to our plea and indicated they would consider our request. Within a month of that meeting, by June 2008, directives were being drafted for our review and consideration. Hospital CEOs were notified that if they requested a waiver to Regulation 127.32, the Department of Health would approve one, something they had previously been unwilling to do. In February 2009, the Department of Health announced the final (revised) regulation.

Doctors in Pennsylvania are once again writing scripts for their patients who need X-rays and other diagnostic tests in a hospital setting, hospital CEOs are happy - and the Hospital & Healthsystem Association of Pennsylvania was so pleased with the outcome that it published numerous communications to members on the regulation change. As always, I just smiled and enjoyed knowing I had a small part in the process.

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