Doctors of chiropractic are once again "physicians" in the Blue Cross Blue Shield Federal Employee Program (FEP), a designation stripped earlier this year when BCBS classified chiropractors as "other covered health care professionals."That status change - and its recent correction - are significant because the BCBS program insures an estimated 4 million federal employees, dependents and retirees; and because it is part of the Federal Employees Health Benefits Program, which has been designated as the model for President Obama's proposed health care reform plan, and has already been used as a benchmark for coverage.
The 2010 BCBS Service Benefit Plan, as administered by the BCBS Association, includes doctors of chiropractic under its definition of physician along with medical doctors, doctors of osteopathy, doctors of medical dentistry and dental surgery, doctors of podiatric medicine and doctors of optometry. According to the American Chiropractic Association, the restoration of physician status in the plan is the result of "intensive negotiations" between the ACA and the BCBS Association:
"The agreement culminates months of negotiations between the ACA and BCBSA and assures that a doctor of chiropractic will be identified and defined as a 'physician' in the FEP," said new ACA President Dr. Rick McMichael. "This plan has been specifically and repeatedly identified by Congress and President Obama as the template for coverage and recognition in national health care reform. Physician status under this health plan is critical, and ACA action has assured that this status is once again recognized."
When the 2009 BCBS Service Benefit Plan was released, the ACA noted that downgrading DCs to "other covered health care providers" could dramatically impact chiropractic inclusion in health care reform, particularly because the plan is so highly regarded as a benchmark for health care reform efforts. The ACA offered this example as illustration of the potential consequences:
"[U]nder the SCHIP [State Children's Health Insurance] program, Section 2109 'Coverage Requirements for Children's Health Insurance' lists the 'Blue Cross/Blue Shield preferred provider option service benefit plan' (42 U.S.C. 1397cc(b)) as a 'Benchmark Benefit Package.' No other private health insurer is identified in such a manner. In addition, SCHIP law provides that 'physician services' are included in 'basic services' that must be covered, whereas the services of other health care providers are considered 'additional services' that are optional (42 U.S.C. 1397cc(c)(2))."
BCBS is not the only organization to pass judgment on whether DCs should be designated as physicians; if you recall, last year we reported on American Medical Association (AMA) Resolution 232, approved at the 2008 AMA House of Delegates meeting. That resolution advocated the use of state legislation and other means to make it a felony for any non-MD/DO to misrepresent themselves as a "physician."