New York chiropractors don’t like the new medical treatment guidelines adopted last December by the New York State Workers’ Compensation Board. These changes focus on the treatment for the mid- and low-back, neck, shoulder and knees. The state’s main chiropractic association is lobbying state lawmakers to reverse the new guidelines.
New York State Chiropractic Association President Bruce Silber told Insurance Journal that the guidelines mostly affect chiropractors and physical therapists. “But really, there was no input from these providers” when the workers’ comp board developed these rules, he said. These rules jeopardize insurance for thousands of workers and retirees, he argued.
“They allow two-to-three months to get better. But in the event that people need longer treatments, there is now a great difficulty in getting additional treatments,” Silber said. “In the past, those with a chronic condition were allowed periodic treatments. But now, if you have a chronic, permanent problem, and if it’s not gonna’ get completely resolved, you cannot get a treatment.”
He said California, a state that had adopted similar guidelines, saw its overall cost of care go up. “They said it would reduce the cost of care but it actually went up because people now turn to more costly drugs and surgeries.”
Silber and New York State Chiropractic Association have been lobbying New York State legislators to address their concern. The State Assembly successfully passed a bill earlier this year that would have reversed the change, but it never came to a vote in the State Senate. Silber said lawmakers would reintroduce a similar measure in a future session
Objective Functional Improvement
But New York State Workers’ Compensation Board spokesman Brian Keegan defended the board’s guidelines. He told Insurance Journal that injured workers now receive care pursuant to clear, objective guidelines that are structured to produce improved medical outcomes. They establish “an evidence-based standard of care” that look for “objective functional improvement.”
“If a provider wants to continue care beyond the timeframes outlined in the guidelines, they must simply supply evidence that the care is necessary and is benefiting the patient,” Keegan said.
To date, medical providers have filed 78,178 valid variance requests and more than two-thirds of them were approved immediately by either the insurance carrier or the board, according to Keegan. “No requested service is denied if the provider can show objective evidence that a treatment medically benefits their patient,” he said.
The spokesman took issue with criticism from New York State Chiropractic Association. He said that especially for chiropractic care, the guidelines’ standard of looking for objective functional improvement is ‘exactly the same’ as that recommended by a recent consensus report of chiropractors published in their own journal, the Journal of Manipulative and Physiological Therapeutics.
The Business Council of New York State, a business organization, supports the new medical guidelines. “The Business Council supports evidence-based medicine and a system where the merits of the treatment matter,” said Communications Director Robert Lillpopp. He said New York was one of the last states to adopt impartial medical treatment guidelines, which reflect medical consensus on appropriate and effective care for injured workers.
“These guidelines were developed by a team of medical professionals. The AFL-CIO and The Business Council both supported this approach to ensure injured workers receive medical treatment backed up by solid medical evidence on its effectiveness,” Lillpopp said.
The Business Council charged that a legislative effort to reverse these guidelines is “being pushed largely by a single sector of medical providers — chiropractors — whose services and income are now subject to evidence-based limits for major categories of injuries.”