• Askew JJ
• Kranz KC
• Whalen WM

• Affiliation / New York State Chiropractic Association
• Affiliation / Sanford Health Chiropractic and Occupational Medicine
• Affiliation(G) / United States / California / Santee
• Affiliation(G) / United States / New York / Niskayuna
• Affiliation(G) / United States / North Dakota / Bismarck
• Chiropractic / legislation and jurisprudence
• Government Employees
• Medicare
• Open Access Document
• Radiography / legislation and jurisprudence
• Unnecessary Procedures
• Workers' Compensation / legislation and jurisprudence

Objective: The purpose of this article is to explore concerns regarding sections of the federal workers’ compensation law that apply to the treatment and management of work-related injuries of federal employees by chiropractors, and to offer a call to action for change.

Discussion: A 1974 amendment to the Federal Employees’ Compensation Act (FECA) stipulates that chiropractic services rendered to injured federal workers are reimbursable. However, the only reimbursable chiropractic treatment is “manual manipulation of the spine to correct a subluxation as demonstrated by X-ray to exist.” This means the chiropractor must take radiographs in order to be reimbursed. As with other health care professions, chiropractors are expected to practice according to best practices guided by studies in the scientific literature. Yet in the federal workers’ compensation arena, this law requires chiropractors to practice in a manner that is fiscally wasteful, contradicts current radiology standards, and may expose patients to unnecessary X-ray radiation. Presently, there is discord between what the law mandates, chiropractic training and scope, and what professional guidelines recommend. In this article we discuss how FECA creates problems in the following 7 categories: direct harm, indirect harm, contradiction of best practices, ethical dilemma, barriers to conservative treatment, fiscal waste, and discrimination.

Conclusion: The 1974 FECA provision requiring chiropractors to take radiographs regardless of presenting medical necessity should be updated to reflect current chiropractic education, training, and best practice. To resolve this discrepancy, we suggest that the radiographic requirement and the limitations placed on chiropractic physicians should be removed.

Author keywords: Chiropractic; Medicare; Radiology; Workers’ Compensation

Author affiliations: JKA: Sanford Health Chiropractic and Occupational Medicine, Bismarck, North Dakota, United States; KCK: New York State Chiropractic Association, Niskayuna, New York, United States; WMW: Santee, California, United States

This abstract is reproduced with the permission of the publisher. Click on the above link for free full text. PubMed Record