October 25th, 2016
On October 19 the Office of Inspector General for Health and Human Services (OIG) released another report on chiropractic. Oddly enough the Wall Street Journal had an article on that report published the day it was released (I wonder how that happened). This report stated that 82% of chiropractic services in 2013 were paid in error. This means that chiropractors as a group were overpaid by hundreds of millions of dollars. There are a few problems with this report.
The first being that, based on the other information available from 2013, it is totally wrong. According to the Comprehensive Error Rate Testing program (CERT), the improper payment rate for chiropractors for 2013 was 51.7%. Not good, but certainly not 82%.
The second problem is the methodology used in the development of this report. The authors of the OIG report arrived at 82% by dividing chiropractic services into three groups. The first group included services up to 12 visits, the second group included services between 13 and 30 visits, and the third group included services of 31visits or more. They then randomly selected 35 services for each group and had those services reviewed. You read that right, 35 services per group, a total of 105 services as a representative sample of more than 17 million services performed in 2013. That is 0.0006%. Hardly a representative sampling in this author’s opinion.
The third problem is that the recommendations in this report are a repeat of the same old tired recommendations of the past reports. Essentially they were another attempt to limit chiropractic visits to a certain number annually and disallow all visits after that number is reached.
The flaw in this recommendation is that it would, in certain circumstances, deny Medicare beneficiaries medically necessary care to which they are statutorily entitled.
The fourth problem is that by choosing 2013 as the year studied, this report does not take into account the educational efforts put forth in recent years. There has been considerable effort by the profession through state and national associations to educate the doctors on proper Medicare procedures.
While the CERT improper payment rates have not yet been released for this year, I would expect to see a reduction in those rates as a result of these efforts. This report is very disappointing. After the report issued by the OIG last year that identified specific problems within the profession to be addressed, I was hopeful that real progress was being made in correcting some of the problems that we had with Medicare. This report makes me question that. Especially in light of the fact that an advanced copy appears to have been leaked to the media and used for such a negative article. I see that we still have a long way to go.