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Chiropractors' and Accupuncturists' Fight

 Acupuncturists, Chiropractors Reintroducing Bills :


Chiropractors, acupuncturists, social workers and even massage therapists − now left out on the edges of New York state's workers’ compensation system − are trying again in 2014 to get inside.


State Sen. Kevin S. Parker, D-Brooklyn, has introduced a bill, S00803, that would authorize the treatment of workers' compensation claimants by licensed acupuncturists, a bill that stalled in 2013.


Oddly, another acupuncturist bill that would have shifted the regulation of their claims from the Workers’ Compensation Board to the state Board of Acupuncture passed both chambers last year, but was vetoed in September by Gov. Andrew Cuomo.


In his veto message for the bill, Cuomo appeared to presume acupuncturists already are health care providers in the workers’ compensation system, but acupuncture is not mentioned in the workers' compensation law.


"This would create a new system of oversight for acupuncturists separate from that governing other service providers in the workers' compensation program," Cuomo wrote. "I see no reason for affording this one class of providers different treatment."


The vetoed bill, sponsored by state Sen. Jack Martins, R-Mineola, and co-sponsored by Senate Labor Committee Chairwoman Sen. Diane Savino, D-Staten Island, has not been reintroduced. "That’s not going to get a veto override," said Bryan Clenahan, general counsel for Savino. "That’s seismic when that happens."


While acupuncturists are back to square one, chiropractors are continuing to try to build on their entry into the state's workers’ compensation system in 1997.


"It can take time for bills to get traction," said Perry Ochacher, a senior vice president at the Albany lobbying firm of State and Broadway. He represents chiropractors in their third bid to pass a bill that would allow chiropractors to set up business partnerships with physicians. Workers' comp insurers are wary of such arrangements, which they often call "doc-in-a-box," because in the past some doctor-chiropractor partnerships have become medical mills.


The bill’s sponsor last year, Sen. Charles Fuschillo Jr., has retired and the chiropractors are currently looking for a new sponsor for the bill, S1940. But Ochacher said he’s confident one will step forward.


"This is a good time for this bill because of health care developments on the federal level," Ochacher said. "Allowing us to collaborate will contribute to patient care and reduced costs. The question is whether legislators will want to tackle another health care change − even a relatively small one."


Dr. Jason Brown, secretary of the New York State Chiropractic Association, agreed that the bill to allow physician-chiropractor business partnerships will be reintroduced.


"We’ve tried to move this bill for a couple of years," he said, noting that other professionals, including psychologists and psychiatrists, may seek to be added to the bill this time around.


Chiropractors are amenable to that, if legislators are so inclined, Brown and Ochacher agreed. But Ochacher acknowledged that the bill has obstacles, even without tacking on the other professional groups.


"There are certain legislators who are concerned that it might violate the state’s corporate practice of medicine doctrine," he said, referring to regulations aimed at preventing a deterioration of treatment quality by underqualified practitioners. That group includes Sen. Deborah Glick, chair of the Assembly’s Education Committee.


Plus, the New York State Medical Society opposes it. On the other hand, chiropractors have submitted the names of more than 100 doctors who favor the partnerships the bill would allow, and the partnerships are voluntary.


A policy posted on the NYSMS website suggests that the society’s opposition may not be categorical.


It reads: "Whether a physician should have professional relations with chiropractors must be the individual choice of the physician, based on what the physician believes is in the best interest of the patient. As with any limited license practitioner, a physician should be mindful of state laws which prohibit a physician from aiding and abetting a person with limited license in providing services beyond the scope of his license."


At Ochacher’s last count, at least 12 states, including California, Pennsylvania, Florida, Texas and New Jersey, allow chiropractor-physician business partnerships. And several of those states, including New Jersey, also have corporate practice of medicine doctrines like New York’s.


The New York bill contains language designed to address concerns that business partnerships might affect the way patients are treated, Ochacher said. "We specifically say in our bill that chiropractors make chiropractic decisions, while physicians make physicians’ decisions," he added.


Since first winning the legal right to be reimbursed within the workers’ compensation system in 1997, chiropractors have been gradually edging toward parity with physicians on a number of fronts, Ochacher said. "We’re narrowing the gap, but it’s still a work in progress," he added.


Meanwhile, state senators have introduced 2014 bills to expand the operations of licensed clinical social workers and massage therapists in the workers' compensation system. Sen. Jeffrey D. Klein introduced S02360A for the social workers, and Sen. George D. Maziarz introduced S01114A for the massage therapists. Both were referred to the Labor Committee.

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