ACA makes the CARF team

Journal of the American Chiropractic Association, Feb 2001

For years, chiropractors and their patients have been denied access to hospitals and other health care facilities. While those doors have yet to open wide for the profession, important new developments indicate the welcome mat is out. As of January 2001, the American Chiropractic Association gained membership in the Commission on Accreditation of Rehabilitation Facilities (CARF), which oversees the accreditation of rehabilitation facilities that meet its strict national standards. Kim Christensen, DC, DACRB, and president of the ACA Council on Chiropractic Physiological Therapeutics and Rehabilitation, has been selected by the ACA Board of Governors to represent the ACA this year at CARF board meetings. The first meeting is scheduled for March.

Although chiropractic and CARE share a commitment to the highest-quality patient services and outcomes, chiropractors have been conspicuously absent from CARE integrated case management teams. These certified teams currently include physical therapists and other specialists who treat acute and chronic care patients with catastrophic injury.

"Chiropractors have been left out of the integrated health care team," says Dr. Christensen, who is codirector of five clinics in southern Washington. "For years, chiropractors have not been recognized by CARE as part of the delivery of health care services even in areas where there is a natural fit, such as occupational health."

Facility accreditation by organizations such as CARE has become a critical issue, as an increasing number of states have legislated that facilities must meet certain levels of credentialing in order to qualify for medical plans, workers' compensation, and other related programs. At the same time, CARF has led an aggressive campaign to promote its accreditation process to providers, health maintenance organizations, and legislators.

As recently as a few years ago, chiropractic groups have had serious concerns with CARE guidelines. However, several factors have brought about a change in attitude. Recent research and legal actions have garnered increased respect for the chiropractic profession. Additionally, the CARF board, composed of major medical associations across the United States, is experiencing a change in leadership.

"CARE administrators grew more approachable in large part due to the efforts of ACA Vice President Pat Jackson, who had worked with Peggy Neale, one of the CARE national directors and a former insurance associate of Pat's," Dr. Christensen explains. "Pat arranged for me to attend the CARF annual symposium a year ago, and while I was at the convention, I asked their medical directors and CEO if I could spend an evening discussing with them how chiropractic can contribute to the programs they accredit. They all accepted that proposal and thought it was a positive step for the organization."

CARF offers two levels of membership: sponsoring membership, which comes with voting privileges, and associate membership, which does not include voting but does allow members to attend all board functions. Dr. Christensen pursued the latter.

"Rather than jumping in to secure a voting membership immediately, something that might actually work against our getting in the door, I proposed that we enter more gently through an associate member position," Dr. Christensen explains. "The board accepted and granted the ACA an associate membership in CARE, which allows us to be in front of their board members three times over the next year and to provide them with information about how chiropractic fits into their accreditation process. After the March board meeting, I will make a report on the inroads we were able to achieve. The intent is not to push or shove, but to share with them the high-quality chiropractic research and literature that has been produced in recent years in order to open their eyes to what chiropractic can offer their accredited programs."

The value of CARE membership can extend nationwide, opening a broader range of opportunities to chiropractors to provide services in hospitals and other health care facilities. As participants in CARE case management teams, chiropractors may have opportunities in as many as 10,000 programs throughout the country.

"Even if only 5,000 of these were in institutions and hospitals of major significance, that would be a huge boost for chiropractors," Dr. Christensen adds.