ACA's 2002 Annual report

Journal of the American Chiropractic Association, Nov 2002 by Cuneo, Garrett F

Lawsuits: The Good, the Bad, and the Ugly

Four years ago this November, we filed our lawsuit against the Department of Health and Human Services. In August 2000, we filed lawsuits against National Blue Cross Blue Shield and against Trigon Blue Cross Blue Shield of Virginia. After each filing there was real excitement at ACA and within the pro fession. Four years later, we are still in the lawsuits and the results have already shown significant benefit. But the fundraising is becoming more difficult. It is important to keep things in perspective. I think all the reasons that we initiated both suits are as valid today as they were four years ago and the cost is justifiable. The Wdk suit was long and costly, our doctors stuck it out, and we prevailed. Now we have an advantage that our predecessors didn't have in the Wilk case: We have some specific successes to point to. Not only have we survived motions for dismissal in both suits, but we can also point to the following:

* HHS reversed a policy held since 1994 that permitted HMO managed care companies to use physical therapists in providing the chiropractic benefit, manual manipulation of the spine to correct a subluxation.

* National Blue Cross Blue Shield scheduled a meeting of the medical directors from all their plans with ACA leadership, allowing an opportunity for both sides to speak frankly and openly about their differences. The result of this meeting was the establishment of a liaison program throughout the country, with tangible results in some states. Neither the meetings with the medical directors nor the liaison program would have occurred if the lawsuit had not been filed.

* National Blue Cross Blue Shield agreed to push for a chiropractic provision in its federal health plan for employees. At this juncture, 200,000-plus contracts have been signed that include the chiropractic benefit, and while the coverage needs to be improved, it would never have been implemented without the lawsuit.

* And there is a definite benefit that has nothing to do with the litigation: When was the last time this profession was so unified behind a specific issue? Not since Milk!

Litigation isn't cheap. We are opposed by one of the largest law firms in the country in the lawsuit against HHS and by prominent firms representing the Blues. George McAndrews has had to use as many as 14 attorneys and paralegals to match the opposition's resources. We are also faced with the problems of going back to court to compel Trigon to provide basic discoverable information, as well as to cover the depositions scheduled by both sides. There are 38 separate depositions, the majority of which occur in the mid-Virginia area.

Resources Stretched to the Maximum

I have been working in the association field for nearly 19 years, and the one thing I could count on is that the period from January through July each year would always be the most hectic. In addition to the normal hectic schedule in each department, the entire staff- or good portions of it-were involved in more meetings of the Board, the preparation of a budget, a heightened legislative period, a legislative conference, and an annual meeting.

But this year, this same period seems to be more hectic than ever before. By the end of June, we went through two face-to-face BOG meetings in less than six months, held an NCLC, spent two weekends preparing a budget, and had the usual preparation time for an annual meeting with bylaws submission allotted. We added new items that impacted two or more departments at ACA:

1. Our involvement in Parker seminars, which began in January and extended throughout the year, was like mini-NCLCs. The amount of planning and coordination was intense. Our staff and volunteers were present at each of the programs, in Las Vegas, Dallas, San Diego, Toronto, and Miami.

2. The revision and consolidation of the Long Range Plan required not only an intense two-day, face-toface meeting, but also conference calls prior to and after the meeting, as well as considerable staff time to complete the project.

3. Our National Chiropractic Legislative Conference is scheduled in March. It has always been a full-staff effort, even when it was only a two-day program. In recent years, we have added seminars and social functions in an attempt to make this meeting more like a convention. But in the past two years, something new has been added to an already crowded agenda-a special House of Delegates meeting. Just about everything done for the annual meeting is done for the special meeting, as well.

4. Raiser's Edge, the ACA database, has required a considerable amount of attention. It is not an exaggeration to state that two departments at ACA went through a sixweek period meeting as a group nearly every day, working through the problems of the software and establishing protocols to avoid problems in the future.

5. Fundraising for the lawsuits has taken a greater proportion of staff time, in addition to membership drives and fundraising for the PAC.