MEDICARE MADE EASIER; CHIROPRACTORS RECEIVE A BREAK.

Byline: Ben Sullivan Daily News Staff Writer

Amid all the back-slapping that followed Congress' passage of the Balanced Budget Act of 1997, a little-heralded provision passed which will make it far easier for Medicare patients wanting to see a chiropractor to get the treatment paid for.

The provision eliminates in the year 2000 a longstanding requirement that patients must have a spine X-ray taken - a process Medicare wouldn't pay for - before the government would pick up the tab for chiropractic treatment.

Eliminating the requirement was the industry's biggest legislative win since getting chiropractic treatment included in Medicare a quarter century ago, officials say, and comes none to soon.

As the population ages and the first baby boomers hit their 60s in the next decade, record numbers of seniors are expected to seek out chiropractic treatment for what remains the most common health ailment among the elderly - lower back pain.

Indeed, at a time when other health care providers face slowed revenue growth and in some cases lost ground due to managed care belt-tightening, chiropractors are poised for their flushest period yet.

``It's a good thing for the consumer, and a good thing for the chiropractic physician,'' said Wayne Press, a Simi Valley-based chiropractor who is a member of the National Board of Chiropractic Examiners. ``Overall, it'll impact my practice in a real positive way.''

The Congressional Budget Office projects that elimination of the X-ray requirement alone will generate an additional $2 billion in Medicare reimbursements for the industry in the first decade. Other changes now being lobbied for could push that figure higher still.

Additional business ``wasn't the compelling reason'' to eliminate the X-ray provision, said San Bernardino chiropractor Jerilynn Kaibel, but more business for chiropractors will be a result of the change. Kaibel was appointed by Secretary of Health and Human Services Donna Shalala to Medicare's Practicing Physicians Advisory Council and helped advise the Clinton administration on the new legislation.

Chiropractic services make up a small fraction of the nation's total health care spending. Out of an estimated $1 trillion that Americans spent last year on health care, chiropractic treatment accounted for just $12 billion, according to the American Chiropractic Association.

In part, that is due to lingering suspicion among the mainstream medical establishment toward the field. It was the American Medical Association that lobbied to have the Medicare X-ray provision implemented and helped keep it in place so long. And many physicians still consider chiropractic treatment a risky form of pseudo-medicine.

But loyal support from patients, and more recently efforts by the managed care industry to attract enrollees, has given chiropractors expanded clout.

``That's the trend out there,'' said Pamela Phillips, vice president of government relations at the American Chiropractic Association. ``There's this steady growth in the number of patients going to a chiropractor and general acceptance of chiropractic treatment.''

Nowhere is the acceptance greater than among baby boomers, Phillips and others say. While previous generations of seniors may have felt a bias against the treatment, baby boomers are more open to alternative medicine in general and chiropractic treatment in particular, she said.

In fact, said Alan Tomiyama, a spokesman for the California Association of Health Plans, it has largely been baby boomers who have pushed HMOs to offer chiropractic treatment as an optional service.

``Market-driven is a good way to coin this,'' Tomiyama said. ``Health care consumers are more sophisticated and much more interested, aware and involved in their own health now than what we saw in our parents' or grandparents' generations.''

Tomiyama said further acceptance of chiropractic and other alternative medicine treatments is likely, if not inevitable.

Next on the American Chiropractic Association's agenda is to expand the number of annual chiropractic visits Medicare will pay for and the kinds of treatments that chiropractors are sanctioned to perform.

A Medicare patient can visit a chiropractor 12 times a year for spinal manipulation alone. In the future, Press said, chiropractors should be reimbursed for general examinations, physical therapy, pain treatment and treatment of various neuromuscular disorders.

``That's our training, what we know how to do,'' Press said. ``But there's still a lot of bias and prejudice out there.''

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Photo: (Color) Dr. Wayne Press, a Simi Valley chiropractor, demonstrates his technique on physical therapy aid Kimberly Horner.

Phil McCarten/Daily News