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UVCA Issues Position Statement Re: Radiology

Monday, January 7, 2019  

Dear Unified VCA Members:

 

In April of 2012, the foundation.of the American Board of Internal Medicine (ABIM Foundation), along with Consumer Reports, formally launched the Choosing Wisely® campaign to “[advance] a national dialogue around avoiding unnecessary medical tests and treatments.”1

On August 15, 2018, as part of the Choosing Wisely® (CW) campaign, the American Chiropractic Association (ACA) released the guidelines currently found on the CW website at  http://www.choosingwisely.org/clinician-lists/aca-spinal-imaging-for-acute-low-back-pain/.

 

From the beginning, the guidelines related to the use of radiology in chiropractic practice have been a source of debate.  In adherence with the UVCA’s Mission (“Helping Doctors of Chiropractic deliver exceptional care”), members of the Executive Board felt a need for a UVCA position statement regarding the application of radiology in chiropractic practice.

 

With a focus on protecting practice rights and an emphasis on clinical decision making, the UVCA Executive Board conducted lengthy discussion and analysis of the debate.  The goal was to produce a position statement that expressed a balanced discussion on the appropriateness of utilizing radiology.

 

The following document is the product of that extensive collaborative effort.  The goal of this document is to help guide our membership in clinical decision making and, should the need arise, address objection of appropriate radiology by third party payers.  It has been approved by the UVCA Board of Directors for distribution to the membership and posting on the UVCA website with other position documents.

 

Should you have any questions, please feel free to contact any member of the Executive Board or me personally.

 

We all wish you a very successful 2019.

 

Sincerely,

 

 

David B. Dolberg

UVCA President

 

1 For further information on the CW campaign’s history and mission, visithttp://www.choosingwisely.org/our-mission/history/andhttp://www.choosingwisely.org/our-mission/.

 


PO Box 15, Afton, VA  22920

Phone 540-932-3100

Fax 540-932-3101

www.virginiachiropractic.org
.

 

UVCA Position Statement Regarding Radiology-Related Statements Included in the Choosing Wisely®.Campaign

 

December 31, 2018

 

The UVCA is guided by the following Mission and Vision statements.

 

The Unified VCA’s Mission: Helping Doctors of Chiropractic deliver exceptional care.

The Unified VCA’s Vision: Chiropractic positioned as a highly regarded health care profession that improves and advances public health and well-being.

 

In consideration of the above statements, the UVCA does not support the statement “Do not obtain spinal imaging for patients with acute low-back pain during the six (6) weeks after onset in the absence of red flags” that appears in the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely® campaign.1

 

The UVCA recognizes and appreciates the ABIM’s reassurances that Choosing Wisely is intended to promote dialogue between patients and their doctors, not to establish coverage decisions or exclusions.  However, the UVCA is concerned that, although it may be contrary to the ABIM’s intent, the referenced language may:

  • Provide an opportunity for entities such as third party payors and insurance claim reviewers to try to deny use of radiographic studies to patients or reimbursement for such studies.
  • Suggest a guideline to practitioners that insufficiently recognizes the importance of clinical judgment and evidence-based decision-making.
    .

The UVCA strongly supports evidence-based science for appropriate radiologic evaluations of patients. However, the Choosing Wisely statement referenced above should not supersede clinical judgment and/or widely accepted radiological guidelines.

 

The UVCA urges practitioners to consider carefully costs in terms of ionizing radiation exposure, financial burden, and patient time related to diagnostic studies, including all modalities of clinical imaging. Imaging examinations should be clinically indicated and expected to provide clinically relevant information.

 

The UVCA recognizes radiology as a scientifically proven component of the chiropractor’s clinical practice.  Diagnostic radiology is clinically useful in evaluating multiple aspects of human spinal anatomy, biomechanics, postural faults, misalignments, vertebral subluxation complex, and other pathologies. The UVCA supports Virginia Chiropractors’ use of good clinical judgment, standards of care and practice, and evidence-based decisions in these areas.

 

The UVCA understands that clinical practice guidelines are intended to optimize patient care, improve patient outcomes, and increase safety by using best available scientific evidence and broad consensus to develop appropriate care parameters.  Clinical practice guidelines should not represent an absolute prescription of care and should accommodate critical factors such as the chiropractor’s judgment and individual patient circumstances and values.

 

The UVCA holds that diagnostic imaging decision making is not always black and white; that gray areas may be encountered. No guidelines can replace clinical decision making made by the chiropractor in the course of treating an individual patient.

 

In conclusion, the UVCA applauds the ABIM’s goal of promoting dialogue between patients and their doctors but remains concerned about the Choosing Wisely statement related to radiology.  The UVCA urges all Virginia Chiropractors who utilize radiologic evaluations in their practice to familiarize themselves with practice standards, protocols and/or guidelines from well-established and recognized organizations, including those with chiropractic expertise such as Clinical Compass, the American College of Radiology’s Appropriateness Criteria, and Practicing Chiropractors’ Committee for Radiology Protocols (PCCRP).

 

1 http://www.choosingwisely.org/clinician-lists/aca-spinal-imaging-for-acute-low-back-pain/


 


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