Yesterday the WCA published a document titled State Practical Exam Update. Again, our purpose for responding is not to attack the new Executive Director as most of this occurred before her tenure at the WCA. She is at the great disadvantage of relying on others for the information, who may not be providing her with all of the data. Unfortunately, the information recently provide by the WCA to the chiropractors in Wisconsin requires clarification and corrections so that the DCs can understand and know ALL of the facts surrounding this examination.
Per the WCA newsletter:
“In 2011, the Chiropractic Examining Board, with the support of the legislature and the Governor, determined that a supplemental practical exam administered by itself be implemented. The WCA supported the reinstitution of a state level practical exam. Unfortunately, as you are aware, the exam implementation is not going as smoothly as we had hoped.”
Starting with the primary facts:
1. The Leadership of the WCA in 2009 was 100% the sole source and primary driver of the legislation that involved the introduction of the new state exam. This was not a “member” driven project.
2. The language for the exam was passed in the 2009 Budget Bill not in 2011.
3. The Chiropractic Examining Board and legislators did not determine that a supplemental practical examination needed to be implemented. In fact, the Chiropractic Examining Board and the entire Department of Regulations and Licensing was explicitly omitted from any previous knowledge of the WCA’s introduction and successful inclusion of the exam into the Budget Bill.
4. The WCA did not go through the normal legislative process involving public hearings for discussion. The new examination language was inserted at the very last moment into the Budget Bill just before the legislature voted at 1:30 a.m.
a. Important excerpts from the 8/13/2009 BOE meeting tapes (yes we have the tapes):
i. Paul Gabriel: “There wasn’t any discussion by the legislature in passing this. This was a motion that came before the budget committee at 1:30 in the morning and passed along with a number of other items without any discussion.”
ii. Russ Leonard: “We know that in an exam that was running for years we had the failure rate of people who came to Wisconsin and who were not qualified to practice. 40% on average did not complete our exam successfully.”
iii. Russ Leonard: “our intentions are terrific. At the end of the road our organization will be much smaller, I tell you that today.”
5. The validity of the “new” examination is in question. The exam was originally supposed to start in 2011, but due to the inability of the Chiropractic Board to successfully create an exam, the exam start date was shifted to Jan 1 2012.
a. Important excerpts from the 10/8/2009 BOE meeting:
i. Opening comments by then Secretary Jackson “wanting to be on the record” with concerns with continuing education and practical examination. Conflict of interest with Chair and Board going above and beyond what is required by the Legislature.
ii. Gail Pizzaro’s (Specialist within Department) summary of the Department’s position and her position as a professional exam developer of the exam: problematic, duplicative, not necessary and redundant from the get go.
iii. Concerns noted from then Secretary Jackson regarding the appearance of fencing people out and creating costs that are not necessary that will increase the costs to student applicants.
b. Important excerpts form 3/18/2010 BOE meeting
i. Mr. Colons of the Department of Regulations and Licensing expressed concerns related to the WCA newsletter indicating that they were “working with the Board on the new state exam”, course of study for continuing education and continued push by the Board for live subjects that would increase the cost to new licensees.
1. The validity of the examination is questionable at best.
a. The experience level of the developers of the examination in creating a practical examination was low to non-existent.
b. The examination development contains potential security flaws of improper influence of the test creation process primarily fueled by the published WCA statements that they were “assisting the Board”.
c. The failure rate demonstrates not a lack of knowledge by the examinees, but the flaws in the actual exam and examination procedures.
So we agree with the WCA that the State Practical Examination is “not going as smoothly as they had hoped.” The real problem is that it goes way beyond not running smoothly. This exam is flawed and will continue to have validity issues.
The real solution is to understand that this examination was not brought by the Chiropractic Board or Legislature to “protect the public” or by vote of the actual members of the WCA, but was 100% brought forward by the Executive Director and Leadership of the WCA for reasons that are still unclear. As a result, an unnecessary and restrictive barrier to new graduates wanting to practice chiropractic in Wisconsin has been created. This is why the CSW has publicly stated that this examination should be removed from the statutes.
Stay tuned for Myth vs Reality: Part III!
The emergence of a new and “second” chiropractic voice in Wisconsin seems to be unsettling for some.
Communication is a powerful tool that allows information to be disseminated to great numbers of people. In fact, the Internet has made it almost instantaneous. However, there is great responsibility to make sure that the communication that is sent out is correct. Untruths can be disseminated as easily as truth and if repeated enough times without being stopped, can become believed as actual truth. Important information can be altered or omitted, thus decreasing the ability for a Wisconsin Chiropractor to know all of the information or both sides of the story.
It comes as no surprise that communication within the internal Wisconsin chiropractic channels has been dominated by a single voice for many years. The information has been disseminated totally un-vetted, thus providing the ability to create a controlled “reality.” Without having all of the State chiropractors’ emails, it is very difficult and costly for a single person or group to send out alternative messages that would be of benefit to the chiropractors in Wisconsin. Over time, the repeatedly communicated “reality” becomes solid and totally believable.
During our many Founders Forums across the State, we found it very interesting the level of belief in specific Wisconsin chiropractic “realities.” When provided additional information, most chiropractors just sat in disbelief. We also found it very interesting that there is such great concern about the creation of the CSW and the emergence of a “second voice” in Wisconsin. We, however, believe that this new second voice will strengthen our profession and will allow the chiropractors in Wisconsin to receive additional or alternative information to make informed decisions and opinions on where they want the profession to go.
The need for a “second voice” in Wisconsin was recently echoed in the amazingly positive reception that our President elect, Dr. Jay LaGuardia received at the annual COCSA (Congress of Chiropractic State Associations) convention in Atlanta last week. Dr. Jay was greeted with high fives and other warm congratulations from executives from States across the US as he shared our vision and goals for chiropractic in Wisconsin. We have received not only encouragement, but active offers of support and help from other State and National associations as well as multiple chiropractic colleges in our goals and desires to improve the chiropractic profession in Wisconsin.
Our Executive Director, Dr. Steven Conway, is also a member of NACA (National Association of Chiropractic Attorneys). Wisconsin has not been represented at this group for … well no one could remember it had been so long – if ever… There was great information provided at the recent conference in Texas that will benefit the chiropractors in Wisconsin and the CSW will be disseminating this information to its members. The primary issue discussed at the conference affecting chiropractic around the US is unfair co-pays and reimbursements. Both of those are at the forefront of the CSW’s legislative initiatives for 2013.
2013 will be big for Medicare. The CSW will be your primary source for accurate and up-to-date information. Wisconsin will be changing from WPS to NGS – an entirely new carrier and along with that will come new LCDs (rules) to follow. The CSW will be providing seminars around the State for all chiropractors and staff so that they will be prepared for the change. Presenters will be Medicare Guru Susan McClelland and CSW Executive Director, Dr. Steven Conway, who has been assisting various State associations in setting up strategic Medicare audit defense programs.
Medicare PQRS Seminar
We have also finalized a webinar with Susan McClelland related to Medicare’s PQRS, so that all of your staff can listen in and understand the changes needed in your documentation of Medicare patients.
The CSW spent hundreds of hours out in the field this summer and fall and made many positive relationships with lawmakers. We are positioned to introduce legislative initiatives that benefit all chiropractors and do not focus on regulations that restrict or add costs to do business, such as those that have been introduced in the past.
When was the last chiropractic legislative Day in Madison? Hard to remember? Well we are bringing it back and look forward to all of the chiropractors in Wisconsin joining us in Madison in early 2013 for a positive legislative day with our Senators and Assemblymen.
The CSW is a real association with proven dedicated leaders ready to assist in the advancement of chiropractic in Wisconsin.
Today, we will provide additional information to both of the recent WCA newsletters including the Myth vs Reality story. Again our purpose in providing this information is not to attack the credibility of the WCA or its Executive Director, but to demonstrate clarity and comparisons on our goals and vision for chiropractic in Wisconsin and also allow chiropractors in Wisconsin to have additional information to make fully informed decisions.
Let’s look at the Myth vs Reality information recently published by the WCA:
Per the WCA:”Myth #1: The Wisconsin Chiropractic Association maintains a policy regarding the state’s chiropractic exam in order to prohibit new chiropractors from entering the state of Wisconsin, and as a judgment that new graduates are a risk to the public. This is false.”
CSW: Additional information we felt you would find interesting…..
Per the WCA: “Myth #2: My predecessor, Russ Leonard, is employed by the WCA as a consultant. This is False.”
CSW: We wish Mr. Leonard a wonderful retirement. Really…We REALLY DO!
What we found interesting was the fact that Ms. Rockwell has stated to multiple sources that she has never spoken with or had any interaction at all with Mr. Leonard. With the additional resignation of past president, Dr. Wendy Varish, it is our understanding that this would make any transition and/or transfer of operations of an association an extremely difficult task especially when the new Executive Director’s prior background was only in Trucking and Home Building and not chiropractic or even healthcare.
This lack of communication could also present problems with transfer of institutional memory and the lack of knowledge of events such as the WCA lawsuit against the BOE noted above or the very interesting and related information that was presented by former Executive Director Mr. Leonard at several WCA meetings in regards to the purpose behind the WCA’s push for the new state exam. However, we believe Ms. Rockwell is a nice person and wish her well in her new position.
Per the WCA: “Myth #3: The WCA is working with the Chiropractic Examining Board to claim a monopoly on the State’s continuing education credits. This is False.”
CSW: Last week, the WCA carefully crafted an e-newsletter related to its
relationships to the Chiropractic Board of Examiners and the CE issues in Wisconsin. While we can only speculate on the rationale behind the document, we feel it is important for the chiropractors in Wisconsin to receive additional facts that related to these topics. As a short side note, we felt it was almost ironic that the speaker in the WCA seminar pictured in their newsletter, Dr. Dan Murphy, was the same speaker that the Chiro Board denied for Life College’s program for their November seminar. Same speaker, approved for one and not the other ….
The concept at hand in this specific newsletter and the Myth vs Reality article appears to be the WCA attempting to distance itself or separate itself from the BOE and the CE approval process. Again the ironic part is that in the Myth vs Reality newsletter, the Executive Director specifically states that the WCA is directly working with the BOE in regards to the state examination. “For several months the WCA Board of Directors has been communicating with the Examining Board.”
The Short version:
We believe the CE problem exists not with the WCA, but with the BOE and its interpretation of Chir 5, which results in the denial of properly applied for seminars by the chiropractic colleges. The CSW has initiated multiple investigations into the situation and will be reporting to the profession as results are obtained. However, it is interesting to note that what could have been explained as a “delegation” rationale for the approval of WCA vs chiropractic college became quite murky when the BOE denied Life Colleges application that had ZERO delegation and the WCA recently held a seminar in Wausau that potentially included delegated responsibilities to a nutritional entity.
We are also puzzled by a recent October decision by the BOE to reverse and suddenly approve the previously denied NWHSU/MPTC delegated CT courses. The unfortunate part was the CT seminars were to have been given in June and July and thus had been cancelled for months due to the previous denial. We have asked the BOE for an explanation and will provide their response once received.
Update on the State Exam:
You may ask, “It is the same exam I took so what is the problem?”
There is a misconception that the current examination is actually needed and that it is a fair test and the “same” or “similar” to the ones given in the past. It is our opinion that it is not. This examination was written primarily by two or three DCs on the Board of Examiners who personally did not have any prior significant practical examination creation experience. (Compare to NBCE that has given the Part IV to close to 60,000 candidates) Examinations in the past did not have live subjects. This new exam is not even remotely close to any examination given in the past. Examinations in the past did not cost $1500.00 and unfortunately will be much higher in 2013 with some estimates being near a record $5000.00. What??? Due to the way the language initiated by the WCA was snuck into the budget bill, the cost has to be borne 100% by the applicants. The live patient “requirement” by the board (which was NOT stipulated in the regulation and which the State fought hard to avoid) dramatically increases the overall cost of the testing examination process. The initial $1500.00 was based on a conservative estimate of 30 doctors taking the examination. Since only 2 took (both failed) the first exam and 10 took (9 failed) the second exam this past October, the $1500.00 did not cover the costs. This greatly increases the risk of higher examination fees for future applicants.
The recent publication that the WCA has been in direct communication with the members of the BOE brings with it great concerns. The CSW has requested an explanation from the BOE and Department. Once gained we will provide that information to our members.
Final Discussion on “Reality”
There is a great void in the information that has been disseminated to the chiropractors in Wisconsin over the past few years allowing for certain “realities” to have been created. Again, at our multiple Founders Forums we were shocked to learn that the majority of chiropractors in Wisconsin were not even aware of some of the basic events that have happened in Wisconsin including:
The CSW’s reality is that:
We are not a “second voice”, but we believe we represent the actual voice of chiropractors in Wisconsin and we ask that if you agree with our goals, vision and “reality” for chiropractic in Wisconsin… Join us as members for 2013. We have many amazing projects and programs lined up to expand and enhance your practices.
Governor Walker’s Decision regarding a Wisconsin Health Insurance Exchange
Just a short time ago, Governor Walker announced that Wisconsin will not establish a state health insurance exchange and, instead, will defer to federal officials.
Click here to view the Governor’s letter to U.S. Department of Health and Human Services Secretary Sebelius notifying her of this decision. It points to lack of flexibility and unknown costs to state taxpayers as two drawbacks to sate exchanges.
Also see a letter to stakeholders explaining the reasons behind the Governor’s decision in more detail.
The Governor’s advisors have indicated that this decision is final. Only if the Obama Administration chooses to revise its approach to state exchanges and address the many concerns that have been raised would the Governor consider revisiting the decision.
During discussions with Walker Administration officials this week, they shared their intentions to work with stakeholders to identify unresolved issues related to exchanges and work to amend state statutes or administrative rules to address them, if possible. They acknowledge that the state won’t be able to address every problematic or outstanding issue this way, but they have expressed a commitment to do what they can. While Wisconsin DHS and OCI have already identified some issues that they would like to address including the role of navigators, adverse selection concerns and treatment of risk pools, they will be looking to stakeholders to identify other issues. We will keep you informed about these activities as more information becomes available.
In the meantime, please let us know if we can answers questions or provide more information about Governor Walker’s decision.
Important Update on Obamacare (PPACA) and Its Effect on Chiropractic in Wisconsin
As we have done in the past, we will have the short version so that you can see the highlights and then follow with a longer version containing as much detail as is available.
Compiled by Jodi Jensen of DeWitt Ross & Stevens S.C.
On Monday morning, WMC hosted a meeting with Governor Walker’s Chief of Staff and select providers, insurers and employer groups to discuss the Friday deadline related to health care exchanges. The Governor’s Chief of Staff said that a final decision about whether to establish a state-based exchange has not been made. Prior to the Governor making an announcement on Friday, his staff will notify health care stakeholders and employer groups of the decision. This notification is expected to take place only an hour or so prior to the public announcement.
The Governor and his advisors have identified three main concerns about establishing a Wisconsin exchange:
Governor Walker is at the Republican Governors Association meeting this week and all of the governors will meet on Thursday to discuss their decisions related to the exchanges. While many Republican governors may choose the same path, there will not be a coordinated response. However, if 20-plus governors choose not to establish a state exchange, some believe it may prompt the Obama Administration to begin communicating more with states and to try to address some of the concerns of the governors.
No matter Governor Walker’s decision on Friday, his advisors believe changes to state regulation will be necessary to address preventable problems created by either a state or a federal exchange. In a separate meeting of WMC’s Health Care Committee today, J.P. Wieske, OCI Legislative Liaison/Public Information Officer, expanded on this by providing two examples. First, he said that the state should establish some consumer protection mechanisms related to the activities of navigators. J.P. acknowledged that the state’s authority on this issue is unclear, but added that it would be politically difficult for the federal government to prevent consumer protection efforts. Second, he said that the state should address the adverse selection that could occur if plans in the exchange can reject new members unless they enroll during a defined enrollment period while plans in the private market are not given the same flexibility. Both the Governor’s Chief of Staff and J.P. indicated that they will be looking to health care stakeholders to identify state laws and regulations that should be amended or created to address, to the extent possible, problems inherent in the exchanges.
Compiled by Jodi Jensen of DeWitt Ross & Stevens S.C.
The Governor’s impending decision about whether to establish a state health insurance exchange, J.P. Wieske, OCI Legislative Liaison/Public Information Officer, spoke to the committee. J.P. echoed what the Governor’s Chief of Staff had said in separate meeting this morning with select providers, insurers and employer groups about the effect of exchanges on taxpayers being a major consideration for the Governor.
Highlights from J.P.’s Presentation:
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