PCA’s Day on the Hill
It’s all about OUR State Senators and Representatives Actively Supporting PCA’s Delegation of Therapeutic Exercise Legislation.
Pennsylvania State Capitol Building
Tuesday, May 2, 2023
House Bill 630
· On September 15, 2005, State Farm Mutual Automobile Insurance Company and State Farm Fire and Casualty Company (collectively “State Farm”) filed a Complaint against Robert J. Cavoto, D.C. and various entities alleging, amongst other things, the impermissible delegation of therapeutic exercises to unlicensed individuals. On September 21, 2018, the Pennsylvania Superior Court affirmed a lower court decision that therapeutic exercises may not be delegated to unlicensed individuals.
· The judge determined that non-licensed supportive personnel do not have the proper training to provide therapeutic exercise for our patients, which removed our ability to delegate therapeutic exercise.
· This ruling has disrupted standard procedures in chiropractic offices relating to delegation of safe and effective supervised therapeutic exercise which chiropractors have been delegating for decades prior to the ruling with great benefit to the patient.
· This has created a unique problem for both chiropractors and patients as Pennsylvania is the only state restricting delegation of therapeutic exercise in our region.
Certified Chiropractic Assistant:
· We are trying to correct the ruling legislatively by creating the position of a certified chiropractic assistant.
· HB 630 adds definitions to the Chiropractic Practice Act that would allow us, as chiropractors, to be able to delegate therapeutic exercise to our supportive personnel, which is commonly referred to as a chiropractic assistant.
· HB 630 will allow for the adequate training and certification of “Certified Chiropractic Assistants” through the state board of chiropractic. To obtain the certification, the staff member will need to complete a certified chiropractic assistant program as defined in the bill and successfully pass an examination approved by the board.
· HB 630 makes it clear that therapeutic exercise may be delegated to certified chiropractic assistants who are certified and are subject to direct, on-premises supervision by the licensed chiropractor.
· All medical decision making will be made by the Doctor of Chiropractic including which exercises are to be performed and when the exercise should be progressed. The CCA will not be evaluating, diagnosing, treating, or have the ability to make any changes to the treatment of a patient. Their role is essentially to oversee the patient while doing the exercises prescribed by the DC. Their scope is very narrow and limited strictly to only therapeutic exercise.
· Therapeutic exercise is a timed therapeutic procedure, which means that we are required to see a patient between 8-22 minutes in order to perform one unit of therapeutic exercise. Because we are unable to delegate this therapeutic procedure, chiropractors who would like to utilize exercise therapy are limited to seeing approximately 4 patients per hour. This bill will improve the quality of care for your constituents by allowing chiropractors to help more patients in a given day.
· In a 2018 study series on low back pain, the Lancet, which is one of the most prestigious medical journals in the world, stated that exercise therapy should be considered a first line treatment for low back pain. Low back pain is one of the most common conditions that chiropractors will treat. The evidence from this article and many others suggest that exercise therapy should be utilized when treating low back pain.
· In a time when people are looking for non-opioid options for treatment of low back pain, it is now more important than ever to give all people the opportunity to receive the best care they can for their low back pain. The delegation of therapeutic exercise bill works toward that goal.