The project eventually became known as the Chiropractic Health Care Demonstration Program (CHCDP). Originally slated to last three years, the program received an extension from Congress in 1998 and was expanded to 16 facilities, including three "control" sites, before it ended in September 1999. Even after Congress terminated the CHCDP, it required the DoD to maintain the level and scope of chiropractic care services at the authorized sites until at least September 30, 2000.
In February and March of 2000, the CHCDP's contractor (Birch/Davis) and chiropractic members of the Oversight Advisory Committee (assisted by Muse and Associates) submitted separate reports to Congress. While the Birch/Davis report stated that it would be "feasible to establish chiropractic services within the DoD," it advised against adding such services due to high costs. The Muse report contradicted the Birch/Davis report in terms of cost-effectiveness, stating that adding chiropractic services would result in an "annual net savings to the DoD of $25.8 million." Both reports, however, agreed that it would be overwhelmingly positive for the federal government to incorporate chiropractic health care services into the military. (Editor's note: see http://www.chiroweb.com/archives/18/09/13.html for more information.)
The findings of the CHCDP had a substantial influence in Congress making chiropractic care a permanent benefit for members of the military. On October 30, 2000, President Clinton signed House Resolution 4205, the National Defense Authorization Act for Fiscal Year 2001, requiring access to chiropractic services including "care for neuromusculoskeletal conditions typical among military personnel on active duty." The law also required that full implementation of chiropractic benefits be phased-in over a five-year period, throughout all three service branches of the military, and mandated that the DoD develop an "implementation plan" to ensure the benefits be adequately provided.
Since HR 4205 became law, integration of chiropractic care into the military has been slow, but steady. Approximately 20 military facilities now provide chiropractic services to active personnel. The biggest advance has been in the Air Force, where the number of sites that offer chiropractic care to active duty members has doubled. In addition to the original four locations (Offutt Air Force Base (AFB), Omaha, Neb.; Scott AFB, Belleville, Ill.; Travis AFB, Fairfield, Calif.; Wilford Hall Medical Center/Lackland AFB, San Antonio, Texas), chiropractic is offered at Keesler AFB (Biloxi, Miss.); Andrews AFB (Md.); Langley AFB (Langley, Va.); and the U.S. Air Force Academy in Colorado Springs, Colo.
The director of the Air Force's chiropractic program is Lieutenant Colonel Dr. Robert Manaker, a family practitioner and former chief of the medical staff at Hill AFB in northern Utah. In an interview with the Air Force Print News, Dr. Manaker stated that the increase in chiropractic services will permeate all branches of the military.
"Over the next five years, we will gradually increase the availability of chiropractic services across the Air Force," Dr. Manaker said. "A similar thing is happening across the Army and the Navy. This is a tri-service program."
Several of the sites employ a "patient choice" model, which gives patients the option of seeing a traditional provider or chiropractor directly for musculoskeletal complaints. However, most sites still utilize a referral system, in which the medical doctor makes an initial diagnosis and then refers the patient to a chiropractor for additional care.
Military members who want to see a chiropractor can be referred to any of the facilities that currently employ a DC. For now, they will not be able to seek treatment from private-practice chiropractors.
"If there isn't one at your base, you do not have the option of going off base to find a chiropractor," Manaker said.
However, primary care providers can refer personnel to a chiropractor at another military facility nearby.
According to Dr. Manaker, the Air Force is working to increase the number of bases that offer chiropractic care, with an emphasis on areas that have large populations of military personnel.
"We wanted to get this benefit out to the most active-duty members that we could," he said. "We are looking at places where there are multiple bases, or where there are the greatest number of active-duty members, and putting chiropractors there first."
Manaker estimates that by 2007, the majority of active-duty members should have easy access to a chiropractor, either at their own base or at a base nearby.
Reference: Lopez CT. Eight bases add chiropractic services to medical facilities. Air Force Print News, November 15, 2002.
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