Interview with the President of the Congress of Chiropractic State Associations (COCSA), Jeff Fedorko, D.C.

Jeffrey Fedorko graduated from the National College of Chiropractic in 1981 and has been an active member of the Ohio State Chiropractic Association (OSCA) throughout his career. He was first elected to office at the district level in 1984 and moved up through the ranks, eventually being elected President of OSCA in 1998 and Chairman of the Board in 2000. He was named Chiropractor of the Year in 1999 and 2000.

In 2000 he got elected to the board of COCSA. He believes that COCSA provides the opportunity for state associations to give and to receive and in their ability to provide an arena where chiropractic can come together to work through its differences and agree on its commonality. Additionally, he has contributed to several manuals of the Ohio State Chiropractic Association as well as co-authored the Backpack Safety Manual.


TAC: Could you explain the role of COCSA and your particular role in it?

Fedorko: The Congress of Chiropractic State Associations (COCSA) was born in 1969 with the mission to provide an open, nonpartisan forum for the advancement of the chiropractic profession through service to member state chiropractic associations. The vision of COCSA is to provide a forum for unifying the profession and inspiring the achievement of universal understanding and utilization of chiropractic. As president, as for every president before me, I work to uphold the mission of COCSA while bringing my own specific talents to the process.


TAC: What are the new goals that COCSA will implement this year?

Fedorko: President Barack Obama has declared health care reform to, in part, ensure widespread access, as a high priority; thus, the health care landscape as we have known it will undoubtedly begin to change. If chiropractic is to have a say in the outcome, the state associations must be poised to respond rapidly and effectively with positive messages of action to our member doctors and their patients. Therefore, now more then ever, COCSA must commit to its core mission of supporting the state associations.


TAC: Tell us about the services COCSA offers to the state associations.

Fedorko: The true value of COCSA membership can best be summed up in one word—networking—in an atmosphere of camaraderie. COCSA provides the foundation for successfully harnessing this priceless value through state chiropractic association networking opportunities at the annual COCSA convention, use of COCSA’s multiple communication platforms that include email broadcasts, monthly newsletters, monthly executive director conference calls, the COCSA web site, and COCSA listserv and direct mail. While state laws, economies and regional practice styles differ, the basic opportunities and challenges faced by state chiropractic associations are the same. COCSA provides a forum for state associations to learn from each other—what trends and challenges are sweeping the country, what has or has not worked in other states in dealing with these challenges and opportunities, and what types of projects have been successful in other states that could be duplicated in their own.

In addition to providing cutting edge information on chiropractic association management issues, COCSA continues to develop a resource center through which associations can obtain products and services to assist them with increasing their own member benefits and non-dues revenues. As the organization that represents the largest number of doctors of chiropractic in the nation through our member associations, COCSA is positioned to negotiate programs with companies that individual associations could not. We feel this is a valuable service, especially for smaller associations, and the financial benefits could easily return the investment of the COCSA dues many times over.

TAC: How does it impact the chiropractor in the field?

Fedorko: The purpose of a state association is to protect the rights and privileges of each chiropractor within that state. When COCSA can assist the state association to become stronger, the impact flows through to the chiropractor in the field.

Without the state associations looking out for the field doctor, the DC could lose his or her ability to practice, or experience restrictions with a legislative stroke of a pen. The men and women who dedicate their time to the associations are working to secure the chiropractors’ rights to care for patients.


TAC: What is the biggest challenge for the chiropractic profession this year?

Fedorko: There are approximately 15,000 DC’s and students that belong to the ACA and approximately 5,600 DC’s and students that belong to the ICA in the US. In total, that is less then the number that belongs to the NO CA (Chiropractic Association). The biggest challenge is to get the NO CA doctors engaged in the process. Each DC, member of a national association or not, has to decide to make the decision to be the one to make a difference. They must decide they are willing to step up to the plate and get involved. The DC and their patients can change the path of health care for the better, only if we believe they can. In order for the chiropractic profession to take advantage of any opportunity that may present itself, our national and state associations must be strong. Membership in the national and state organizations is the doctors’ vote of confidence as we strive for full access in Medicare. I would request each doctor of chiropractic to become a member of their state and national associations today; don’t procrastinate, join now! Our future may depend on it.


TAC: How will COCSA plan to help with potential State problems?

Fedorko: COCSA exists to serve. COCSA is a coherent vibrant organization held together by mutual respect and dependence on each member state association. COCSA is not me or its board members, it is all state member DC’s working together by way of state representation. We help each other.


TAC: How do you plan to convince insurance companies to cover all beneficiaries when prescribed by a chiropractor?

Fedorko: COCSA is involved on two fronts. First, COCSA is a steering committee member of the Summit working together with 39 other chiropractic organizations with a unified voice to secure Freedom of Choice: In health care reform, the beneficiaries should have the right to choose and be reimbursed for health care services from doctors of chiropractic without barriers and limitations that unfairly restrict their freedom of choice.

Benefits: Chiropractic care is extraordinarily effective in improving function, mobility and quality of life for beneficiaries through the use of conservative methods which reduce reliance on expensive drugs and surgery. Its safety, effectiveness and cost savings are well-supported by scientific evidence. Likewise, improved access to health care services provided by doctors of chiropractic will assist the health care system in responding to emerging challenges due to an aging population, including the shortage of health care providers and the rising burden of neuromusculoskeletal conditions.

Scope: Except for the single service of spinal manipulation to correct a vertebral subluxation, Medicare currently does not provide reimbursement to beneficiaries for otherwise covered services when those services are provided by a doctor of chiropractic. Any health care reform plan should provide reimbursement to beneficiaries for the full range of covered health care services consistent with state law when provided by doctors of chiropractic.

Second: COCSA is also working with AMI, Alternative Medicine Integration. AMI has documented and published industry leading chiropractic outcomes data, furthering chiropractic’s cause/agenda with the payor community. AMI is working with or has governmental programs in nineteen states.


TAC: Should chiropractors be considered physicians?

Fedorko: For years many chiropractors interpreted the term physician to be MD and, therefore, the practice of medicine and surgery. With regard to etymology, the word physician φýσις (physis) and its derived adjective physikos, mean “nature” and “natural.” This is the way I am going to use this word. There are a few opportunities or challenges for the chiropractic physician that chiropractic must be made aware of.

1) If chiropractors are not considered physicians, they are unable to bill an insurance carrier for an evaluation and management code (exams and re-exams).

2) The government is mandating all providers use electronic health records in the next few years. If chiropractors were considered physicians, they would be able to apply for assistance in transitioning to such a system, up to $65,000 per office.

3) Recently, National Blue Cross and Blue Shield changed the status of the chiropractor to non-physician. The National Blue Cross and Blue Shield system is most likely the template for a national health care platform. If we are not considered physicians, we will be out of the system before it even starts.

4) Currently we are considered physicians under Medicare.

5) Finally, the chiropractor should be the Wellness Physicians for natural health care. If we are to be the natural wellness specialists, my colleagues must ask themselves if they are ready to take their rightful place as the health care wellness physicians with all the associated rights and responsibilities.


TAC: Your congress this year is focused on communicating with lawmakers and patients relative to healthcare reform. What will you do to ensure its success?

Fedorko: The national associations are developing a grass roots patient database. COCSA will continue to encourage the state leadership to persuade their docs to work in unity to this end. We, as a profession, must accumulate millions of patient advocates to our cause. I would encourage each DC to visit one of the following sites: or to begin signing up their patients to the grassroots database.


TAC: What other avenues are there to make the public aware of the benefits of chiropractic?

Fedorko: A good friend of mine always reminded me that “unseen and unheard equals unknown.” Each one of us must take it upon ourselves to teach. People are hearing messages from everywhere and they should certainly hear it from us. I challenge every DC to give five lectures outside of their office this
year on a chiropractic topic. I challenge each DC to meet his or her state and national legislators and tell a chiropractic story. But most importantly, I challenge every DC to make a commitment to give $10 to $20 a month to the Foundation for Chiropractic Progress at The Foundation is making a difference, check out Sports Illustrated January 2009.


TAC: Do you still practice?

Fedorko: I serve my patients 35 hours per week and I serve my profession as president of COCSA 20 plus hours per week.


TAC: Does COCSA have any plans for marshalling its resources to facilitate the approval of HR484, enabling TRICARE beneficiaries direct access to chiropractic services?

Fedorko: Upon graduation of chiropractic school, chiropractors took an oath. There may be a few versions of this oath but, in essence, here is what I remember: “I will at all times stand ready to serve my fellow man, without distinction of race, creed or color, in my lifelong vocation of preventing and alleviating human suffering, wherever it may be found, by exemplifying in my own life a pattern of living in harmony with the Laws of Nature.”

Our men and women who serve our country and their families are deserved of our care. By virtue of my chiropractic oath, I must work to insure all Americans have open access to what chiropractic has to offer. Both of our national associations are in favor of this Bill, so COCSA is always willing to work in unity for an increase in utilization of chiropractic for the betterment of our American citizens.


TAC: Any final words to our readers?

Fedorko: As a practicing DC I have total admiration for those DC’s that dedicated their lives to ensure I have the right to practice. I have respect for the leaders of this profession who are currently giving of their time to secure our rights to provide care and I have hope and faith that, as a profession, we all come together to insure the next generation of DC’s will continue, not only to survive, but to thrive as they serve the patients who seek chiropractic care as their choice of health care.


Dr. Fedorko can be contacted by e-mail at [email protected]

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