WAPA Position on AB260 and Pre-Participation Examinations (PPE)
Wednesday, July 26, 2017
Leading health experts have grave concerns over Assembly Bill 260, mandating Wisconsin’s schools, technical colleges and UW system 2-year colleges to accept physical exams completed by chiropractors. The coalition opposing the measure includes 18 key physician organizations, other health care providers, health systems, hospitals, academic centers and other parties with a vested interest in the health and well-being of Wisconsin’s student athletes.
There are several key issues with the PPE portion of the bill:
- While annual physical examinations are recommended for children ages birth - 21, the rate drops dramatically as children progress through school. Therefore, securing the pre-participation evaluation is frequently the child’s only encounter with a physician or other qualified medical practitioner.
Ideally this examination would take place in the medical home - the clinic where the patient receives their routine medical care by a provider who is qualified in providing all aspects of routine medical care, including the PPE.
- During that visit, clearance to play is just one part of the appointment. A PPE is a comprehensive medical examination.
- Conducting a full annual exam with the athlete’s primary care provider ensures a comprehensive evaluation for, among other things:
- Cardiovascular conditions
- Appropriate immunizations
- Growth and development
- Mental and behavioral health
- Laboratory tests
- Hearing and vision screening
- Anticipatory guidance related to adolescent risk-taking behaviors
- Health education
- Capturing the details of this annual visit, when conducted in the primary care provider’s office, ensures full recording of the encounter in the patient’s detailed electronic medical record. In addition, it allows the provider to have access to the patient’s medical record, leaving less room for error, less risk for missed or omitted medical information, compared to examinations performed outside the primary care office.
- A 2016 American Medical Association issue brief reports that while physicians complete 10,000+ clinical patient care hours (plus additional classroom and laboratory experience), chiropractors are required to only complete 4,200 hours of combined classroom, laboratory and clinical experience.
- Chiropractors do not have the training necessary to provide the comprehensive examination provided in the primary care provider’s office. Such evaluations clearly fall outside the established definition of chiropractic practice as described in the Chiropractic Administrative Code (see CHIR 4.03, attached).
- One of the key purposes of the screening exam is to screen for conditions that may be life threatening or disabling. Cardiac conditions which can lead to sudden death are rare and often difficult to detect. A comprehensive cardiovascular history and examination performed by a practitioner with thorough training in these conditions is best qualified to perform the PPE.
As physicians, other healthcare providers and other interested parties with a vested interest in the
health and well being of children, adolescents and young adults in Wisconsin, we urge the State
Assembly to remove sections of AB-260 that allow chiropractors to perform PPEs or other
comprehensive assessments of a patient’s overall health.
Alliance of Health Insurers
Children’s Hospital of Wisconsin
Medical College of Wisconsin
WI Academy of Family Physicians
WI Athletic Trainers Association
WI Council of Child and Adolescent Psychiatry
WI Medical Society
WI Primary Health Care Association
American Medical Society for Sports Medicine
Marshfield Clinic Health System
Sixteenth Street Community Health Centers
UW Health - American Family Children’s Hospital
WI Academy of Physician Assistants
WI Chapter of the American Academy of Pediatrics
WI Interscholastic Athletic Association
WI Neurological Society
WI Psychiatric Association
American Academy of Pediatrics. Policy Statement , Scope of Practice Issues in the Delivery of Pediatric Care . 2013.
American Academy of Pediatrics (AAP). State Advocacy Infographic : Pediatric Education and Training.
American Medical Association (AMA). Geomap Wisconsin Primary Care Physicians to Chiropractors.
American Medical Association (AMA). Issue Brief Chiropractors (available via electronic copy), 2016.
Davis, Lindsay. Column : Why Wisconsin Should Not Allow Chiropractors to Perform Sports Physicals . USA Today , June 29,
Palmer College of Chiropractic. 2017-2018 Course Catalog.
American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine,
American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, American
Osteopathic Academy of Sports Medicine. Preparticipation Physical Evaluation, 4th Edition , ISBN-13: 978-1-58110-376-2,
May 1, 2010.
National Collegiate Athletic Association (NCAA). Sports Medicine Handbook (©2013-2014) , Page 11, Guideline 1C:
“Medical Evaluations, Immunizations and Records.”
National Athletic Trainers’ Association (NATA). Position Statement : Preparticipation Physical Exams and Disqualifying
Conditions . Journal of Athletic Training, Volume 49, Number 1. February 2014.
Northwestern University Health Sciences. Curriculum Review (current).
Wisconsin Academy of Family Physicians. Testimony to the Wisconsin Assembly Committee on Health, April 26, 2017.
Wisconsin Chapter of the American Academy of Pediatrics. Position Statement . Pre-Participation Physical Exams (PPEs)
for Student Athletes . April 24, 2017.
Wisconsin Pediatric Healthcare Coalition. Infographic , AB260 Opposition . June 2017.
Wisconsin Pediatric Healthcare Coalition. Letter to the Wisconsin State Assembly Committee on Health: AB260 and Pre-
Participation Examinations . April 26, 2017.
Wisconsin Pediatric Healthcare Coalition. Press Release : Wisconsin Healthcare Leaders Oppose Chiropractor Bill . June 12,
Wisconsin Pediatric Healthcare Coalition. Letter to the Wisconsin State Assembly, AB260 and Pre-Participation
Examinations . June 16, 2017.
Wisconsin Psychiatric Association. Testimony to the Wisconsin State Assembly on Health: Opposition to Assembly Bill
AB260 . April 26, 2017.