July August - Texas Chiropractic Association

Transcription

Texas
What has New
Mexico Done?
Passed legislation that will
have a profound impact
on the profession
CHIROPRACTIC
7 Mistakes of
Back-Pain
Sufferers
Hear from the author of
The 7 Day Back Pain Cure
an Apple a Day
keeps the M.D.
AWAY
ACA Reports:
tICD-10 - What Is It?
tHIPAA Update
tReducing the High Cost of
Health Care
The Problem
with Groupon
Is it a Good Idea for
Chiropractors?
Holistic Chef
Provides 5
Recipes that
Prove Healthy
is the New
Delicious
Exploring
Alternative
Diets
JULY-AUGUST 2013
VOLUME XXVIII ISSUE 4
$10
Copyright 2013 All Rights Reserved: Texas Chiropractic Association
texas
JOURNAL
OF
CHIROPRACTIC
Helping Chiropractors Help People
The Official Publication of
the Texas Chiropractic
Association
1122 Colorado St., Ste. 307
Austin, TX 78701
512.477.9292 phone
512.477.9296 fax
www.chirotexas.org
tca@chirotexas.org
EXECUTIVE OFFICERS
DEPARTMENT COORDINATORS
President: Jack Albracht, DC
President-Elect: James Welch, DC
Secretary/Treasurer: Cindy Vaughn, DC
External: Dan Petrosky, DC
Governmental: Devin Pettiet, DC
Internal: Steve VanOsdale, DC
Scientific: Mark Bronson, DC
BOARD OF DIRECTORS
TCA STAFF
District 1: Tony Smith III, DC
District 2: Jeff Williams, DC
District 3: Jason Helton, DC
District 4: Mike McGarrah, DC
District 5: JP Quinlan, DC
District 6: Darrell Frost, DC
District 7: Lorin Wolf, DC
District 8: Michael Henry, DC
District 9: Mark Roberts, DC
District 10: Chad Carpenter, DC
District 11: Max Vige, DC
District 12: Tom Hollingsworth, DC
CEO: John Darby
Director of CE: Sterling Isdale
Accounting Manager: Tracy Edwards
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Receptionist: Nicole Grimes
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Annual subscription to the Texas Journal of Chiropractic is included in TCA membership dues. Contact the TCA for subscription rates for nonmembers. The print Texas Journal of Chiropractic is published up to six times per year by the Texas Chiropractic Association under the supervision
of the TCA Publication Committee. Opinions expressed are those of the contributors and do not necessarily reflect the policy of the Texas
Chiropractic Association or the Texas Journal of Chiropractic. Publication of an advertisement does not imply approval or endorsement by the
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The opinions expressed are those of the authors and do not represent the opinions of the TCA.
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Chiropractic
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Helping Chiropractors
Help People
The Texas Chiropractic
Association represents
chiropractic professionals
throughout the state.
TCA serves to protect
chiropractic professionals,
their patients, and the
right for Texans to choose
chiropractic as one of their
health care options.
First formed in 1916, this
historic association has
existed for nearly 100
years representing the
interests of Texans who
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What Has New
Mexico Done?
By Dr. Tim McCullough, DC,
DABCI
Disclaimer: Dr. Tim McCullough
is a member of the Texas Board of
Chiropractic Examiners. This
article does not represent the
TBCE, the State of Texas, any
individual or organization in
Texas.
New Mexico chiropractors have
passed legislation that will have a
profound impact both on the
profession as well as the people of
New Mexico. A brief historical
background is necessary to
complete understanding and
appreciation of this history making
legislation. Exactly what have
New Mexico chiropractors done?
If you ask several chiropractors
what chiropractic is, you will get
different answers usually based on
that doctor’s philosophy or
experience. However, the fact is
that chiropractic is what the state
legislature determines in their
individual state statues, also called
enabling legislation - no more and
no less. Chiropractic is defined
differently in each state and is
typically referred to as the
chiropractic act. The law does not
address chiropractic philosophy,
training, or personal belief
systems. Knowing and
understanding the state’s
chiropractic law is the first part of
understanding the legal equation.
The next part of the equation is to
understand the function of the
board of examiners. Most boards,
whether chiropractic or medical,
are enabled/empowered in the
chiropractic/medical act by a state
legislature to: 1) make rules - a
legislative function and 2)
adjudicate claims/disputes - a
judicial function. They are a
governmental/administrative
agency (1) with the police power of
the state to regulate the profession.
The board is prohibited from
formulating laws/legislation.
However, they are empowered by
the legislature to engage in rulemaking, the avowed purpose of
which is to clarify the intentions of
the legislature. The line often
becomes blurred and the board’s
rules/regulations function as law.
If any individual or group
disagrees with a board constructed
rule/regulation the board may be
challenged in public hearings,
written testimony or in court. This
is designed to prevent the board of
examiners from becoming a
regulatory dictator with no checks
and balance. (2) All administrative
boards, whether regulating
professions, corporations, or
conduct are required to comply
with the state’s Administrative
Procedures Act to engage in rulemaking which guarantees that
their actions comply with due
process, fundamentally, notice and
an opportunity to be heard.
Here is an example of how a board
of examiners can turn itself into a
regulatory dictator. By legislative
law/statue the medical profession
has no scope of practice
limitations. A licensed MD can
treat any mental or physical
disease or disorder or a physical
deformity or injury by any system
or any method. However, the
individual MD’s are limited by
medical board rule allowing only
allopathic medicine in many states
and prevented from using natural
based medicines for treatment of
conditions, usually in the name of
public safety. When a board uses
the terminology, “In order to
protect the public” this is a
warning sign that they are in fact
restricting behavior in favor of one
idea or group over another.
Unless an individual or group
challenges the board’s action
either in public or in court and the
rule is removed or changed, it will
stand.
Chiropractic on the other hand is
specifically limited by legislative
law in a similar manner as dentist,
podiatrist and optometrist. When
the board of examiners writes
rules according to these limitations
stated in the law the rules are
usually more restrictive than
chiropractic education and
training. Since most chiropractic
laws do not allow a scope-ofpractice to the extent of
chiropractic training and expertise,
the rules constructed by the board
of examiners are, in the minds of
many chiropractors, hostile and
restrictive to the chiropractic
profession.
This is part of the current
controversy in Texas. The medical
doctors have sued the chiropractic
board of examiners several times
taking the position that the
chiropractors have expanded the
scope-of-practice by rule-making
rather than the legislative process
and the chiropractors are upset
with the board because they feel
the board has restricted the
profession by rule-making beyond
what the legislature intended.
So, we have in many states a
situation where medicine with no
legal restrictions is being limited
to allopathy by board rule and
chiropractors are limited by law/
statue, but attempting to achieve
full scope-of-practice-by-training
through board rule. The only
effective way to correct this
problem is to include full-scope
chiropractic and full access to
naturally based medications and
nutrients in the language of the
chiropractic or medical practice
acts. This legislative action would
also serve to limit the board of
examiners from attempting to
define chiropractic practice by
rulemaking. When the board is
allowed to use rulemaking to
expand or limit scope-of-practice
it functions like a trade union
instead of a fair and impartial
regulatory agency interpreting
what the legislature intended.
The chiropractors in New Mexico
have taken an historic first step
toward correcting this difficult
problem by convincing the
legislature to pass a law
designating the advanced
chiropractic physician and
granting prescriptive authority. An
advanced practice chiropractic
physician in New Mexico is
granted the authority by legislation
to practice full-scope chiropractic
as well as access to natural
therapies by law. So, the situation
of the board determining what a
profession is or is not by board
rule is reduced. The authority to
prescribe in the language of the
statue/law is critical to insure that
the scope of chiropractic is
determined by the legislature and
not by the board of examiners.
This history making legislation is
the first of its kind in the country
and is landmark legislation for
chiropractic’s future.
Where do drugs come into play in
this situation? First, the drug
situation in New Mexico has been
overblown by the media and the
ICA. The first drug on the
formulary is sterile water. Second,
all of the medications the
chiropractors included in the law
are naturally based; specifically
naming vitamins, minerals,
homeopathics, herbals and other
natural based substances. Third,
the FDA regulations regard any
substance used for medicinal
purposes as a drug and their goal
is to make all nutrients
prescription only. They have
already started to restrict
homeopathic medications and
herbs. This situation is
ameliorated in New Mexico
because the naturally based
substances that have been used in
chiropractic for over 100 years
chiropractors are now authorized
to prescribe. So, if tomorrow the
FDA makes all these nutrients by
prescription only the APC doctors
in New Mexico will still have
access to them for their patients.
The people of New Mexico will
have access to these substances
through their chiropractor even if
the osteopaths and medical
doctors’ board prohibit their use.
Drugs were also included
because state law in New Mexico
requires a physician to have
prescriptive authority that
includes drugs. In most states
chiropractors do not legally
qualify as physicians. The
authority to prescribe is a step
toward equality and crucial for
the chiropractic profession.
Remember, if your competition
by law is unrestricted and you
are restricted then the law
requires you will be
discriminated against. This is
why chiropractors often seem to
lose in court and health related
issues more than the MD/DO.
The law requires the courts to
discriminate against unequal
parties.
Prescriptive authority is another
important concept to understand
and it is critical if chiropractic is
to ever obtain any degree of
parity. In most states
chiropractors can recommend but
they cannot prescribe. The
authority to prescribe is a step
toward creating parity with other
providers because it empowers
the practitioner’s
recommendations with the power
of the state. Let me give you an
example. If a chiropractor
recommends that a child take a
digestive enzyme after meals at
school the public school does not
have to allow the child take the
supplement. If a chiropractor in
New Mexico with prescriptive
authority prescribes a digestive
enzyme after meals the school is
legally required to obey because
the state has empowered the
practitioner with the authority to
prescribe that treatment. It is a
powerful tool and essential for
parity and equality. What is
prescribed is not the issue. It is
the ability to prescribe
empowered by the state that
creates parity. In order to qualify
to obtain prescriptive authority
any profession must meet the
states’ requirements and in New
Mexico and most states the
authority to prescribe drugs is
part of the requirements.
Prescriptive authority begins to
level the playing field in the
medical-legal world. If
chiropractors had equal status in
the law they can demand equality
and equal treatment. They would
have standing in the court to
uphold anti-discrimination laws.
Without it the law requires
chiropractors must be
discriminated against because
chiropractors do not have
statutory authority to prescribe
their treatment.
There is another very important
point that the New Mexico
doctors were careful to include in
the legislation. Even though the
advanced practice doctor in New
Mexico has the authority to
prescribe treatments, the board of
examiners is prohibited from
making rules that require him/her
to prescribe a drug like the
osteopaths and the medical
doctors have been forced to by
their board rule. The chiropractor
has the right to use and has the
access to natural products and
therapies listed in the law. This is
a landmark piece of legislation
not only for chiropractic to gain
equality and parity, it is the first
of its kind attempting to ensure a
profession will not lose it tenets
by board rule.
So, what was has New Mexico
done? They have passed
visionary legislation to insure
that the philosophical foundation
of naturally based chiropractic
can survive into the future. They
have also insured that the people
of New Mexico will have access
to natural chiropractic care even
if the FDA makes all
supplements available by
prescription only and the medical
boards restrict the use of natural
products in the practice of
medicine. They have insulated as
much as possible against
potential or existing power
struggles on the board of
examiners that threatens that one
group can change chiropractic to
their philosophy. They have also
taken the first steps in giving the
chiropractors in New Mexico
true parity so they can sit at the
table with the MD and DO in
matters concerning the health
and welfare of the people of New
Mexico. The chiropractic leaders
in New Mexico are visionaries
and history makers who have led
the way in guiding chiropractic
politics and law into the future.
(1) For historical context, the advent of Administrative Agencies in the U.S. and their enabling legislation, as it impacts/affects upon any profession
engaged in healthcare, did not begin until the mid-1910’s. The first medial practice act in Texas was passed in 1913. The philosophical, scientific, and
treatment protocols distinguishing allopathy, osteopathic, and chiropractic practice developed twenty-five years earlier in the mid to late 1890’s. (2)
Acting ultra vires, or “outside their authority.”
CHIROPRACTIC
DIRECTORY
COMING
SOON
7 Mistakes of BackPain Sufferers
By Jesse Cannone
Back pain is one of the most
common health issues in the
United States, with up to 80
percent of the population
suffering the condition at some
point in one’s life.
“But this exceedingly high
number is just the beginning of
the problem, because multiple
studies indicate that roughly 70
percent of back surgeries fail,”
says Jesse Cannone, a back-pain
expert and author of The 7-Day
Back Pain Cure,
(www.losethebackpain.com).
“It’s so common that there’s a
name for it – failed back surgery
syndrome, or FBSS.”
One recent study monitored
1,450 patients in the Ohio
Bureau of Workers’
Compensation database; half of
those on disability endured back
surgery, half did not. After two
years, only 26 percent of those
who had surgery returned to
work. Additionally, 41 percent of
those who had surgery saw a
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drastic increase in painkiller use.
“The success rate for the most
common treatments is
pathetically low, so it’s no
surprise people often struggle
years or decades with back pain,
with few ever finding lasting
relief,” Cannone says. “The
majority of back surgeries are
not only ineffective, but most
could have been completely
avoided.”
He reviews seven common
mistakes made by back-pain
sufferers:
• Continuing treatment that
isn't working: One of
Cannone’s clients experienced
70 treatments resulting in no
relief. “Here’s a general rule to
follow,” he says. “If you see no
improvement after going
through a three-month period
of treatment, consider making
a change.”
• Failing to solve the problem
the first time: Take pain
seriously the first time.
Cannone’s own mother
suffered a significant bout of
back pain, which subsided after
a few days. But two years later
it came back, and the second
time was so debilitating she
couldn’t work. “If she had
taken the first bout more
seriously, she probably would
have prevented the second,
more debilitating bout.”
• Thinking you’re too healthy
or fit to have back pain:
Staying in shape is always a
good idea, but it does not make
you invulnerable. People who
train their body can be more
prone to back pain because
they often push their body’s
limits, says Cannone, who has
been a personal fitness trainer
since 1998.
• Treating only the symptoms:
Cortisone shots, antiinflammatory drugs, ultrasound
and electrical stimulation only
address pain symptoms. “You
may get rid of the pain, but the
problem causing the pain will
persist if not addressed,” he
says. “If you want lasting
relief, you must address the
underlying causes, and it’s
never just one.”
• Not understanding that back
pain is a process: In most
cases, back pain, neck pain and
sciatica take weeks, months or
even years to develop; the
problem may exist for quite a
while before the sufferer
notices it, except for rare onetime trauma incidents like
automobile accidents. Most
people sit for hours at a time,
yet the body was developed for
diverse movements throughout
the day. “Think of a car with
steering out of alignment;
eventually, tires will wear
down unevenly and there will
be a blow out,” Cannone says.
“The same is true with your
body.” Just as the damage was
a process, recovery is the same
and can be time-intensive.
• Believing there are no more
options left: Not only does
back pain hurt and prove
physically debilitating; it also
tries the morale and
determination of the patient. A
sufferer can run the gamut of
treatments. But, often, it takes
a mixture of treatments that
address all of the underlying
causes. “Remember, you can’t
really treat the root of pain
until you know what’s causing
it,” Cannone says. “In so many
cases, this is precisely the
problem.”
• Failing to take control:
Doctors and other specialists
are ultimately limited to what
they know and what they’re
used to. If you have a
debilitating back problem, it
should be among your top
priorities to learn all you can
about it, and how to fix it. Get
a second, third and fourth
opinion if treatment isn’t
working; try out alternative
therapies, and consider a
healthy mix of treatment. Most
importantly, take control; it’s
your back, your body and only
you can heal it, with help from
others.
“I may be critical of how most
handle back pain, but that’s
because I’ve proven to patients
that there are flaws in the
traditional approaches as well as
more effective alternatives,”
Cannone says. “I also feel that
I’m offering a hopeful message
because of my high success
rate.”
Jesse Cannone is a leading back
pain expert with a high rate of
success for those he consults. He
has been a personal trainer since
1998, specializing in finding root
causes for chronic pain, and
finding solutions with a
multidiscipline approach.
Cannone publishes the free email
newsletter “Less Pain, More
Life,” read by more than 400,000
worldwide, and he is the creator
of Muscle Balance Therapy™.
One Society’s Opinion
“There is a huge push for the 'expansion of chiropractic' throughout the US. … The CST
[Chiropractic Society of Texas] will never support such an 'expansion' in our profession...
The ACA has made it very clear that they are in support of chiropractors prescription rights.
For this reason, I urge you to not support the ACA, nor any organization that supports the
ACA."
-- Newsletter from CST, May 30, 2013, emailed from Chiropractic
Society of Texas (info@texaschiropractic.org)
Holistic Chef
Provides 5 Recipes
that Prove Healthy
is the New Delicious
By: Shelley Alexander, CHFS
With adventurous food tastes and
concerns ranging from personal
health to ethical agriculture and
livestock practices, more people
are exploring alternative diets.
But that’s not always easy – or
palatable.
“You have paleo and primal diets,
pescatarian and raw foods,
vegetarian and vegan, and they all
have wonderful merits, especially
when compared with the
processed foods many Americans
continue to eat,” says Holistic
Chef and Certified Healing Foods
Specialist Shelley Alexander,
author of “Deliciously
Holistic,”
(aharmonyhealing.com).
“My focus is on easy-to-follow
healing foods recipes that make
delicious, completely nourishing
meals. Some will appeal to those
who adhere to a strict diet, such as
vegan, and all will make people
feel noticeably healthier without
sacrificing any of the enjoyment
we get from sitting down to eat.”
Alexander offers five recipes that
can be used for any meal of the
day or night, including:
• Mango chia ginger granola
(raw, vegan): 2 ripe mangos,
peeled, cored and sliced in oneinch cubes; 2 cups Living
Intentions chia ginger cereal; 2
cups nut or seed milk. Put
ingredients in a bowl and enjoy!
The cereal is gluten-free, nutfree, and raw- and vegan-diet
friendly, and extremely
nutritious. Preparation takes five
minutes or less and is hearty
enough to satisfy appetites the
entire morning. The ingredients
can be substituted for dietary
needs or preferences.
• Portobello mushroom and
grilled onion burgers (vegan):
Marinade for the mushroom is
essential – 2 tablespoons
Balsamic vinegar; 1/3 cup extra
virgin olive oil or avocado oil; 1
tablespoon wheat-free Tamari or
organic Nama Shoyu soy sauce;
1/8 teaspoon smoked sweet
paprika; 1 peeled garlic clove
(grated or minced); 1/8 teaspoon
cayenne pepper; 2 teaspoons
organic maple syrup – grade B.
The burgers include 4 large
Portobello mushrooms – cleaned
and patted dry; 1 large white
onion (peeled and cut into thick
slices); olive or avocado oil to
cook mushrooms and onions; 2
sprouted whole grain hamburger
buns –toasted; Dijon mustard; ¼
cup baby romaine lettuce –
washed and patted dry. Marinate
mushrooms and onions for 30
minutes. Drizzle with oil and
cook on medium heat for 15
minutes, turning mushrooms
halfway through. Serve
immediately.
• Wild blueberry smoothie (raw,
vegan): 3 cups vanilla Brazil nut
milk (there is an additional
recipe for this); 2 cups fresh or
frozen wild or organic
blueberries; 1 peeled banana –
organic or fair trade; 2 to 3 cups
organic baby spinach; 1 small
avocado – peeled and pitted; ¼
teaspoon cinnamon; (optional) a
preferred protein powder or
superfood. Blend until creamy.
Blueberries are an amazing fruit
packed with antioxidants,
vitamins, minerals, fiber and
phytonutrients.
• Raw corn chowder (raw,
vegan): 4 cups organic corn
kernels (best during summer
months); 2¼ cups unsweetened
almond milk; 1 clove peeled
garlic (remove inner stem); 2
teaspoons fresh lemon juice; ½
teaspoon smoked sweet paprika;
1/8 teaspoon pure vanilla
extract; ½ avocado (peeled and
seed removed); unrefined sea
salt and fresh black pepper to
taste. Blend ingredients and
strain; top with corn kernels and
diced organic red bell pepper.
Among other nutrients, corn
provides lutein – an important
carotenoid that protects eyes
from macular degeneration.
• Dijon honey chicken wings: 1/3
cup Dijon mustard; ½ medium
peeled lemon – remove all the
white pith; ¼ cup raw honey; 1
teaspoon unrefined sea salt; 2
large, peeled garlic cloves –
grated; 1/8 teaspoon fresh
ground black pepper; 12 whole
chicken wings – rinsed and
patted dry; ½ teaspoon paprika.
Preheat oven to 400 degrees.
Blend ingredients in a blender,
except for wings and paprika,
until smooth. Add salt and
pepper to taste. Remove tips of
cleaned wings and store in
freezer for future stock. Place
wings on lightly greased baking
dish, sprinkle lightly with salt
and pepper, place in oven. After
30 minutes baste wings with
juices from pan, then brush
mustard sauce all over wings,
sprinkle with paprika and
continue baking for an additional
25 to 30 minutes. Wings should
have internal temperature of 165
degrees when done. These are a
healthy and tasty alternative to
deep-fat-fried wings.
About Shelley Alexander, CHFS
Shelley Alexander has enjoyed a
lifelong love of delicious, locally
The Problem with Groupon
By Dr. R. A. Foxworth, FICC, MCS-P
I get asked now and again whether offering
Groupons is a good idea for chiropractors. The
answer, unfortunately, is far from simple. Each state
has its own rules about what’s allowable and what
isn’t.
In Oregon, for instance, two different medical boards
have disallowed Groupons for chiropractor and
dentists on the grounds that Groupon’s terms violate
kick-back fee and split-fee guidelines.
Other states are still on the fence.
As it stands right now, chiropractors offering
Groupons stand a good
chance of running afoul of third-party payer
regulations.
Apart from legal concerns, there are professional
ones as well. I don’t know about most of you,
but I see Groupons mostly for restaurants, family
activities, salons, and travel. And while I do also
occasionally see one for a chiropractor, what
message does this send potential patients about our
profession? Would someone really use a Groupon
for, say, a tonsillectomy, a bowel resection or a knee
replacement?
When we put chiropractic adjustment on the same
playing field as a pedicure, how much
value are we placing on chiropractic care in the mind
of the public?
We understand the temptation to get in on a Big New
Marketing Thing. It’s tough out there,
and DCs, understandably enough, want to stay
competitive, attract new business and offer
affordable fees, especially for their uninsured, underinsured and partially insured patients. But rather than
take a huge risk offering discounts that may well turn
out to be illegal, we here at ChiroHealthUSA want to
make sure chiropractors stay in compliance and offer
discounts LEGALLY.
grown, seasonal foods. She
received her formal chef’s
training at The Los Angeles
Culinary Institute. Alexander is a
certified healing foods specialist,
holistic chef, blogger and owner
of the holistic health company, A
Harmony Healing, in Los
Angeles.
This is not to say we are big boosters of offering
discounts. But we’ve seen that the reality is,
any doctor who participates in any health plan
already takes network discounts.
Our stance remains the same: document correctly,
code correctly, bill correctly and,
IF you discount, discount correctly!
That’s where a Discount Medical Plan Organization
(DMPO) like ChiroHealthUSA comes in.
We offer a discounting solution that is legal,
extremely affordable for patients, and costs the
doctor
not a single penny. Better yet, we make it easy to
find out more about becoming a provider by holding
our overview webinar, “Why do I need
ChiroHealthUSA?,” every Tuesday at 12:15 PM
EST.
DCs look to their state associations for invaluable
support, and it’s our mission to help.
Find out more by registering for our free Tuesday
webinar at www.chirohealthusa.com.
Dr. Foxworth is a certified Medical Compliance
Specialist and President of Chi¬roHealthUSA. A
practicing Chiropractor, he remains “in the trenches”
facing challenges with billing, coding, documentation and
compliance. Dr. Foxworth is a 1984 Honors Graduate,
(Cum Laude), of Cleveland Chiropractic College in
Kansas City, MO. He served as Staff Chiropractor for the
G.V. Sonny Montgomery VA Medical Center 4 years and
is a member of the American Chiropractic Association
and a 3 term past-president of the Mississippi
Chiropractic Association. He was voted by his peers as
Chiropractor of the Year for several years and is currently
a Fellow of the International College of Chiropractic. He
was appointed to the Mississippi State Board of Health by
Governor Kirk Fordice and again by Governor Ronnie
Musgrove and served 12 years, two of them as Chairman.
You can contact Dr. Foxworth at 1-888-719-9990,
info@chirohealthusa.com or visiting the
ChiroHealthUSA website at www.chirohealthusa.com
ISSUE BRIEF
Conservative Care First:
A Strategy to Reduce the High Cost of Health Care
The cost of health care is becoming an ever-larger portion of the federal budget. In 2011, $2.7 trillion was spent on
health care in America and $551 billion was spent on Medicare alone. We cannot sustain these rapidly increasing
costs. The number of Medicare patients are growing as baby boomers enter retirement age and the care of patients
with chronic conditions continue to drive increasing costs of health care. The average health care cost for all
Medicare patients in 2006 was $8,344, but the average cost for the top 10 percent of Medicare patients was
$48,2001. In May 2013, the Medicare Board of Trustees revealed the Medicare trust fund, as currently configured,
will run out of money by 2026.
The rapidly increasing prevalence of chronic conditions is an important factor. In 1987, 31 percent of Medicare
patients were treated for five (5) or more chronic conditions. In 1997, that number jumped to 40 percent and by
2002 the number had increased to more than 50 percent. An estimated 96 percent of Medicare spending in 2006
was for patients with multiple chronic conditions; 79 percent for those with 5 or more chronic conditions2.
The incidence of obesity doubled between 1987 and 2002, along with diabetes, hyperlipidemia and hypertension3.
Obesity and diabetes are increasing in all age groups including children and adolescents. Seventy-two million
Americans are obese, with estimated annual health care costs of $147 billion4. There are also more that 100 million
chronic pain patients in the US according to the Institute of Medicine, with costs exceeding $635 billion annually5.
These numbers continue to rise, showing a deterioration of Americans' health status, even as we continue to spend
more and more on “health care.” The truth is that we spend very little in the U.S. on “health care;” what we call
health care is mostly “disease care” with services and expenditures largely focused on very expensive illness and
symptom treatment. This focus must change to promote the use of safer and less expensive conservative care
interventions first. We must encourage increased patient education and counseling on risk avoidance and health
promotion strategies, including lifestyle modifications that are necessary to avoid or mitigate costly and debilitating
chronic illnesses and diseases6.
Our health care system is overloaded and medical providers are stretched to see increasing numbers of patients.
There are growing shortages in Primary Care Providers (PCP). We must change our approach to patient care.
Provider shortages are predicted to increase dramatically but can be safely and effectively mitigated by using all
available physician level health care providers at the top of their licenses7. Chiropractic Physicians are educated as
conservative primary care providers who serve as portal of entry8 and perform many PCP services9 safely, efficiently
and effectively. The full inclusion of doctors of chiropractic (DCs) in America's health care system can help to reduce
health care costs, while maintaining excellent clinical outcomes and patient satisfaction levels and without rationing
care, reducing access or excluding large segments of America's population.
Changing health care to the conservative-care-first (CCF) approach of Chiropractic Physicians, and increasing the
nation's focus on health promotion, prevention and wellness, will achieve major reductions in health care costs –
but this will require significant changes in America's health care delivery and the culture of our health care system.
With the decline in Americans' health status, the increase in chronic conditions, the worsening shortage of primary
care providers, and rapidly escalating health care costs, significant changes are critical. Authors Marvasti and
Stafford note there is a need for “transformational change,” a “fundamental reordering of our health care system”
and “reengineering prevention into health care”6,10. But how can this be done?
The major cost drivers in health care are largely related to our approach to treating chronic pain and diseases. We
can effectively reduce expensive, high risk cost drivers by reducing the use of unnecessary and/or excessive
services11: surgeries (e.g. spine surgeries)10,12, invasive procedures (e.g. spinal injections)10,13, hospital admissions
and readmissions14,15, prescription drugs (e.g. opioids and NSAIDS)14,16,17,18, diagnostic imaging (e.g. MRIs and
CTs)11,19,20 and other diagnostic testing20, as well as related hospital infections15,21, surgical/hospital mistakes15,21,22,
prescription drug adverse events15,23 and follow-up care necessitated by mistakes and adverse events15.
Considerable cost savings will accrue with maximum elimination of the unnecessary and/or excessive portion of
these major cost drivers. This can be facilitated by transitioning to a conservative-care-first model of health care.
This model will focus patient care first on conservative diagnostic testing and treatment, offered in an out-patient
setting, directed toward whole-person wellness -- providing an appropriate trial of conservative care (non-drug,
non-surgical approach) and incorporating health promotion and wellness counseling (and coaching) from the start
of care.
CCF providers must be placed on the front line of health care wherever practical; it is here that these providers can
have the greatest impact on changing the focus of patient care -- from symptom and disease treatment to
promotion of lifestyle modification, chronic disease prevention and whole-person wellness. CCF providers deliver
essential services, as defined by §1302 of the Patient Protection and Affordable Care Act (PPACA)24; they examine,
diagnose and set care plans that employ the best conservative options and refer to other providers when patients
present with acute medical emergencies or when conservative options are not readily available or appropriate.
Optimal savings will be achieved by employing more conservative, less risky and less expensive options - first. The
logical first step to jumpstart this important transformation to a CCF approach is to fully employ well established and
broadly available CCF providers on the front line of health care.
The CCF approach will not be the only change necessary to improve health care and reduce related costs but this
change alone will offer a significant step in the right direction. The use of broadly available Chiropractic Physicians
as CCF providers can foster significant improvements in patient-centered care and can significantly reduce health
care costs. This approach will ensure more patients receive a trial of conservative care before more costly and
higher-risk procedures and interventions are attempted. This approach will also help to reduce the burden on PCP
and specialty provider resources, improving access to these valuable resources for patients who truly require more
invasive and/or expensive interventions.
Providing patients with the opportunity to choose a CCF provider, and indeed encouraging and directing patients to
make this choice, will have a swift and definitive impact on how care is delivered -- effectively changing the focus
and reducing the cost of health care. Engaging patients earlier, and more often, with good health habits and wholeperson health care strategies can improve patients' short and long term health and the viability of our health care
system in America.
The Institute of Medicine has estimated that approximately 75 percent of our health care dollars are spent to treat
patients with chronic conditions; $635 billion is spent on chronic pain patients alone. The National Center for
Chronic Disease Prevention and Health Promotion (CDC) has noted that a large number of chronic conditions are
lifestyle related – due to poor health habits – perhaps as many as 80 percent25. These chronic conditions can be
avoided or mitigated by modifying a patient's lifestyle and teaching them good health habits. As physician level CCF
providers, DCs are well educated and experienced to fill this transformational role safely and effectively8,9. Some
DCs may be used as PCPs for spine care or musculoskeletal conditions26, while others may be used as
conservative/CAM PCPs for general health counseling and coordination of care27,28. These strategic uses of
Chiropractic Physicians will ensure the maximum application of a conservative-care-first approach and result in
significant cost savings and will begin to make much needed changes in the focus of America's health care.
A 15-20 percent reduction in America's health care costs would result in $400-500 billion in annual savings. Such
significant savings may be achieved with the CCF approach. Studies have shown large savings with use of DCs as
first contact doctors. Patients were given the choice of consulting a DC or MD as their Primary Care Provider in AMI
studies26,27; those who chose a DC were assured a CCF, whole-person, non-drug, non-surgical approach when
appropriate, and referral when necessary. The AMI studies showed 40-50 percent savings on prescription drugs,
surgeries, hospital admissions and hospital stays for patients who chose DCs as their PCPs. Another study on a
large population of patients in Tennessee showed 20 percent reduction in cost of care for patients with low back
pain when they chose to see a DC first, compared to those patients who saw an MD first29. The CCF approach is
patient-centered, rational and doable and it holds great potential for reducing America's health care costs. Current
access and coverage restrictions placed unilaterally on non-MD/DO providers (and their services) reduces patient
choice and increases costs overall30.
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Millions of patients can significantly reduce the cost of their health care with the CCF approach, while achieving
excellent clinical outcomes and high patient satisfaction. Using Chiropractic Physicians and the CCF approach to
patient care presents a significant solution strategy for America's health care challenges.
References Cited:
1
Medicare Spending & Financing-A Primer-2011, Lisa Potetz, Juliett Cubanski, Tricia Newman, The Henry J Kaiser Family Foundation
2
Responding to the Growing Cost and Prevalence of People with Multiple Chronic Conditions, Gerard Anderson, PhD, Johns Hopkins Bloomberg School
of Public Health, 2007
3
The Rise in Spending Among Medicare Beneficiaries: The Role of Chronic Disease Prevalence and Changes in Treatment Intensity, Kenneth E. Thorpe,
David H. Howard, Health Affairs, August 2006
4
Annual Medical Spending Attributable to Obesity: Payer-and-Service-Specific Estimates, Eric A. Finkelstein, Justin G. Trogdon, Joel W. Cohen, William
Dietz, Health Affairs 28, no.5, July 2009
5
Relieving Pain in America- A Blueprint for Transforming Prevention, Care, Education and Research, Institute of Medicine, June 2011
6
7
8
9
Farshad Fani Marvasti, M.D., M.P.H., and Randall S. Stafford, M.D., Ph.D., N Engl J Med 2012; 367:889-891
Patient Protection and Affordable Care Act (ACA); Sec. 2706, Non-Discrimination in Health Care
Educational Standards; Council on Chiropractic Education (CCE); 2013
Practice Analysis of Chiropractic; National Board of Chiropractic Examiners; 2010
10
Outcome of Invasive Treatment Modalities on Back Pain and Sciatica: An Evidence-Based Review, wan Tulder MW, Koes B, Seitsalo S, Malmivaara A,
Eur Spine J, January 2006
11
Squandering Medicare’s Money, Rita F. Redberg, Editor Archives of Internal Medicine, San Francisco, May 2011
12
13
MRI Abundance May Lead to Excess in Back Surgeries (Study Shows), Welsh J, Stanford University School of Medicine, Oct. 14, 2009.
Medicare Payments for Facet Joint Services, Department of Health and Human Services, Office of Inspector General, Daniel R. Levinson, September
2008
14
Adverse Drug Reactions Cause Too Many Hospital Admissions, BMJ, July 2004
15
Adverse Events in Hospitals: National incidents among Medicare beneficiaries, Department of Health and Human Services, Office of Inspector
General, Daniel R. Levinson, November 2010
16
Alarming Rise in Unintentional Drug Overdose Deaths in Ohio, Ohio State University College of Pharmacy, Ohio Department of Health Violence and
Injury Prevention Program, 2009
17
Crossing the Quality Chasm: A New Health System for the 21st Century, Washington, DC: National Academies Press, Institute of Medicine, 2000
18
19
20
Epidemic: Responding to America's Prescription Drug Abuse Crisis, Executive Office of the President, 2011
The Relationship Between Low Back Magnetic Resonance Imaging, Surgery and Spending, Schreibati JB, Baker LC, Health Serv Res, 2011
Exposure to Ionizing Radiation and Estimate of Secondary Cancers in the Era of High-Speed CT Scanning: Projections from the Medicare Population,
Meer AB, Basu PA, Baker LC, Atlas SW, J Am Coll Radiol, 2012
21
Hospital Incident Reporting Systems Do Not Capture Most Patient Harm, Daniel J. Levinson, Department of Health and Human Services, Office of
Inspector General, January 2012
22
To Error Is Human: Building a Safer Health Care System, Washington DC: National Academies Press, Institute of Medicine, 1999
23
24
25
Incidence and Preventability of Adverse Drug Events Among Older Persons in the Ambulatory Setting, Gurwitz J. H., JAMA 289 (9): 1107-1116
Patient Protection and Affordable Care Act (ACA); Sec. 1302, Essential Health Benefits Requirements
National Center for Chronic Disease Prevention and Health Promotion (CDC); The Power of Prevention-Chronic Disease... the Public Health Challenge
of the 21st Century; 2009
26
A Hospital-Based Standardized Spine Care Pathway: Report of a Multidisciplinary, Evidence-Based Process, Ian Palkowski, DC, Michael Schneider, DC,
PhD, Joel Stevans, DC, John Ventura, DC, and Brian D. Justice, DC, JMPT February 2011.
27
Sarnat, R.; Winterstein J. Clinical and Cost Outcomes of an Integrative Medicine IPA, JMPT, 2004
28
29
Sarnat, R.; Winterstein J.; Cambron JA, Clinical and Cost Outcomes of an Integrative Medicine IPA; an additional 3-year update, JMPT, 2007
Cost of Care for Common Back Pain Conditions Initiated with Chiropractic Doctor vs. Medical Doctor/Doctor of Osteopathy as First Physician:
Experience of One Tennessee-Based General Health Insurer, JMPT 2010
30
Plateaued, Suggesting Role In Reformed Health System-US Spending On Complementary And Alternative Medicine During 2002-08, Matthew A.
Davis, Brook I. Martin, Ian D. Coulter and William B. Weeks, Health Affairs, 32, no.1 (2013):45-52.
Other References:
Chiropractic Summit Partners: American Chiropractic Association, Association of Chiropractic Colleges, Congress of Chiropractic State Associations,
International Chiropractors Association, et al; Consensus Document-Doctors of Chiropractic Serving as Prevention and Wellness Providers; 2011
32
Chiropractic Summit Partners; American Chiropractic Association, Association of Chiropractic Colleges, Congress of Chiropractic State Associations,
International Chiropractors Association, et al; Consensus Document-Doctors of Chiropractic: Providers of Conservative, Patient Centered Primary Care
and Essential Benefits. Helping to Fill the Workforce Gap and Decrease Health Care Costs (The Case for Full and Non-Discriminatory Inclusion of Doctors
of Chiropractic in America's Health Care System); 2011
33
International Chiropractors Association, et al; Consensus Document-Doctors of Chiropractic: A Low Cost Solution to High Cost Health Care; 2010
34
International Chiropractors Association, et al; Consensus Document-Doctors of Chiropractic Can Improve the U.S. Primary Care Workforce Challenge;
2010
35
International Chiropractors Association, et al; Consensus Document-Chiropractic Cost Effectiveness; 2009
31
! "#$%&'( ! &)*$+*'( * "&,'& (
Prospering with ObamaCare: The
Chiropractic PosturePractice Scenario
!
It's decided: ObamaCare will become our new American
healthcare system. Like it or not, the economics of US
healthcare will be guided by a new rulebook, one which puts
Americans into silver, bronze or gold insurance plans... or
face an increasingly punitive tax.
As the arguments continue between faceless bureaucrats and
regulators on who wins, who loses a little and who loses a
lot, remember this:
It takes years to change a healthcare system- 2014 is just

beginning of what has already been legislated, and taking
away any new benefits will become far more difficult as
time goes on.
People always want the best they can get for themselves
Boomers are getting older, and older people suffer with
more back, joint and muscle pain
Back pain has been rising since 1992 (not surprising in an
increasingly sedentary society), with more doctor visits-MD, PCP and chiropractic-- more drug prescriptions, and
more surgeries
So like it or not, the healthcare system will change. PostMVA care models and PIP are changing. Insurance coding
will change dramatically with ICD-DVWKHFRGHVZH¶UH
used to become obsolete. But change brings opportunity as
well as danger, so OHW¶V look at what's some likely changes
coming between now and 2020 as ObamaCare becomes the
healthcare framework for the next few decades.
The Obvious- Healthcare utilization will go up. "I'm paying
for it with my tax dollars, so I am going to use it."
The Very Probable- National expenditures on healthcare
will go up....and there will be more controls on price and
utilization
And Also- Tech will disrupt healthcare, from off-shore
radiology tele-medicine to cell camera otoscopes and do-ityourself iphone EKG apps.
The Less Obvious- People will get used to paying for more
non-urgent care in cash as more controls are put into place
The Less Obvious, but Very Probable- Opportunities will
grow for chiropractors (along with massage therapists and
!"#$#%&'#(%()#*+&,-&
other manual therapy providers) who physically touch people
to build strong relationships, especially when they also
empower and help them get the best value for their money.
A posture focused practice builds awareness with a photo and
common-sense concepts, and then educates people towards
stronger posture with focused individualized exercise. Helping
people manage their own problems builds perceived value,
and sets the stage for a long term health relationship.
As sedentary boomers slump into old age, a PosturePractice
can help them stand taller to not only manage their back pain
and arthritis to feel (and often look!) perceptibly better, but
actually improve other aspects of their health - NMS to
respiratory to gastrointestinal. Especially when the wait to see
a medi-gov doctor stretches from days to weeks to months.
Bottom Line: Patients who honestly know they are getting
value for their dollars in a relationship are more likely to
spend those dollars in that relationship, especially when they
can see a difference in a posture picture, and feel an
improvement in how they can move their body.
Next PosturePractice Corner: Beginning with the First StepA Posture Picture
COM I NG SOON: Why Common-Sense Will Rule. (If people
FDQ¶W easily communicate it to their friends, they won't. But if
they can, they may.)
Dr Steven Weiniger is author of Stand Taller ~ Live Longer: An
Anti-Aging Strategy, and Posture Pictures: Assessment, Marketing,
Screenings & Forms, and lectures internationally on exercise and
posture rehab.Dr. Weiniger has been featured in numerous articles
on posture, anti-aging and exercise in professional journals as well
as mainstream media including )2;1HZV2SUDK¶V2[\JHQ
network, Natural Health Magazine, American Fitness and Bottom
Line Health. He promotes the brand identity of Posture Expert for
DCs, a concept presented to NCLC, COCSA and numerous colleges
and state associations, and serves as Managing Partner of
BodyZone.com, which provides posture, chiropractic, massage and
wellness information and referrals to local Posture Exercise
Professionals (CPEP). Contact Dr. Weiniger at PosturePractice.com
or drweiniger@bodyzone.com.
Your Perception, Your Reality,
Your Choice
By: Chris G. Dalrymple D.C., F.I.C.C.
"I wish things were different." "I wish that we were
better liked." "I wish that people would just see the
good that we are trying to do." We often hear such
"wishes" surrounding our profession. A wish is a
desire or a longing. A wish is not an action carried to
a result.
The results that one achieves in life are based upon
the actions that one takes, or doesn't take. The actions
taken (or not taken) are determined, in large part, by
the tools that you use to carry out those actions, and
the tool that you chose to use is determined by "your
reality," and "your reality" is determined by your
perceptions. To state this as a cliche: "If you think
you can or you think you can't, you're right."
Therefore, more than just changing your tools or your
actions, if you want to change your results you need
to change your perception of your reality.
Lest you think that this is some metaphysical
gobbled-gook, take note that Albert Einstein stated in
1950 "A human being is a part of the whole, called
by us 'Universe', a part limited in time and space. He
experiences himself, his thoughts and feelings as
something separated from the rest — a kind of
optical delusion of his consciousness. The
striving to free oneself from this delusion…
to try to overcome it is the way to reach the
attainable measure of peace of mind."
might be more attractive than “we sell our service.”
2. The tools that we use to share our reality will
also affect our results. Fast-acting marketing tools and
techniques reach as many prospects as possible, as
quickly as possible, and demonstrate your
overwhelming value so that prospects can easily say,
"Wow, where have YOU been!?" Can you see how
“active buzz” is more attractive than “passive
notification” or even isolation?
3. Finally the action that you take, or don’t take,
will have a direct impact on our results. We must take
action, understanding that sharing our reality is a
marathon which cannot be finished (or even started)
unless we take the first steps forward.
This process is natural and ongoing whether you are
aware of it or not. It IS part of your life--the actions
that you take, and the actions that you don't take will
determine your results. Achieving results is not
difficult, and it doesn't necessarily cost any money,
but it does require the difficult mind work needed for
real change. To change a result often requires a
change in perception.
Why is it labeled in the diagram below
"your reality" and not just "reality?"
Because we are in a prison and we can only
experience a portion of reality. The achievement
of results in life are affected by our perceptions,
our tools, and the actions that we take (or don’t take).
They all come into play.
1. Perception plays a LARGE part in determining our
outcomes. If we change the way we perceive
ourselves and our value, we will have an impact on
our results. Can you see how “we improve lives”
In which direction will your
perceptions of "You &
Your Message" travel
through time?
• Will you just be "positive" but take no action and
thus "go nowhere?"
• Will you "take positive action" in order to move
yourself toward a desired outcome?
• Will you just be "negative" and take no action and
thus "go nowhere?"
• Will you "take negative action" in order to move
yourself toward a desired outcome?
• Will you take action and "go somewhere", but not
have stopped to consider whether your direction is
positive or negative?
• These, of course, are the extremes, but it's your
perception, your reality, your choice.
• Will you just "ponder the past" without taking any
action and thus have memories, but achieve no
results?
ACA Reports: The
"Sixth and Seventh
Character" of
ICD-10 - What is it?
not available with ICD-9 and our
present system leaves the doctor
struggling to find ways to
communicate medical necessity
to the payer.
dislocation.
By: Jill Foote, Insurance Quality
Analyst II
ICD -10 is composed of codes
using between 3 and 7 characters.
A code meets ICD-10's highest
specificity requirements by using
all seven characters. We begin by
finding the three-character
category heading of the code in
the tabular list, which is divided
by chapters. An overview of the
chapters can be viewed at
ICD-10-CM Chapters. http://
hhic.org/_library/documents/
audioconferences/icd-10/icd-10cm_chapters.pdf.pdf
The sixth character
communicates to the payer
whether or not it is a subluxation
or dislocation.
While the deadline for ICD-10 is
still more than a year away, now
is the time to become familiar
with ICD-10 coding terms. The
U.S. Department of Health and
Human Services (HHS) has
indicated that there will be no
grace period for ICD-10
implementation.
A good starting point is to
familiarize yourself with the
"characters" that make up an
ICD-10 code. (Please feel free to
review the basics of ICD-10 by
visiting ACA's Q & A on
ICD-10, before reading this
article.) http://
www.acatoday.org/pdf/
ICD10FAQs.pdf
There is no need to dread
ICD-10. Implementation will
benefit patients in the long run.
How? Through use of additional
characters, ICD-10 makes it
possible for the provider to paint
a more accurate picture of the
patient's condition. This new
coding "language" allows for
comorbidities, etiology,
causation, complications,
manifestations, degree of
functional impairment, detailed
anatomic site, phase/stage of
treatment, lateralization,
localization, joint involvement,
sequelae, and even age-related
conditions. This level of detail is
For example:
Chapter 19 Injury, Poisoning &
Other Certain Consequences of
External Causes
S33 "Dislocation and Sprain of
Joint and Ligaments of Lumbar
Spine and Pelvis"
Not unlike ICD-9, ICD-10 codes
are invalid if they have not been
coded to the highest level of
specificity.
The fourth character indicates
the specific body part and helps
the code come "alive" as it
begins to communicate to the
payer a more complete portrait of
the patient's condition.
S33.1xx_ "Subluxation and
dislocation of lumbar vertebra"
S33.11x_ "Subluxation and
dislocation of L1/L2 lumbar
vertebra"
S33.110_ "Subluxation of L1/L2
lumbar vertebra"
S33.111_ "Dislocation of L1/L2
lumbar vertebra"
The seventh character of ICD-10
is often a required character in
codes involving musculoskeletal
diseases (Chapter 13, M00-M99),
injuries and poisonings (Chapter
19, S00-T88). The purpose of the
7th character is to communicate
to the payer the "type of
encounter" such as initial (A),
subsequent (D), or sequela (S). If
a code requires a seventh
character, you will see it listed
with an underscore "_" in the last
column of the ICD-10 code, as
shown in the prior examples.
An example of the process of
coding subluxation with all seven
characters:
S33.11 Subluxation and
dislocation of L1/L2 lumbar
vertebra
----S33.110 Subluxation of
L1/L2 lumbar vertebra
S33.110A initial encounter
The fifth character
communicates to the payer the
level of the subluxation or
S33.110D subsequent encounter
S33.110S sequela
ICD-10 has yet to arrive, but the
need to become familiar with the
process is critical. The structure
is in place, so why not start by
making a list of commonly used
ICD-9 codes in your practice and
finding the ICD-10 GEM
(General Equivalency Mapping)
so you will be ready?
Information on GEMs can be
found online at: CMS GEMS
Reference. http://www.cms.gov/Medicare/Coding/ICD10/2013-ICD-10-CM-and-GEMs.html
Once you have found the three-character code that is similar to the ICD-9 code, begin applying the technique
of coding to the highest level of specificity. This is performed by further subdividing the layers of
differentiation within the diagnosis by use of the fourth through the seventh digits, which follow the decimal,
and communicate greater detail. Understanding the structure of ICD-10 will assist you in developing the
accurate and detailed documentation that is necessary for successful ICD-10 coding.
More Than Urban
Legends
By Dr. R. A. Foxworth, FICC,
MCS-P
President, ChiroHealthUSA
Certified Medical Compliance
Specialist
Urban legends are kind of fun, if
only for the sheer, shivery
surprise factor. You've probably
heard the one where someoneusually a young woman at home
alone and often a baby sitter-gets a terrifying series of phone
calls. The police trace them and
find out the calls are coming
from inside the house. Screams,
mayhem and white knuckles on
the remote control aren't far
behind!
There's a similar threat brewing
from inside your house-your
practice-and we wish we could
tell you it's just an urban legend.
Frighteningly, however, it's all
too true. Thanks to recent
changes from the Centers for
Medicare and Medicaid Services
(CMS), the biggest threat to the
survival of your practice could
now come from your patients
themselves.
In late April, the CMS issued a
new rule that would substantially
boost the rewards for whistleblowers, i.e., anyone reporting
information that leads to the
recovery of funds from practices
just like yours who might have
inadvertently fallen into
Medicare fraud or abuse simply
by unknowingly offering dual
fee schedules or time-of-service
discounts above and beyond the
safe 5-15% limit that correlates
with an OIG opinion about your
discount relating to your
collection costs.
This isn't the first time the
government has encouraged
citizens to turn each other in; the
IRS has been giving anyone who
provides tips on tax fraud a
significant cut of the proceeds
for years. In fact, the government
has generated over $2 billion in
revenue since 2003, and it paid
out $16 million to whistleblowers last year alone. The
government has the proof that
this is a system that works, so
they are taking it to the next level
by expanding to recruit your
patients now to keep an eye on
YOU!
By contrast, the CMS, who has
been paying out rewards for
monies recovered since 1998,
has to date been playing it lowkey. In all that time, they've paid
out just $16,000.
This new rule proposes to change
all that. Looking to generate the
kind of revenue the IRS enjoys,
the CMS is proposing to increase
payouts substantially. Looking at
the new system, a patient who
hops from practice to practice to
report Medicare fraud could earn
as much as $10 million! Don't
just take our word for it...read it
here: http://www.hhs.gov/news/
press/2013pres/
04/20130424a.html
With this much money at stake,
your innocent-looking new
patient could be looking at you
as their new "retirement plan."
Keep in mind, with the recent
changes in the economy many of
your Medicare patients have lost
a large chunk of their retirement,
and this may be a very enticing
"opportunity" to them as a result!
SOMETHING ALWAYS
TRIGGERS AN
AUDIT
Don’t take unnecessary risks by running ads offering discounts or free services that could be considered inducements...
Patients aren’t the only ones who read your ads!
CMS/Medicare and insurance companies are investing more resources in the enforcement of provider agreements, and
with fines of up to $10,000 per occurrence for inducement violations, many practices are just one audit away from a
financial disaster.
Offering discounts to your cash and underinsured patients can be legal if done properly! Over 1,800 doctors are doing
it the RIGHT way... Are you?
And that’s not all... Over 100,000 patients appreciate their doctors for keeping health care affordable for their families;
join ChiroHealthUSA and yours will too!
No joining or credentialing fees.
You set your own discounts.
You stay in control.
And if that’s not enough, ChiroHealthUSA is proven to help converting shopper calls into new patients, and can help transition
patients from insurance to cash, as well as offering options for HIGH deductibles plans and affordable family plans.
Don’t risk it; contact us now and start practicing with peace of mind!
1-888-719-9990
www.chirohealthusa.com / info@chirohealthusa.com
JOIN US EVERY
You can have a one page simple financial policy as a member of ChiroHealthUSA.
Request a sample copy today! Send an email to info@chirohealthusa.com
with FORM in the subject line.
Mention the code TXCA when registering for the webinar
for a chance to win a $250 Amex Gift Card!
TUESFOD-PAACYKED
FOR AN IN
WEBINARE AT
ONLIN .COM
REGISTEORHEA
LTHUSA
WWW.CHIR
Very few DCs knowingly and
intentionally engage in Medicare
fraud-but now that we're all
under the microscope from both
regulatory agencies AND our
own patients, it's more important
than ever that our billing, fee
schedules, coding and referral
activities be audit-proof-and
whistle-blower proof.
Here's how to keep you safe
from the danger that now lurks
within:
• Document everything. That
means documenting your
policies and proceduresespecially those relating to
compliance and regulation. Put
everything in writing, and
make sure your policies are
spelled out in a formal manual
and available to every member
of your team. Document your
patient care correctly by
documenting each episode of
care. If you are not sure what
that means or where you
should begin, we can help you
get the assistance you need by
introducing you to specialists
in the field of compliance.
• Train your team. Compliance
is a process. It will not be done
in a day. Once installed, it will
need to be maintained, as
regulations change, as your
procedures change and as your
personnel change. When you
have defined your policies and
your procedures, you need
every member of your team
appropriately trained. Make
sure you systematically train,
review and document your
training. Just like with patient
care, if it isn't written down, it
didn't happen.
• Join a DMPO. Too many
doctors are still incorrectly
discounting their fees or
creating dual fee schedulesusually because they want to
help their patients receive the
care they need at a price they
can afford. In reality, these
DCs are putting themselves at
tremendous risk. Remember,
all it takes is one new patient
with money on their mind to
bring your practice down.
An easy way to help your
patients and stay clear of whistleblowers is through the use of a
Discount Medical Plan
Organization (DMPO), which is
a safe and legal way to offer your
patients discounts. There's no
cost to you to become a provider.
Go to www.chirohealthusa.com
to sign up for a webinar to learn
more about getting a start on
building your compliant officeand staying safe from the threat
that could be sitting right out in
your waiting room--today.
ACA Reports:
HIPAA Update
By: Julie Lenhardt,
Director, Insurance Advocacy,
American Chiropractic
Association
With the advent of EHR,
clearinghouses, electronic claims
filing, and other means of
transferring information
electronically, the responsibilities
covered entities (providers) have
with regard to privacy and
security have become more
complicated because a portion of
those responsibilities now
influence your relationships with
vendors.
With the implementation of the
final HIPAA Omnibus Rule, the
regulations' requirements have
been extended even further to
include the subcontractors of
those vendors. What that means
is that covered entities should be
planning now to accommodate
these changes. Additionally,
covered entities should also be
aware that there are changes to
the breach standard - what is
required when a covered entity
determines that protected health
information has been
compromised.
Business Associates: A Business
Associate is defined as "...a
person or entity that performs
certain functions or activities
that involve the use or disclosure
of protected health information
on behalf of, or provides services
to, a covered entity." Previously,
this meant a Business Associate
was only the organization or
individual with whom a covered
entity directly did business.
However, under the Omnibus
Rule, this definition has been
expanded to include any
subcontractor that handles
protected health information
(PHI) on behalf of the Business
Associate, even if their
relationship with the covered
entity itself is indirect.
This means that all business
associate agreements must be
updated to include these changes.
Existing agreements may continue
to be used until they are amended
or renewed, or until September 22,
2014, whichever is earlier. A
sample agreement can be found
here: http://www.hhs.gov/ocr/
privacy/hipaa/understanding/
coveredentities/
contractprov.html
In addition, the Omnibus Rule also
made changes to liability where
business associates and their
subcontractors are concerned.
Previously, if there was a breach,
(if PHI was shared inappropriately)
business associates did not have
any liability to the federal
government. Under the Omnibus
Rule, business associates are now
directly liable for breaches of PHI.
Such breaches include both civil
and monetary penalties. This
change does not shift liability away
from covered entities should a
breach be discovered. It does,
however, mean that business
associates must now implement
full compliance programs and that
business associates must enter into
business associate agreements with
their subcontractors.
Another important change under
the Omnibus Rule is that there is a
new breach standard. Previously,
HHS defined breach to mean the
"acquisition, access, use, or
disclosure" of PHI that
"compromises the security of
privacy" of PHI to the degree that
the acquisition, access, use, or
disclosure "poses a significant risk
of financial, reputational, or other
harm to the individual." HHS
determined that the concept of
harm was not being construed as
they intended. Therefore, under the
Omnibus Rule, any impermissible
disclosure or use is considered a
breach unless it is proven that there
is a low probability that PHI was
compromised via a detailed risk
assessment by the covered entity
and business associate, if
applicable.
The risk assessment should
include, at the very least:
• The nature and extent of the PHI
involved, including the types of
identifiers and the likelihood of
re-identification;
• The unauthorized person who
used the PHI, or to whom the
disclosure was made;
• Whether the PHI was actually
acquired or viewed; and
• The extent to which the risk to
the PHI has been mitigated.
of a state or smaller jurisdiction
(such as a county, city, or town),
the covered entity or business
associate must also notify a
prominent media outlet that is
appropriate for the size of the
location with affected
individuals.
• Notice to HHS: Information
regarding breaches involving 500
or more individuals (regardless
of location) must be submitted to
HHS at the same time that
notices to individuals are issued.
If a particular breach involves
500 or fewer individuals, the
covered entity is required to
report the breach to HHS within
60 days after the end of the
calendar year in which the breach
occurs via the HHS web portal.
Under the Breach Notification
Rule (which is not new and has not
changed under the Omnibus Rule),
covered entities are obligated to
provide the following notifications
in the event they determine that
there has been a breach:
• Notice by Business Associates
to Covered Entities: A business
associate of a covered entity
must notify the covered entity if
the business associate discovers a
breach of unsecured PHI. Notice
must be provided without
unreasonable delay and in no
case later than 60 days after
discovery of the breach.
• Notice to Individuals: Affected
individuals must be notified
without unreasonable delay, but
in no case later than 60 calendar
days after discovery. The notices
must be written in plain language
and include basic information
that is detailed in the Interim
Final Rule. Under certain
circumstances, a substitute notice
may be used.
Already in 2013, HHS has
collected over $15 million in
settlements in cases involving
HIPAA violations, so it is in your
best interest to make sure that you
are up to speed with all of the
changes that were made by the
Omnibus Rule. Ensure that your
compliance program has been fully
updated to meet these new
requirements.
• Notice to Media: If a breach
affects more than 500 residents
! "#$%&'( ! &)*$+*'( * "&,'& (
Engaging People with their Favorite Subject - Themselves
!
When you see yourself in a photo via Facebook tag, phone
capture or old school printout, who do you look at first and
hardest? Right- YOU! We humans are wired to look at
ourselves. This normal tendency is why a standardized
posture photo is a great tool to get someone's attention and
begin a conversation to promote the importance of
chiropractic for treating bio-mechanical problems, athletic
performance, active living and aging well.
GRQ¶WFRDFKWKem. Cueing people toward their perceived best
posture provides a more subjectively reproducible baseline
and a strong beginning point to strengthen posture control and
build a new baseline of StrongPosture.
HOW TO TAKE A POSTURE PI CTURE
The first step in taking a picture is to perform a static posture
exam, which is simply the concrete action of looking at a
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body, as wHOODVEXLOGFUHGLELOLW\DVWKH³3RVWXUH([SHUW´
The AHA! M oment of BEST POSTURE POSI TI ONI NG
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discount how asymmetric their picture appears. A common
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posture, they become self-conscious. If your patient stiffens
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cue your patient to look straight ahead and stand tall. Once
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standing straight) with your objective observations (Look at
this distortion).
When looking at posture in a static exam or pKRWRGRQ¶W
worry about trying to understand everything, just observe
asymmetry and distortion. Look from the bottom up and note
how their head is balancing on their torso, and their torso
over their pelvis and center of pressure (CoP) of the feet.
When taking the picture a consistent background, positioning
and procedure are essential to minimize image variation over
time for both in-office clinical and community-based events.
A flat wall or a grid works well for the background.
Give your subject these instructions:
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Cueing is important for consistent images for comparisons
over time. To effectively create posture consciousness and
build an internal benchmark for the patient sa\³EHVW
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should be? People naturally try to assume a good posture, so
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This creates an Aha! Moment when the patient sees their
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A digital photo is a practical, inexpensive and clinically
intelligent way to track progress. Adding a grid allows the DC
to infer many of the observations we used to make on 14x36
x-rays, at lower cost and without harmful radiation.
People are engaged to see changes at the end of a phase of
care or when you show progress (or decline) with annual
posture picture comparisons. Increasing awareness and
posture consciousness is the springboard for a narrative story
communicating the relationship between their concern with
pain, performance or wellness, the biomechanics of their body,
and the services you provide.
COM I NG SOON: Why Common-Sense Will Rule. (If people
FDQ¶W easily communicate it to their friends, they won't. But if
they can, they may.)
Dr Steven Weiniger is author of Stand Taller ~ Live Longer and
lectures internationally on exercise and posture rehab. Dr. Weiniger
has been featured in professional journals and mainstream media
including )2;1HZV2SUDK¶V2[\JHQQHWZRUN1DWXUDO+HDOWK,
American Fitness and Bottom Line Health. He serves as Managing
Partner of BodyZone.com, which provides posture, chiropractic,
massage and wellness information and referrals to local Posture
Exercise Professionals (CPEP). Contact Dr. Weiniger at
PosturePractice.com or drweiniger@bodyzone.com.
Resistance is Futile
By Dr. R. A. Foxworth, FICC, MCS-P
President, ChiroHealthUSA
Certified Medical Compliance Specialist
There will always be those amongst us who have
great affection for old school style: stovetops over
microwaves, LPs over CDs, handwritten letters over
email. You might even be one of them. For you, the
good news is that you can opt out of filing electronic
Medicare claims and continue to submit them the oldfashioned, paper-based way. But, and you knew there
was going to be a but, if you want to actually get paid
you're going to have to surf the wave of the future and
accept reimbursement by Electronic Funds Transfer
(EFT). It's all part of recent Medicare changes made
as part of the Insurance Portability and Accountability
Act (HIPAA). Resistance is futile.
Here's the relevant formal language of the act,
outlined in a message from Part B Medicare
Administrative Contractor (MAC) Palmetto GBA:
"Existing regulations at 42 CFR 424.510(e)(1)(2)
require that at the time of enrollment, enrollment
change request or revalidation, providers and
suppliers that expect to receive payment from
Medicare for services provided must also agree to
receive Medicare payments through electronic funds
transfer (EFT). Section 1104 of the Affordable Care
Act further expands Section 1862(a) of the Social
Security Act by mandating federal payments to
providers and suppliers only by electronic means. As
part of CMS' revalidation efforts, all suppliers and
providers who are not currently receiving EFT
payments are required to submit the CMS-588 EFT
form with the Provider Enrollment Revalidation
application, or at the time any change is being made
to the provider enrollment record by the provider or
supplier, or delegated official."
The reason for the change is obvious: the government
will save approximately a bazillion dollars by not
printing and mailing checks. But the implication is
more subtle. If the government is looking to save and
recoup money wherever and whenever it can, what do
you suppose will happen to you and your practice if
they determine you've been overpaid and decide to go
after you?
Clearly, it's more important than ever to get your
financial house in order. If you're billing correctly,
coding correctly and discounting correctly, you can
breathe easy-you have no need to be worried about
fund recoupments. But, if like many doctors, you're
not 500% confident in your practice's financial
foundation, it's time to act--now. Here are a simple
few steps to keep the government wolves (or, if you
prefer, the Borg) from your door.
1) Implement Your Compliance Program
Compliance is the law and a requirement of the
Affordable Care Act, but it's also your best protection
against running afoul of Medicare issues. Bringing
your practice into compliance is a process, not an
event, and one in which we're extraordinarily wellpositioned to help. As a result of attending many state
association meetings and other events across the
nation to educate our profession about the benefits of
using a Discount Medical Plan, we've had the
opportunity to get to know some of the brightest
minds in our profession, including compliance
experts. Our friends are your friends. If you don't
have a Compliance Program in place, just give us a
call at 888-719-9990 and ask for a compliance
referral. Depending on the size and complexity of
your practice, whether it's a solo practice or a fully
integrated DC/MD/PT practice, we'll do our best to
steer you to an expert that best suits your needs.
2) Get Your Fees Straight
If you're not confident in the legality of your fee
schedule, if you haven't implemented a valid
Hardship Program, or if you don't have written
policies and procedures about how your practice
manages its finances, you've got a glaring problem
(and a red flag for the government) that needs to be
fixed. Call ChiroHealthUSA and we will be happy to
refer you to one of the many consultants we work
with that can help with get this area of your practice
cleaned up once and for all. We work with consultants
that have educational materials that walk you through
the process if you are a do-it-yourselfer, or we can
refer you to consultants that will assist you every
step of the way.
3) Join a DMPO Today
ChiroHealthUSA is a Discount Medical Plan
Organization (DMPO). DMPOs allow you to offer
legal network based discounts for your uninsured,
under-insured or partially insured patients. That's a
big deal to most doctors, many of whom report that
concern for their financially challenged patients
tempts them to lower their fees or to offer time of
service discounts in excess of the 5-15% range
considered reasonable by the OIG in one of their
opinions. Don't fall victim to leaving money on the
table, or allow your practice to be at risk of incurring
fines for inappropriate discounts or inducements.
Join ChiroHealthUSA today and start practicing with
more peace of mind. There is NO cost for you to join
and our free webinars teach you how to protect
yourself and get your financial side of the practice in
tip top shape! Go to www.chirohealthusa.com to
register today.
What Lies Ahead
The Texas Chiropractic Association (TCA) has
completed the 2013 Legislative session, but work
continues preparing for the 2015 session. The
American Chiropractic Association (ACA) has
announced its vision for the future and reported on
the interactions between these state and national
chiropractic associations. Let us review these
visions and activities as they have recently been
reported.
ACA'S VISION FOR THE FUTURE
The ACA has committed itself to a vision for the
future for the next ten years. Says that ACA "we
commit ourselves to the highest clinical and ethical
standards, freedom of choice of healthcare providers
and the pursuit of optimal health for the healthcare
consumer." Within the next ten years the ACA hopes
to help bring about collaboration with other health
care disciplines and integration of the chiropractic
doctor into all health care delivery models that
enhance individual health, public health, wellness,
and safety. ACA also will work to introduce change
into the public policy, legislative, and regulatory
arenas that will result in a more effective health care
system for the United States. They will seek
improved health care access and freedom of choice
for the American people without discriminatory
obstacles. Increased value of health care for
patients, policymakers, and the public will be the
result of high professional and educational standards
of the chiropractic profession and healthier and more
productive lives for the American People are the
sought after outcomes.
ACA President Keith Overland D.C. offers his "topten list" of ideas to accomplish these goals:
•
•
Create strong public demand for our services.
Increase professional integration and collaboration
with health care providers in clinical and educational
arenas.
• Develop formal residencies and post-graduate
educational opportunities both in the last year of
education and upon graduation.
• Remove arbitrary limitations preventing patient
access in federal, state, and commercial health care
models.
• Deliver the message that we are a physician-level,
portal-of-entry provider.
• Improve intraprofessional enforcement against
inappropriate conduct by a small minority of DCs.
• Support funding for research that would allow
intraprofessional development of a full breath of best
practices, guidelines and standards.
• Review all 50 states' laws and encourage a
uniform minimum standard allowing DCs to practice
to the fullest extent of their education.
• Never depute our internal professional issues in
public.
• Reverse the growing trend perpetuating the
divisive belief that some in the profession follow
chiropractic philosophy and others do not. We need
to grasp … a foundation of therapeutic conservatism,
naturalism and holism.
WORKING CLOSELY AT THE STATE LEVEL
The ACA State Affiliation Program is intended to
benefit the profession and its patients by bringing
together the strengths of the ACA and state
chiropractic associations. While the national
association generally has information and resources
beyond what is available to the state organizations,
the state organizations possess local infrastructure of
active members working for the profession is its
chief strength. The exchange of representation--state
representatives to the ACA and ACA representatives
to the state organization--insures that a balanced
state/national perspective is maintained. The Texas
Chiropractic Association was represented at each of
the four ACA House of Delegates meetings held
during the past year. The TCA Representative,
Michael Martin D.C., has been appointed to the State
Affiliation Committee and has been working within
the ACA committee structure to further oversee,
develop, and grow the State Affiliation Program.
Currently the ACA Insurance Liaison Program and
the TCA Insurance Relation committee have worked
to integrate information and resources into their
committees and operations; The Public and Media
Relations Committee of the TCA has worked to
access ACA information and provide needed
assistance at the regional level; The TCA leadership
is also making use of ACA information and
developing necessary infrastructure. Other aspects
of the TCA are also beginning to collaborate with
ACA resources: Continuing Education,
Governmental Affairs, Membership Development,
and Information technology are a few. During the
past year advancements have been made and more
are coming on line in the current year.
TEXAS LEGISLATURE 2015
The 83rd Texas Legislature was barely completed
before the TCA began to develop its plans for
improving the standing of our profession through the
legislative process. Such plans include much more
interactive dealings with the Texas Board of
Chiropractic Examiners, a greater engagement in the
rule making process of the TBCE, and seeking closer
relationship with various key legislative personnel.
We continue to develop our ability to make use of
grass roots activation, and continue to maintain a list
of possible legislative activities to pursue in
legislative sessions to come.
YOUR INVOLVEMENT IS NECESSARY
It is often promoted, but seldom documented the
direct effect that membership in your professional
associations brings. Have you ever considered what
would be lacking if there were no organization to
work on behalf of the profession as a whole? Here is
but a short list of some of the things that happened
this past year that would have left the chiropractic
profession lacking if there were no effective state or
national chiropractic association:
•
The Texas Medical Association would have
removed your right to render a diagnosis--TCA and
TBCE pursued the defense of this legal authority,
only the TCA "took it all the way to the Supreme
Court of Texas."
• Various anti-chiropractic bills would have passed
if the TCA Governmental Affairs team had not been
present to insure that discriminatory legal language
did not become State Law.
• Various pro-chiropractic bills would not have
gotten as far as they did. We fell short of attaining
our goals, but with continued year-round education
of our legislators some of these bills may stand a
better chance in 2015. Continued persistent effort is
required.
• The Patient Protection and Affordable Care Act
(National Health Care) may very well have included
language discriminatory to the chiropractic
profession if the ACA was not diligent in watching
and working to prevent it. This diligence continues
to be required. The American Medical Association
has publicly stated that it is their desire to see
discriminatory language inserted into the federal law.
• The strong pro-chiropractic directive of the House
Armed Services Committee official committee
report accompanying the FY 2013 National Defense
Authorization Act would not have been included.
This report asserts that the services provided by
doctors of chiropractic for our uniformed services is
of "high quality" and has become a "key" benefit
within the military health care system.
•
Pro-chiropractic congressional representatives
may have lost their elections without the help of the
ACA.
• Certain large insurance companies might have
continued their discriminatory chiropractic policies
if the ACA had not intervened for injunctive relief.
• Other large insurance companies might have
continued their "all or nothing" contracting
relationships with doctors of chiropractic if the
national organization had not negotiated a policy
change.
• Media assistance would be lacking if the ACA and
TCA were not available to members of the media to
answer their questions, and successfully represent
the profession in its entirety.
who is a part of a body of people engaged in an
occupation or calling-- and be a professional--one
who makes a public declaration of that occupation.
Be a chiropractic professional and join your state
and nation chiropractic associations.
KEEP YOUR
EYES PEALED!
These accomplishments, and there are
certainly many more than these few, would not have
been possible without the active support of
membership dues in these state and national
chiropractic associations. Your membership in your
state's chiropractic organization and in the national
chiropractic association are vital to insure that the
profession remains a viable option for doctors who
seek to restore normal function to the body.
Dr. Overland concisely states what lies ahead: "as a
profession we have an opportunity facing us like no
other in our history. Our entire U.S. health care
system is transforming. The payment mechanisms
and delivery systems are changing, and evidence and
cost savings are required. The work-force shortage
is opening opportunities for all providers. Most
important, people are looking for healthier lifestyles.
But when illness strikes, they can first utilize a
highly effective treatment that is the most
conservative, least invasive and safest approach to
health care. That, my colleagues, is chiropractic."
What lies ahead is what has always been there-opportunity, change, and lots of work. The question
is will WE join together to make the work load
lighter, or will "each individual" seek to remain an
"island unto himself?" What lies ahead is divided
we fall. United we stand.
Take a stand for chiropractic. Be a professional--one
The next
Texas Journal of
Chiropractic
will be out
OCTOBER 1st!
HAVE A STORY TO SUBMIT?
SEND IT TO
editor@chirotexas.org
FOR REVIEW
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You deserve to have professional liability insurance that is
country strong. OUM understands the unique needs of
chiropractors and protecting them is our only business.
Contact us to see why our professional liability coverage
sounds so good.
“OUM” and “OUM Chiropractor Program” do not refer to a legal entity or
insurance company but to a program or symbol of a program underwritten,
insured and administered by either PACO Assurance Company Inc. or PICA,
both with Excellent ratings (A- and A, respectively) by A.M. Best.
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