Texas Chiropractic Association

Texas Journal of ChiropracticVolume XXVi, Issue 1 July/ August 2011 .

2011 TCA Convention Issue

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Texas Chiropractic Association

Texas Journal of ChiropracticVolume XXVI, Issue 1 July/August 2011

Inside

Chiropractors Work Together on Scope Rule! ! 4TCA Convention ! ! ! ! ! ! 6Supreme Court Strikes Commercial Speech Restriction 10Supreme Court Rejects Generic Drug Labeling Suits ! 10Suit Upholds Telemarketing Limitations! ! ! 11TBCE Publishes New Rules! ! ! 11-16TBCE Proposes Rules Changes 16-18!Out with the Pyramid, In with the Dinner Plate! ! 18Use of Research to Substantiate Health Claims!! 19CMS to Release Medicare Data to Rank Docs! ! 20No Pay for "Reasonably Preventable Conditions" ! 20U.S. 36th in World Life Expectancy! ! ! 20Key Components of the E/M Guidelines! ! ! 21TMA Hails its Discriminatory Attitudes! ! ! 24Medicaid for the middle class?! ! ! ! 25Insurer Errors Cost Billions Annually! ! ! 25Gov. Report Notes Benefits of Spinal Manipulation 26"Principles of Conservative Prescribing"! ! ! 27Financial Conflicts of Interest Linked to Outcomes! 27Chiropractic a Concise History! ! ! ! 28Chiro Care Valuable for Work Related Back Pain! 32New Vitamin D Guidelines! ! ! ! ! 33College News! ! ! ! ! ! 34Other News! ! ! ! ! ! 35-38

Publication of an advertisement does not imply approval or endorsement by the Texas Chiropractic Association. The association shall have the absolute right at any time to reject any advertising for any reason.

For advertising rates contact the TCA Office. All advertising material must be in graphics ready format and submitted as a .jpg, .jpeg, .gif, .swf, or .png file type. Copyright 2011 All Rights Reserved: Texas Chiropractic Association

Texas Journal of ChiropracticThe Official Publication of

The Texas Chiropractic Association

1122 Colorado, Suite 307Austin, TX 78701

Phone: 512 477 9292Fax: 512 477 9296

E-mail: info@chirotexas.orgwww.chirotexas.org

Executive OfficersPresident: Jorge Garcia D.C.

President Elect: Jack Albracht D.C.Secretary: James Welch D.C.

TCA StaffExecutive Director: Chip Kent

Editor: Chris Dalrymple D.C.

Board of Directors

District 1 Paul Munoz D.C.District 2! Jon Blackwell D.C.District 3! Jason Clemmons D.C.District 4! Mark Bronson D.C.District 5! Dr. John Quinlan D.C.District 6! Cody Chandler D.C.District 7! David King D.C.District 8! Shawn Isdale D.C.District 9! Mark Roberts D.C.District 10! Shane Parker D.C.District 11! Max Vige D.C.District 12! Yvonne Landavazo D.C.

Policies

Annual subscription to the Texas Journal of Chiropractic is included in TCA membership dues. Contact the TCA for subscription rates for non members.

The print Texas Journal of Chiropractic is published up to four times per year by the Texas Chiropractic Association under the supervis ion of the TCA Publ icat ion 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.

Chiropractors to Work Together on Scope of Practice RuleT h e T e x a s B o a r d o f Chiropractic Examiners met on Thursday, July 28, 2011.

Included on the agenda for this meeting were:

• The election of a Board V i c e - P r e s i d e n t a n d Secretary/Treasurer;

• C o n s i d e r a t i o n t o recommend changes to Rule 71.15 to reflect r e q u i r e m e n t s f o r Chiropractic Nutrition as a recognized chiropractic specialty;

• Consideration to adopt proposed amendments to Rule 74.3 to clarify that operating a facility without a current certificate of registration constitutes operating a facility without a certificate of registration;

• Consideration to adopt proposed amendments to Rule 80.3 regarding use of letters of protection;

• Consideration to adopt proposed amendments to Rule 75.2 Proper Diligence and Efficient Practice of Chiropractic;

• Consideration to adopt proposed amendments to

Rule 75.17 Scope of Practice;

• Consideration to propose amendments to Ru le 7 1 . 1 3 r e g a r d i n g Chiropractic Specialties and Rule 75.7 regarding R e q u i r e d F e e s a n d Charges;

• Consideration to propose amendments to Ru le 7 1 . 1 5 r e g a r d i n g Recognized Specialties to ou t l i ne the spec ia l t y r e q u i r e m e n t s f o r Chiropractic Neurology, A c u p u n c t u r e , a n d Nutrition;

• Consideration to propose amendments to Rule 75.1 r e g a r d i n g G r o s s l y Unprofessional Conduct prohibiting overtreating/overcharging, to make the r u l e s o n s e x u a l misconduct more clear, and to add a requirement that licensees provide gowns/draping for patients disrobing;

• Consideration to propose new Rule 75.27 regarding A n i m a l C h i r o p r a c t i c ; consideration to propose amendments to Rule 77.2 regarding Publicity and to R u l e 7 7 . 5 r e g a r d i n g Misleading Claims to make t h e r u l e s r e g a r d i n g advertising more specific;

• Consideration to propose amendments to Rule 80.1 regarding Delegation of Authority to clarify that while a DC does not need to be in the treatment room, he/she needs to be on-site, and to define "on-call";

• Consideration to propose amendments to Rule 80.11 regarding Code of Ethics;

• Consideration to propose new Rule 81.1 regarding Definitions, and new Rule 81.3 regarding Petition for Adopt ion of Rules to promulgate rules;

• and more.

In attendance were nearly 30 visitors in addition to board members and staff.  The TBCE allowed for 30 minutes of public comment on the proposed rule, in addition to the four hour public hearing the TBCE held on Tuesday.  There were two members of the general public and nine doctors of chiropractic who offered thoughtful and well reasoned points of information regarding the proposed scope of practice rules for over 30 minutes.

Dr. Cynthia Tays, TBCE President reported that a "Scope of Practice History" had been prepared by staff. R e g a r d i n g a S c o p e o f Practice Rule, she stated that  while she is in favor of thoughtful deliberation,  she does not recommend "waiting

4Texas Journal of Chiropractic www.chirotexas.org

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until all appeals are finalized" b e c a u s e " h i s t o r y demonstrates a negative o u t c o m e " w h e n o t h e r professions have attempted to wait until "all appeals are finalized." 

Retiring TBCE Executive D i r e c t o r G l e n n P a r k e r presented his final report and reported that there are 4979 current licensees, 227 new DCs the past year, and  3734 facilities currently registered.

Dr. Tays then moved to the election of executive officers for the TBCE.  Dr. Pat Thomas was elected to be Vice-president and Dr. Larry Montgomery was elected to be Secretary-Treasurer.

T h e R u l e s C o m m i t t e e p r e s e n t e d i t s recommendations:

The committee recommended to amend Rule 74.3 Annual Renewal of Chiropract ic Facil i t ies, to clari fy that operating a facility without a c u r r e n t c e r t i fi c a t e o f r e g i s t r a t i o n c o n s t i t u t e s operating a facility without a certificate of registration.  The board voted to approve the recommendation.

The committee recommended the adoption of proposed amendments to Rule 80.3 Request for Information and Records from Licensees regarding use of letters of protection. The board voted t o a p p r o v e t h e recommendation.

The committee recommended t o t a b l e p r o p o s e d amendments to Rule 75.2 Proper Diligence and Efficient Practice of Chiropractic, and the proposed amendments to Rule 75.17 Scope of Practice.  The board voted to table consideration of the scope of practice rule and will continue to work upon it in the coming months in stake holder meetings.

T h e c o m m i t t e e f u r t h e r recommended amendments to Rule 71.13 regarding Chiropractic Specialties and Rule 75.7 regarding Required F e e s a n d C h a r g e s t o eliminate the fee charged in an application for recognition of a specialty.  The board approved the amendments to be published for public comment.

The committee moved to table  amendments to Rule 71.15 r e g a r d i n g R e c o g n i z e d Specialties to outline the specialty requirements for Ch i rop rac t i c Neuro logy, Acupuncture, and Nutrition.  The board moved to table consideration.

The committee proposed amendments to Rule 75.1 r e g a r d i n g G r o s s l y Unpro fess iona l Conduct proh ib i t ing over t reat ing/overcharging, and to make t h e r u l e s o n s e x u a l misconduct more clear to add a requirement that licensees provide gowns/draping for patients disrobing. The TBCE moved to pub l ish the proposal to the Texas

R e g i s t e r f o r p u b l i c comment.

The committee considered proposal of a new Rule 75.27 regarding Animal Chiropractic and wi l l cont inue to do committee work to determine what procedures are required w h e n w o r k i n g w i t h a veterinarian.

The committee recommended amendments to Rule 77.2 regarding Publicity and the b o a r d a d o p t e d t h e recommendation .  The amendments to Rule 77.5 regarding Misleading Claims to make the rules regarding advertising more specific was tabled by the board. 

The committee recommended amendments to Rule 80.1 regard ing Delegat ion of A u t h o r i t y .  I t e m ( 1 ) c o n s i d e r a t i o n o f a n amendment to (c)(2) to clarify that while a DC does not need to be in the treatment room, he/she needs to be on-site was p a s s e d .  I t e m  ( 2 ) c o n s i d e r a t i o n o f a n amendment to (i) to define "on-call" will continue to be i n v e s t i g a t e d b y t h e committee.

The full board moved to table consideration of amendments to Rule 80.11 regarding Code of Ethics and will continue to work on the issue.T h e c o m m i t t e e recommended and the board passed proposal of new Rule 81.1 regarding Definitions and new Rule 81.3

Texas Journal of Chiropractic 6 www.chirotexas.org

regarding Petition for Adoption of Rules to promulgate rules required the Administrative Procedures Act, §2001.021 outlining the form of such a petition and the procedure for its submission, consideration, and disposition.

The committee presented several questions regarding s c o p e o f p r a c t i c e , specifically regarding the i n t e r p r e t a t i o n o f b l o o d c h e m i s t r y a n d recommendations based on those interpretations, as well as advertisement for said i n t e r p r e t a t i o n /r e c o m m e n d a t i o n s ; t h e performance of and use of computerized posturography; and the online advertisement of the sale of nutritional products and whether this implies a "diagnosis".  The committee reported that the committee found that these issues were within the s c o p e o f c h i r o p r a c t i c practice as presented.

The Chiropractic Society of Texas had requested that "the rule regarding addit ional Medicare documentation CE hours be reconsidered."  The Committee voted to deny t h e r e q u e s t f o r reconsideration of Medicare hours, and the full board concurred.

Following a brief recess the TBCE resumed consideration o f t h e v a r i o u s recommendations from the Enforcement Commi t tee r e g a r d i n g v a r i o u s enforcement actions.

The board retired to executive session to discuss legal matters at about 4:30 pm.  At about 5:00 pm the board resumed in open session and it was moved and passed that current legal c o u n c i l Y v e t t e Ya r b r o u g h be hired as t h e n e x t E x e c u t i v e Director of the TBCE. 

Upcoming meeting dates for the TBCE are November 17, 2011,  February 23, 2012, May 24, 2012, August 16, 2012, and November 15, 2012. 

The board adjourned at about 5:30 pm

☆☆☆

TCA CONVENTION

The Annual Convention of the T e x a s C h i r o p r a c t i c Associat ion was held in Austin, Texas with several hundred in attendance.

Doctors Jorge Garcia, Jack Albracht, and James Welch were installed as the new executive officers for the association.

The annual banquet saw the presentation of awards to those who worked hard during

the year on behalf of the TCA and for chiropractic in Texas.

The TCAʼs most prestigious award, the Keeler Award, was p resen ted to TCA Pas t President, and long-time chiropractic advocate Dr. George Aubert.

The Young Chiropractor of the year award was presented to Dr. J. P. Quinlan.

The Ford Johnston Memorial Award to recognize the person who best represents s e r v i c e t o t h e Te x a s Chiropractic Associationx was p r e s e n t e d t o D r D a n Petrowsky.The P. A. Wilmon Memorial award to recognize a recipient from, or serving the people of, a rural area was presented to Dr. Kevin Raef.

The Presidentʼs Award was presented by Outgoing TCA President Dr. Ed Fritsch to all those serving at TCA State Directors and Department Coordinators.

☆☆☆

Supreme Court Strikes Down Commercial Speech RestrictionData on which doctors are prescribing which drugs is speech that is protected by the First Amendment, and

7 Texas Journal of Chiropracticwww.chirotexas.org

Dr. Jon BlackwellDr. Kevin Raefʼs Son accepts P. A. Willmon Award from Dr. Dan Petrowsky

Drs. Fritsch, Garcia, Welch, and Albracht

Dr. Ken Perkins

Rick Noriega

Student TCA

Attends Banquet

Lee Woods

Dr. James Welch

Dr. Ed Fritsch, TCA Past President

Dr. Petrowsky

receives Ford

Johnston Award

Dr. Richard Brassard,

“Past everything”

Texas Chiropractic Association

Outoing Pres. Dr. Ed Fritsch

Dr. Jack Albracht

2010-11 TCA Board

Incoming TCA President, Dr. Jorge Garcia

Dr. Dale White

Dr. Curtis Mccubbin of the

Keeler Award Committee

Keeler Award Recipient Dr. George Aubert

2011-12 TCA Board of Directors

2011-2013 TCA Leadership:Secretary, Dr. James Welch, President, Dr. Jorge Garcia, President-elect, Dr. Jack Albracht

2011-12 TCA Board of Directors in Action

Dr. Greg Carter

Convention Speaker Dr.

Murkowsky and Dr. Quinlan enjoy a laugh

2011 Annual Convention

Young Chiropractor of the Year, Dr. J. P.

Quinlan

pharmaceutical companies have every right to buy that information and use it to target their marketing efforts, the Supreme Court has ruled.

In the Sorrell v. IMS Health case, the Supreme Court struck down by a 6-3 vote a 2007 Vermont law that that bans the practice of data mining -- the sale and use of p r e s c r i b e r - i d e n t i fi a b l e information for marketing or promoting a drug, including drug detailing -- unless a physician specifically gives his or her permission to use the information.

The Supreme Court ruled that " t h e c r e a t i o n a n d dissemination of information a r e s p e e c h f o r F i r s t Amendment purposes."When filling prescriptions, Vermont pharmacies collect information, including the prescribing physician's name and address; the name, dosage, and quantity of the medication; the date and place where the prescription was filled; and the patient's age and gender. Pharmacies s e l l t h i s " p r e s c r i b e r information" to data-mining companies.

Writ ing for the majori ty, Justice Anthony Kennedy said the goal of lowering the costs of medical services and protecting public health are laudable goals, but that the law doesn't advance those goals. “Vermont seeks to achieve those objectives through the indirect means o f r e s t r a i n i n g c e r t a i n

speech by certain speakers - - i .e . , by d iminishing detailers' ability to influence prescription decisions," he wrote. "But 'the fear that people would make bad decisions if given truthful information' cannot justify content-based burdens on speech."

Jus t i ces John Rober t s , Clarence Thomas, Sonia Sotomayor, Antonin Scalia, and Samuel Al i to joined Kennedy in the majority opinion.

The Supreme Court's decision upholds an appeals court decision that found Vermont's Prescription Confidentiality Law is a violation of First Amendment rights because it restricts commercial speech, and that it is a violation of the Commerce Clause of the Cons t i tu t ion because i t i m p i n g e s o n i n t e r s t a t e commerce, since data-mining companies sell the prescriber information in states other than Vermont.

☆☆☆

Supreme Court Rejects Generic Drug Labeling SuitsThe Supreme Court ruled that gener ic drug companies cannot be sued under state law over allegations that they failed to provide adequate label warnings about potential side effects.By a 5-4 vote, the justices overturned U.S. appeals court rulings that allowed such lawsuits.

The companies argued that federal law barred such lawsuits because the drug had been approved by the U . S . F o o d a n d D r u g Administration (FDA). Federal law requires generic drugs to have the same labels as their brand name equivalents.

Generic drugs account for more than 70 percent of all prescriptions filled in the United States.

☆☆☆

Suit Upholds Telemarketing LimitationsThe 5th U.S. Circuit Court of Appeals delivered an opinion Wednesday that could silence some telemarketers. The court reversed a lower court

10Texas Journal of Chiropractic www.chirotexas.org

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decision by U.S. District Judge Lee Yeakel of Austin tha t had prevented the enforcement of an ant i -telemarketing measure that passed the Texas Legislature in 2009. Yeakel cited First Amendment issues. That legislation, by Rep. Todd Smith, R-Euless, prohibited solicitation of accident victims for the first 30 days after an accident.

Mark Hanna, a spokesman for the Insurance Council of Te x a s a n d t h e Te x a s Committee on Insurance Fraud, said justice prevailed. “Telemarketers ... will have to seek another way of soliciting business rather than chasing ambulances and contacting crash victims at home,” he said in a statement. “This ruling allows prosecutors to go after this illegal solicitation which has become rampant in every major city in Texas.”

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TBCE Publishes New Rule 75.11The Texas Register reports that the TBCE has adopted a final version of Rule 75.11.

The new rule reads:

(a) The following words and terms, when used in this chapter, sha l l have the following meanings, unless the context clearly indicates otherwise:

(1 ) APA- -Admin i s t ra t i ve Procedure Act, Government Code, Chapter 2001;

(2) Board--Texas Board of Chiropractic Examiners;

(3) Chiropractic Act or CA--Occupations Code, Chapter 201 (formerly Texas Civil Statutes, Article 4512b);

(4) HPCA--Health Professions Council Act, Occupations Code, Chapter 101;

(5) HRC--Human Resources Code;

(6) Licensee--A person who is licensed by the board to practice chiropractic in the State of Texas;

( 7 ) M R T C A - - M e d i c a l Rad io log ic Techno log is t Certification Act, Occupations Code, Chapter 601;

(8) Occ. Code--Occupations Code;

(9) Respondent--an individual or facility regulated by the b o a r d a g a i n s t w h o m a complaint has been filed;

(10) SOAH--State Office of Administrative Hearings;

(11) DSHS--Department of State Health Services.

( b ) T h e t a b l e c o n t a i n s maximum sanctions that may b e a s s e s s e d f o r e a c h category of violation listed in the table [See the following pages.]

( c ) I n a case where a respondent has committed multiple violations or multiple occurrences of the same violation, board staff, the enforcement committee or an administrative law judge may recommend and the board may impose sanctions in e x c e s s o f a m a x i m u m sanction specified in the maximum sanct ion table provided by subsection (b) of this section, if otherwise authorized by law. For the f o u r t h a n d s u b s e q u e n t offenses of any violation listed in the maximum sanction table with three levels of sanct ions, the maximum sanction is revocation and/or $1,000 administrative penalty.

(d) An administrative penalty may not exceed $1,000 per day for each violation. Each day a violation continues or occurs is a separate violation for the purposes of imposing an administrative penalty.

(e) For violation of a statute which is not listed in the maximum sanction table and for which the board is a u t h o r i z e d t o t a k e disciplinary action, the maximum sanct ion is revocation and/or $1,000 administrative penalty.

☆☆☆11 Texas Journal of Chiropracticwww.chirotexas.org

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by clicking on the Online Journal link

CATEGORY I 1st Offense: $1000*; 2nd Offense: $1000* ; 3rd Offense: $1000* *and/or revocation

Violation Reference:

Practicing without a chiropractic license 22 TAC §75.10(d) CA §201.301

Practicing with an expired license (nonrenewal due to default student loan) 22 TAC §73.2(c)(6) and (e) CA §§201.301, 201.351, 201.354(f)

Practicing with an expired license (nonrenewal) 22 TAC §73.2(i) CA §§201.301, 201.351, 201.354(f)

Practicing while on inactive status 22 TAC §73.4(f) CA §§201.301, 201.311(b)(2)

Practicing in non-compliance with continuing education requirements 22 TAC §§73.3, 73.5(g) CA §§201.301, 201.354(f)

Improper control of patient care and treatment 22 TAC §74.5(c)

Grossly unprofessional conduct 22 TAC §75.1 CA §201.502(a)(7)

Lack of diligence/gross inefficient practice 22 TAC §75.2 CA §201.502(a)(18)

Practicing outside the scope of practice of chiropractic 22 TAC §§75.2, 75.17 CA §§ 201.002, 201.502(a)(1) and (18)

Performing radiologic procedures without registering, with an expired registration, or without DSHS approval; failure to renew (including non-payment of fees) 22 TAC §78.1(a), (d), (h)

MRTCA, DSHS rules or order 22 TAC §78.1(h), (j), (o)

Performing (1) radiologic procedures without supervision, or (2) cineradiography or other restricted procedure

22 TAC §78.1(g), (k), (l), (m)

Permitting a non-registered or non-DSHS approved person to perform radiologic procedures or CRT to perform procedures without supervision 22 TAC §78.1(k), (n)

Delegating to a non-licensee authority to perform adjustments or manipulations 22 TAC §80.1(a)

Failure to supervise a student 22 TAC §80.1(b)

Delegating authority to a licensee whose license has been suspended or revoked 22 TAC §80.1(d)

Failure to comply with the CA, other law or a board order or rule 22 TAC §75.10(c) CA §§201.501, 201.502(a)(1)

Failure to comply with down-time restrictions 22 TAC §75.10(f)

Medicaid fraud CA §201.502(a)(2), (7); HRC §§36.002, 36.005 Solicitation Occ. Code §§102.001, 102.006

Default on Student Loan Occ. Code Chapter 56 22 TAC §80.2

Failure to comply with requirements/restrictions on prepaid treatment plans 22 TAC §80.13

Failure to respond to board inquiries 22 TAC §§73.3(1)(C), 75.3(h), 75.6, 80.3(g)

Failure to report criminal conviction 22 TAC §75.3(f)

Other statutory violations CA §201.502(a)(2) - (8), (10), (12) - (17), (19) - (20)

http://info.sos.state.tx.us/fids/201101996-1.html

TBCE Penalty Matrix CATEGORY II 1st Offense: $500; 2nd Offense: $750*; 3rd Offense: $1000* *and/or suspension

Violation Reference:

Submitting an untrue continuing education certification 22 TAC §73.3(1)(E) CA §201.502(a)(2)Operating a facility without a certificate of registration or with an expired registration CA §201.312 22 TAC §§74.2(a), 74.3(e), 74.5(a) Practicing in a facility without a certificate of registration or with an expired registration CA §201.312 22 TAC §74.2(k)Unauthorized disclosure of patient records 22 TAC §80.3 CA §§201.402, 201.405Overtreating/overcharging a patient 22 TAC §75.1(a)(4) HPCA §101.203Deceptive advertising and other prohibited advertising 22 TAC §77.2 CA §201.502(a)(2), (9), (11); HPCA §101.201

CATEGORY III 1st Offense: $250; 2nd Offense: $500*; 3rd Offense: $1000* *and/or suspension

Failure to furnish patient records 22 TAC §80.3Overcharging for copies of patient records CA §201.405(f) Failure to disclose charges to patient 22 TAC §§75.1(a)(6), 77.3(a) HPCA §101.202 Failure to submit to medical examination 22 TAC §80.3(h) Failure to maintain patient records 22 TAC §80.5

CATEGORY IV 1st Offense: $250; 2nd Offense: $500; 3rd Offense: $1000

Failure to display public interest information 22 TAC §§75.7(d), (e), 75.8Displaying an invalid license or renewal card CA §201.502(a)(2), (9) Failure to complete CRT continuing education 22 TAC §78.1(i)

CATEGORY V 1st Offense: $250; 2nd Offense: $400; 3rd Offense: $500

Failure to report change of address 22 TAC §73.1 Failure to report change of facility address/ownership 22 TAC §74.5(d) Failure to report locum tenens information 22 TAC §73.2(b) Use of the term "physician," "chiropractic physician" CA §201.502(a)(22) Failure to use "chiropractor," "D.C." in advertising 22 TAC §75.1(a)(2)

http://info.sos.state.tx.us/fids/201101996-1.html

TBCE Announces New Rule 77.2The TBCE has finally adopted a new version of Rule 77.2. The new Rule reads:(a) A registered facility or licensee shall not, on behalf of himself, his partner, associate, or any other licensee or facility affiliated with him, use or participate in the use of any form of public communication which conta ins a fa lse, f r a u d u l e n t , m i s l e a d i n g , deceptive, or unfair statement of claim, or which has the tendency or capaci ty to mis lead or dece ive the general public.

(b) In any form of public communication, a licensee or registered facility shall not describe services that are inconsistent with the practice of chiropractic as described under §75.17 of this title, relating to scope of practice.

(c) A licensee or registered fac i l i t y engag ing in , o r authorizing another to engage i n t e l e m a r k e t i n g o f prospective patients shall not misrepresent to the person called any association with an i n s u r a n c e c o m p a n y o r another doctor of chiropractic or another chiropractic group or facility.

(1) A licensee, registered fac i l i t y, o r t he i r agen t , engaging in telemarketing shall not promise successful chiropractic treatment of injuries or make any other communication which would

b e p r o h i b i t e d u n d e r subsection (a) of this section.

(2) A licensee, registered fac i l i t y, o r t he i r agen t , engaging in telemarketing are required, at the start of each call, to inform the person called who they are (caller's n a m e ) a n d w h o t h e y represent (clinic/doctor).

(3) A licensee or registered f a c i l i t y e n g a g i n g i n telemarketing, either directly or through an agent, shall keep a copy of each script used for calling and a log of all calls made that shall include the date, telephone number, and the name of each person called. Such scripts and logs shall be maintained for a minimum of two years.

(d) Licensees or registered facilities that intend to include a testimonial as part of any form of public communication shal l mainta in a s igned statement from that person or g r o u p t o s u p p o r t a n y statements that may be used in any public communication for a minimum of two years

f rom pub l i ca t ion o f the testimonial.

(e) Licensees or registered f a c i l i t i e s s h a l l c l e a r l y differentiate a chiropractic office, clinic, or facility from a n o t h e r b u s i n e s s o r enterprise in any form of public communication.

(f) Licensees shall identify themselves as either "doctor of chiropractic," "DC," or "chiropractor" in all forms of public communication. If each licensee that practices in a r e g i s t e r e d f a c i l i t y h a s ident ified themselves as required above, then the facility name need not include "ch i ropract ic" or s imi lar language.

(g) In any form of public communication using the phrase "Board Certified" or similar terminology associated w i th any c redent ia ls , a licensee must identify the b o a r d c e r t i f y i n g s a i d credentials.

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TBCE Announces New Rule 78.1T h e T e x a s R e g i s t e r REPORTS HERE  that the TBCE has adopted a final version of Rule 78.1. The new Rule reads:

(a) Registration required. Any person performing radiologic procedures in a chiropractic facility must register with the

14Texas Journal of Chiropractic www.chirotexas.org

board, on a form prescribed by the board. This section does not apply to registered nurses or to persons certified under the Medical Radiologic Technologist Certification Act.

(b) Eligibility. An applicant for registration must either:

(1) submit proof of the applicant's registry with the Texas Department of State Health Services (DSHS) and completion of training and instruction as required by 25 TAC §140.518 (relating to Mandatory Training Programs for Non-Certified Technicians); or

( 2 ) p e r f o r m r a d i o l o g i c procedures for a licensee to whom a hardship exemption was granted by DSHS within the previous 12 months under 25 TAC §140.520 (relating to Hardship Exemptions).

(c) Application submission. An applicant shall submit an application for registration, proof of status as provided in subsection (b) of this section, along with the radiologic technologist application fee as provided in §75.7 of this title (relating to Fees and Charges for Public Information).

(d) Renewal. On or before January 1 of each year, a CRT shall renew his or her registration, by submitting:

(1) a registration application;

(2) the radiologic technologist application fee as provided in §75.7 of this title (relating to

Required Fees and Charges); and

(3) proof of renewal status as provided in subsection (b) of this section.

(e) Expired registration.

(1) A CRT registration expires on January 1 of each year if it is not timely renewed.

(2) If a CRT's registration has expired, a person may renew his or her registration by submitting to the board all of t h e i t e m s r e q u i r e d b y subsection (d) of this section and a late fee of $25.

(3) A person who fails to renew his or her registration on or before the expiration date may also be subject to an administrative penalty and other disciplinary sanctions as provided in subsection (h) of this section.

(f) Incomplete applications. No registration will be issued on an incomplete submission. A p p l i c a t i o n o r r e n e w a l packages that are submitted without all of the required documents or fees will be deemed incomplete and returned to the applicant.

(g) DSHS authorization. A person may not perform radiologic procedures if that person is removed from the DSHS registry or the hardship exemption under which the person is working is expired or revoked even if the person holds a valid CRT registration with the board. A CRT must

provide to the board a copy of a hardship exemption granted by DSHS within five days of its issuance if the exemption i s g ran ted p r io r to the registration renewal deadline.

(h) Disciplinary sanctions. The board may refuse to issue or renew, suspend, or revoke a CRT reg is t ra t ion and/or impose an administrative penalty for the following:

(1) violation of the rules or an order of the board;

(2) violation of the Medical Rad io log ic Techno log is t Certification Act;

(3) violation of the rules or an order of DSHS;

(4) violation of the Texas Chiropractic Act; or

(5) nonpayment of registration fees.

(i) DSHS compliance. All registrants shall comply with the rules of DSHS for the control of radiation.

(j) Supervision required. A CRT shall perform radiological procedures only under the supervision of a licensee physically present on the premises.

( k ) C i n e r a d i o g r a p h y . Procedures that inc lude cineradiography are limited to use by a licensee who has passed a course in its use, approved by the board.

15 Texas Journal of Chiropracticwww.chirotexas.org

(l) Non-static procedures. Any non-static procedure has the p o t e n t i a l t o b e m o r e dangerous and hazardous and by definition may only be performed by a licensee or a certified medical radiologic technologist.(m) Licensee responsibility. A licensee shall not authorize or permit a person:

(1) who is not registered under this section to perform radiologic procedures on a patient unless otherwise authorized under the Medical Radiologic Technologist Act or 2 5 TA C C h a p t e r 1 4 0 , Subchapter J (relating to M e d i c a l R a d i o l o g i c Technologists); or

(2) to perform radiologic procedures on a patient if that person has been removed from the registry of DSHS or the l i censee 's hardsh ip exemption has been revoked or has expired.

(n) Licensee compliance. A licensee shall comply with the M e d i c a l R a d i o l o g i c a l Technologist Certification Act and all applicable rules of DSHS.

(o) L a w s g o v e r n i n g d i s c i p l i n a r y a c t i o n . Disciplinary action against a CRT, inc luding the i m p o s i t i o n o f administrative penalties, is g o v e r n e d b y t h e Administrative Procedures Act, Government Code, C h a p t e r 2 0 0 1 , a n d applicable enforcement provisions of the Texas

C h i r o p r a c t i c A c t , O c c u p a t i o n s C o d e , Chapter 201, including Subchapters K through M.

☆☆☆

TBCE Announces New Rule 77.5T h e T e x a s B o a r d o f Chiropractic Examiners has adopted a final version of rule 77.5. The new rule reads:A p e r s o n a d v e r t i s i n g chiropractic services shall not use false, deceptive, unfair or m i s l ead ing adve r t i s i ng , including, but not limited to, c la ims that ch i roprac t ic services:

(1) cure or lessen the effects of ailments, injuries or other disorders of the human body which are outside the scope of chiropractic practice as defined by Chapter 201 of the Occupations Code and these rules; or

offer results that are not within the realm of scientific proof b e y o n d t e s t i m o n i a l statements or manufacturer's claims.

☆☆☆

TBCE Proposes Change to Rule 80.3

T h e T e x a s B o a r d o f Chiropractic Examiners has

proposed a change to Rule 80.3, Request for Information and Records from Licensees.

The proposal would only change subsection (d) of this rule by adding the portion in italics and underlined  to read:

  "Denial of request. If the licensee denies the request under subsection (a) of this s e c t i o n f o r a c o p y o f chiropractic records or a summary or narrative of the records, either in whole or in part, the licensee shall furnish t h e p a t i e n t a w r i t t e n statement, signed and dated, stating the reason for the denial. Chiropractic records r e q u e s t e d p u r s u a n t t o subsection (a) of this section may not be withheld based on a past due account for care or treatment previously rendered to the patient or based on the lack of a letter of protection or other similar document."

☆☆☆

TBCE Proposes Change to Rule 80.3T h e T e x a s B o a r d o f Chiropractic Examiners has proposed a change to Rule 80.3, Request for Information and Records from Licensees.

The proposal would only change subsection (d) of this rule by adding the portion in italics and underlined  to read:

16Texas Journal of Chiropractic www.chirotexas.org

Texas Chiropractic Association

The STARS of TCA

TCA’s Top Donor receives The TCA’s Gavel Award in appreciation of noteworthy financial support.

Call TCA: 512-477-9292 and the details will be handled for you.

Thank You for Your Contributions!

Diamond

Sapphire

Platinum

Gold

The Stars of TCA Program gives special recognition to those who generously contribute to TCA.

Their contributions fund special initiatives that advance the Chiropractic Profession in Texas.

Star Levels

opractic A

  "Denial of request. If the licensee denies the request under subsection (a) of this s e c t i o n f o r a c o p y o f chiropractic records or a summary or narrative of the records, either in whole or in part, the licensee shall furnish t h e p a t i e n t a w r i t t e n statement, signed and dated, stating the reason for the denial. Chiropractic records r e q u e s t e d p u r s u a n t t o subsection (a) of this section may not be withheld based on a past due account for care or treatment previously rendered to the patient or based on the lack of a letter of protection or other similar document."

☆☆☆

TBCE Proposes Addition to Rule 75.2T h e T e x a s B o a r d o f Chiropractic Examiners has proposed an addition to Rule 75.2, Proper Diligence and E f fi c i e n t P r a c t i c e o f Chiropractic. 

Text that is underlined is new text. [Text in colored brackets and italics are to be deleted]. Text in bold are used by the editor for emphasis.

T h e p r o p o s e d r u l e , PUBLISHED HERE states: 

§75.2 Proper Diligence and E f fi c i e n t P r a c t i c e o f Chiropractic

(a) A lack of proper diligence in the practice of chiropractic o r the g ross ine ffic ien t practice of chiropractic when applied to a licensee or chiropractic facility includes but is not limited to the following:(1) failing to conform to the minimal acceptable standards of practice of chiropractic, regardless of whether or not actual injury to any person was sustained, including, but not limited to:

(A) - (C) (No change.)

(D) causing, permitting, or allowing physical injury to a patient or impairment of the dignity or the safety of a patient [or];

(E) abandoning pat ients without reasonable cause and without giv ing a pat ient adequate notice and the opportunity to obtain the s e r v i c e s o f a n o t h e r chiropractor and without providing for the orderly transfer of a patient's records; or[.]

(F) failing to refer a patient to an appropriate health care provider when the licensee determines or should have d e t e r m i n e d w i t h i n t h e limitations of the chiropractic scope of practice that the patient may suffer from a condition that requires a d i a g n o s i s o u t s i d e t h e chiropractic scope of practice as author ized by Texas Occupations Code §201.002 or §75.17 of this title (relating to Scope of Practice), or that

requires treatment outside the chiropractic scope of practice as author ized by Texas Occupations Code §201.002 or §75.17 of this title.

(2) (No change.)

(b) (No change.)

TBCE states that the "earliest possible date of adoption [is] July 24, 2011."For further information, please call: (512) 305-6716

☆☆☆

TBCE Proposes Addition to Rule 74.3T h e T e x a s B o a r d o f Chiropractic Examiners is proposing an addition to Rule 74.3.

The rule proposal would add the sentence underlined and italicized to subsection (f) to read:

(f) A facility shall not provide chiropractic services without a c u r r e n t c e r t i fi c a t e o f registration. Operating a fac i l i t y w i th an exp i red cert ificate of registration constitutes operating a facility w i t hou t a ce r t i fica te o f registration.

☆☆☆

18Texas Journal of Chiropractic www.chirotexas.org

Out with the Pyramid, In with the Dinner PlateThe federal government released its new health icon to replace the confusing food pyramid.

After nearly two decades, the U . S . D e p a r t m e n t o f Agriculture is turning from the famil iar food pyramid to illustrate healthy food choices to a dinner plate -- a relatable visual meant to more easily conjure appropriate portion sizes and food selection, the agency says.They state "Government officials are abandoning a triangle for a circle in order to h e l p s h a p e A m e r i c a n s ' decisions about how to make their square meals healthier."

"The colorful graphic, which c a n b e s e e n a t choosemyplate.gov, is divided into four wedges -- fruits, vegetab les, gra ins , and protein -- with another small c i rc le next to the p late representing dairy (a glass of milk, perhaps, but make it fat-free or low-fat, the website says).""Fruits and vegetables take up more than half the plate, adding grains covers about three-quarters, reflecting a shifting emphasis toward plant-based diets."

"Evidence continues to mount on the benefits of a plant-based diet ... Despite this, the vast majority of adults don't

get the recommended fruits, vegetables, and whole grains. There's plenty of work to be done."

The 1992 version of the food guide pyramid illustrated a hierarchy in which grains accounted for the majority of the diet.

The USDA spent $2 million to develop the logo, which included research, focus groups, and a new website.

☆☆☆

Legislation to Allow Use of Research to Substantiate Health ClaimsLegislation that allows the use of credible scientific research to substantiate health claims in the labeling and promotion of foods and supplements (HR 1364) was reintroduced t o t h e U S H o u s e o f Representatives.

A similar bill was introduced in March of 2010 but failed to make it out of committee. As before, Congressman Jason Chaffetz (R, Utah) sponsored the bil l , which does not i nc lude any subs tan t ia l changes from the previous version. The bill cites the plethora of marketing messages received by consumers regarding drugs that target illnesses and their symptoms, stating that many such illnesses can be prevented or reversed through diet and lifestyle changes. HR 1364 seeks to level the playing field in that regard.

A c c o r d i n g t o t h e b i l l ʼs language, by allowing food and supplement producers to cite “ legit imate scientific studies” published in peer-reviewed media, consumers will receive the information they need to make informed choices and take steps that ultimately lower health care costs and improve the quality of life.

Specifically, the bill

• allows producers of foods and supplements to cite legitimate scientific research,

• clearly defines allowable research that may be related to claims,

• prevents the FDA from r e c l a s s i f y i n g f o o d o r supplements as “unapproved drugs” because of the citations used, and

19 Texas Journal of Chiropracticwww.chirotexas.org

• p r o h i b i t s t h e u s e o f fraudulent or misleading c la ims and affirms the authority of the US Food and Drug Administration and the Federal Trade Commission in these cases."

☆☆☆

CMS to Release Medicare Data to Rank DocsMedicare claims data would be used to compare physician performance under new rules proposed by the Centers for Med ica re and Med ica id Services (CMS).

The proposal -- which was part of the Affordable Care Act (ACA) -- would give certain organizat ions access to Medicare claims data starting in 2012 that they could combine with claims data from private insurers to paint a more accurate picture of how physicians, hospitals, and o t h e r p r o v i d e r s a r e performing.

That means that information on how individual doctors in a given location are performing on specific quality and patient care measures will soon be public information.

Currently, Medicare claims data isn't publicly available, so if an organization wants to c o m p a r e p h y s i c i a n s performance in given area, they generally rely on data

f r o m a s i n g l e p r i v a t e insurance company, which may not provide the most a c c u r a t e s a m p l e . T h e Medicare data would be s t r i p p e d o f p e r s o n a l information about specific patients, but organizations would still need to prove they are capable of accurately using and keeping secure the information, which would be culled from Medicare Parts A, B, and D claims data.

CMS is accepting comments on the proposed rule until the beginning of August."

☆☆☆

CMS: No Pay for "Reasonably Preventable Conditions"The Centers for Medicare and Medicaid Services (CMS) announced that hospitals and healthcare providers will no longer be reimbursed for t r e a t i n g t h e i r M e d i c a i d patients for illnesses, injuries, or readmissions that should have been prevented.

A fina l r u l e announced Wednesday enacts a portion of the Affordable Care Act (ACA) that prohibits states f r o m m a k i n g M e d i c a i d payments to providers for conditions that are deemed "reasonably preventable," including transfusing the wrong blood type; falls that result in dislocation, fractures,

or head injuries; burns and electric shocks; catheter-associated ur inary t ract in fec t ions ; surg ica l s i te infect ions af ter bar iatr ic surgery or coronary artery bypass; and manifestations of poor glycemic control.

States can identify additional preventable conditions for which Medicaid payment will be denied.

In 2008, Medicare stopped reimbursing hospitals for treating conditions, infections, o r i l l n e s s e s t h a t w e r e acquired in the hospital, and f o r a n y r e a d m i s s i o n s associated with treating those hospital-acquired conditions.

☆☆☆

U.S. 36th in

World Life ExpectancyLife expectancy at birth for American men was 75.6 years and 80.8 for women in 2007 -- 36th and 33rd in the world -- with wide variation from county to county.

County-level life expectancies for men ranged from 15 years ahead of an international average of top-performing nations to more than 50 years

20Texas Journal of Chiropractic www.chirotexas.org

Weʼre 36th!

behind. The range for women was 16 years ahead to more than 50 years behind.

"The U.S. picture, with its remarkable combination of poor health outcomes despite the highest levels of health spending per capita, is even more stark and disturbing when examined at the local level," authors wrote.

At the county level, l i fe expectancy in 2007 ranged from 65.9 years to 81.1 years for men and 73.5 to 86 years for women. The lowest life expectancies were in counties in Appalachia, the deep South, and across northern Texas, the researchers said.

When compared against an average of 10 nations with the best life expectancy (the "international frontier"), U.S. numbers were lower by 3.2 years -- 13 years behind for men and 16 years behind for women.

"... some [U.S.] counties have a life expectancy today that nations with the best health outcomes had in 1957," authors said.

Overall, more than 85% of U.S. counties have fallen f u r t h e r b e h i n d t h e international life expectancy frontier, the researchers said.

“Despite the fact that the U.S. spends more per capita than any other nation on health, eight out of every 10 counties are not keeping pace in terms of health outcomes. That's a

staggering statist ic," the medical author said.

☆☆☆

Key Components of the E/M GuidelinesChiroeco.com REPORTS HERE on the three key components of the E/M Guidelines. The article points out the three key components of the E/M Guidelines as One: P a t i e n t h i s t o r y ; T w o : Examination; Three: MDM (medical decision-making) and, in this article, focuses on the key components of a patient history.

"According to the 2009 OIG report, 83 percent of all chiropractic claims submitted failed to meet documentation requirements. ... Faced with the failing grades theyʼve received, there are only two choices for DCs: seriously i m p r o v e d o c u m e n t a t i o n p r a c t i c e s o r f a c e t h e possibility of having payments withheld when documentation i s a b s e n t . W o r s e y e t , ch i ropractors could r isk having prepayment reviews on all of their claims ..."

"Chiropractic is one of the only medical professions that consistently obtains optimal patient results. ... it is your duty and responsibility to the patient, in addition to the standard of care, to accurately document in the patient

record. ... the patientʼs health record must a lso te l l a documented story. I f an auditor were to come to your office today and look at one of your patientʼs files, would there be a clear picture? Is t h e r e a n o b v i o u s differentiation between your active, medically necessary care and your wellness or maintenance care?"

"I t al l begins with sol id documentation of your E/M service. Divided into the patientʼs history, examination, and doctorʼs clinical decision-making, this service leads the way for you to lay down foundational documentation for this episode of care. Donʼt forget the auditorʼs credo: 'If itʼs not in the record, then it didnʼt happen.'”

"In order to correctly select the appropriate level of an E/M s e r v i c e , a l l p a t i e n t information must be must be properly documented and meet AMA Current Procedural T e r m i n o l o g y ( C P T ) requirements. So, if selecting the correct levels of the E/M service has you wishing you were back in chiropractic c o l l e g e , f e a r n o t . T h e following will help you be part of the solution in transforming OIG failing grades into golden stars for chiropractic."

"First, relax: Itʼs not that difficult to document correctly. In fact, itʼs much easier than making a spinal adjustment. By documenting correctly you can accurately and with confidence choose the correct

21 Texas Journal of Chiropracticwww.chirotexas.org

levels of E/M service to submit to your third-party payers. Itʼs time to start getting it right — and be appropriately paid — for what youʼre really worth.""The chief complaint (CC); history of present illness (HPI); review of systems (ROS); and past, family and/or social history (PFSH) are the four components of patient history as required by the E /M documen ta t i on guidelines."

"Chief complaint: The CC is generally the patientʼs stated reason for the encounter.""History of present illness: The HPI is a chronological d e s c r i p t i o n o f t h e development of the patientʼs present illness from the first sign or symptom or from the previous encounter to the present. The HPI includes location, quality, severity, duration, timing, context, m o d i f y i n g f a c t o r s , a n d a s s o c i a t e d s i g n s a n d symptoms."

"Tip 1: Only the provider may obtain and document the HPI. This is also where you want to start counting as the eight elements of HPI will often determine the level of history you are able to report." These eight elements are listed in this article to be: Location; Quality of the symptom; Severity; Duration; Timing (when it occurs); Context of onset (what tr iggers i t ) ; Modi fy ing fac tors (what makes it better, worse, or different]); Associated signs/symptoms.

"Review of symptoms: The ROS is a system-by-system review of body functions that begins during the ini t ial pat ient interview and is completed during the physical exam. ... The ROS is usually a list of questions grouped by organ systems that should be part of your patient intake forms, and cover all of the fol lowing: Const i tut ional; Eyes; Ears, nose, mouth and t h r o a t ; C a r d i o v a s c u l a r ; Respiratory; Gastrointestinal; G e n i t o u r i n a r y ; M u s c u l o s k e l e t a l ; Integumentary; Neurologic; Psych ia t r i c ; Endoc r i ne ; H e m a t o l o g i c / l y m p h a t i c ; Allergic/immunologic."

"Past, family, and/or social history: Past history is the patientʼs previous experience w i th i l l nesses , in ju r ies , hospitalizations, surgeries, treatments, allergies, age appropriate immunizations, diet restrictions, and current medications. Family history is the review of the patientʼs family members and includes important information about the health status or cause of death of parents, siblings, and c h i l d r e n ; a n y s p e c i fi c diseases that would relate to the problem of the patientʼs CC, HPI, or ROS; and any hereditary diseases that might place the patient at risk. Social history covers the patientʼs past and current information relating to marital status/living arrangements; c u r r e n t e m p l o y m e n t ; occupational history; use of drugs, alcohol, or tobacco;

level of education; and sexual history."

"Tip 2: The patient and ancillary staff may record and document ROS and PHSH. The provider must review and sign both the ROS and PHSH to indicate he or she has evaluated the information. M a k e s u r e y o u r i n t a k e paperwork does most of the heavy lifting for you and that a team member has reviewed it for completeness."

"Tip 3: For re-exams — whenever a doctor chooses to refer to an ROS or PFSH for a r e - e x a m — i t m u s t b e referenced by date (e.g., “ R O S a n d P F S H w e r e reviewed from February 24, 2011; no changes or change was noted at ...”)"

"Determining the correct level of history: The health history you take from the patient is the first key component required in selecting the appropriate level of the E/M service. Once you have obtained information from the four elements of the patientʼs history — CC, HPI, ROS, and PFSH, the next step is assigning the correct level of history: Problem focused; Expanded focus; Detailed; Comprehensive."

22Texas Journal of Chiropractic www.chirotexas.org

Give Your Talent and Time. Right now, Doctors, your time and talents are needed in massive “Grass Roots” campaigns for both political and public action. Serving in the areas of Fundraising, Vendor Relations, Public Relations, and Insurance can help advance the Chiropractic Profession in Texas. Doctors should reach out by phone calls, emails, social media or all of the above to their colleagues, friends, peers, and patients to make sure they know what’s going on. While it’s on your mind, take action to volunteer by emailing pr@mytexasdoctor.org or call Texas Chiropractic Association (TCA) at 512-477-9292. It is also a good time to make sure your TCA membership is current. If it has lapsed, or you would like to become a member now, please contact TCA or follow this link: http://www.chirotexas.org/node/451

Give Your Patients the Information and Get Them Active.Your patients choose you for your level of education, training, and expertise. Help them ensure that right! Sign them up by going to MyTexasDoctor.org and clicking the “Take Action” link. By quickly entering their contact information, it immediately informs their legislators and key officials that YOUR Patients value YOUR Chiropractic Care. It is that simple and it also signs them up for important email updates, as well as information about how to donate.

Give Your Money.The greatest challenge right now is raising adequate funds. This battle will not be fought with money, but it takes money to fund the cause. Donations to the Defense Fund from Doctors, Vendors, Businesses, and Patients make this possible. Give what you can and give often. Some will give extravagantly. Encourage your patients, friends and peers to give. Remember, no donation is too small and no donation will go un-noticed.

It’s Time. . .For All Texas D.C.’s to Pull Together.

Everyone has something to give.

It’s Time… To Move Forward

Here’s how to donate by credit card.Go to: 1. http://www.chirotexas.org/donateChoose 2. Defense fundFill out required information3. Enter donation 4. (nothing is too small)The option of a 5. Recurring Monthly Donation is available

Here’s how to donate by mail.Go to: 1. http://www.chirotexas.org/sites/default/files/AUTO_DRAFT_FORM.pdfPrint out form / fill in info. 2. (Attach voided check or fill in Credit Card information.)Fax it to: 3. 512-477-9296 or mail it to: TCA, 1122 Colorado St., Suite 307, Austin TX 78701

Here’s how to donate by phone or in person.Call TCA at 1. 512-477-9292, and the details will be handled for you.

Texas Chiropractic Association

The article points out that the f o l l o w i n g d e s c r i p t o r s determine the level of history:

LEVEL OF HISTORY                     

HPI ROS PFSH

Problem focused                          Brief NA NA

Expanded focus                           Brief Prob focus NA

Detailed                                      Extend Extend Pertinent

Comprehensive                            Extend Complete Complete

"Obtaining and documenting as much information from the patient history as possible is a very important aspect of the patientʼs evaluation;" it will also allow you to bill the level of E/M service appropriate to the work you are performing. "Making sure you have met and documented all the E/M requirements before selecting the code is the first step t o w a r d i m p r o v i n g y o u r documentation."

☆☆☆

TMA Hails its Discriminatory AttitudesT h e T e x a s M e d i c a l Association states" "Thanks to the hundreds of physicians, medical students, and TMA A l l i a n c e m e m b e r s w h o contacted their senators ...

and aggressive advocacy by TMA ʼs l obby team, the association won a major scope battle."

One of the TMA's chief concerns was "As approved by the committee Monday, Senate Bill 1001 by Sen. John Carona (R-Dallas) would have prevented the Texas Medical Board from taking legal action t o s t o p a n i n d i v i d u a l chiropractor from violating the Medical Practice Act if the chiropractic board said the chiropractor was practicing within his or her scope."

Perhaps the primary motivator for TMA's fear, however was their opinion that "the bill also would have circumvented cu r ren t i nsu rance code p r o v i s i o n s c o n c e r n i n g nondiscrimination against nonphysicians, which would a l l o w m o r e t h a n 3 0 nonphysician health care groups to get paid for more services ... And lastly, the bill would have allowed a number of these groups to create pa r t ne r sh i ps and o the r professional structures with physicians..."

Heaven forbid that DCs and M D s s h o u l d b e c o m e "partners" in healthcare! H e a v e n f o r b i d t h a t discrimination against "non-MDs" should cease!

The Texas Tribune reported, “After a fierce fight, the stateʼs leading physician groups won a change in legislation backed predominant ly by Texas chiropractors that could have

prevented one health care l i c e n s i n g a g e n c y f r o m challenging the ruling of another in court. The bill reached final passage on the Senate floor today after addition of an amendment added by Sen. John Carona, R-Dallas, who authored the bill, reflecting a compromise between the Texas Medical Association and the Texas Chiropractic Association.”

Unfortunately the end of the legislative session occurred be fo re t he ch i r op rac t i c sponsored non-discrimination bills could be finally voted upon. Therefore medical discrimination continues, and m e d i c a l - c h i r o p r a c t i c p a r t n e r s h i p s a r e " s t i l l forbidden".

In a related story the AMA REPORTS HERE that "The AMA, along with the Texas Medical Association and the American Associat ion of Physicians of Indian Origin, filed an amicus brief June 7 in the U.S. Court of Appeals in support of the cardiologists. T h i s a m i c u s b r i e f demonst ra tes organ ized medicine's stand against discrimination based on a physician's ethnicity."    When "organized medicine" learns to overcome its bigotry and can see its way clear to to avoid supporting discrimination in every venue then the public will be better off.

☆☆☆

24Texas Journal of Chiropractic www.chirotexas.org

Medicaid for the middle class?The new health reform law would let several mill ion middle-c lass people get nearly free insurance meant f o r t h e p o o r , a t w i s t

g o v e r n m e n t n u m b e r c r u n c h e r s s a y t h e y discovered only after the complex bill was signed.

The change would affect early retirees: A married couple could have an annual income of about $64,000 and still get

Medicaid, said officials for the Health and Human Services department.

"Up to 3 million more people could qualify for Medicaid in 2014 as a result of the anomaly. That's because, in a major change from today, most of their Social Security benefits would no longer be c o u n t e d a s i n c o m e f o r determining eligibility. It might be compared to allowing middle-class people to qualify for food stamps."

Early retirees would be a new group for Medicaid. While r e t i r e e s c a n n o w s t a r t collecting Social Security at age 62, they must wai t another three years to get Medicare, unless they're disabled.

Some early retirees might see it as a relatively painless way to satisfy the new law's r e q u i r e m e n t t h a t m o s t Amer icans ca r ry hea l th insurance starting in 2014. It would help tide them over until they qualify for Medicare.

The actuary's office said the early retirees eligible for Medicaid would be on top of an estimated 16 million to 20 million new people that new law already brings into the program, by opening it to childless adults with incomes near the poverty level.

☆☆☆

25 Texas Journal of Chiropracticwww.chirotexas.org

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Insurer Errors Cost Billions Annuallyinsurers incorrectly process more than 19% of all medical claims, which wastes about $17 billion annually, according to the American Medical Association (AMA).

The AMA's fourth annual Nat iona l Hea l th Insurer Report Card reports that insurers got a little worse in their accuracy of paying claims over the past year. Last year's report card found t ha t commerc ia l hea l t h insurers incorrectly processed about 18% of medical claims.

Doctors' offices spend an average of 10% to 14% of their total operating costs d e a l i n g w i t h i n s u r a n c e

companies, according to the AMA.

The AMA found that insurance companies have an overall claims processing accuracy rate of about 81%.

The private insurer that was t h e m o s t a c c u r a t e a t processing claims was United, with an accuracy rate of 90%.

The AMA also looked at Medicare's accuracy rate, and the public insurer bested the private companies with an accuracy rate of 96%.

The company with the lowest accuracy rate paid just 61% of claims accurately, which is a notable decline from its 74%.

The report card also found:

• Doctors received no payment for 23% of claims submitted

• Response time varied from a median of six to 15 days.

☆☆☆

Government Report Notes Benefits of Spinal ManipulationThe National Prevention Council (NPC), recently called for the development of a National Prevention Strategy  t o o u t l i n e g o a l s a n d r e c o m m e n d a t i o n s f o r improving health and wellness for all Americans.

The National Prevention Strategy highlights several p r e v e n t a t i v e m e a s u r e s t h r o u g h o u t t h e r e p o r t

26Texas Journal of Chiropractic www.chirotexas.org

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including alternative therapies for back and neck pain.

According to the report, one key aspect of expanding preventive services is to “enhance coordination and i n t e g r a t i o n o f c l i n i c a l , b e h a v i o r a l a n d c o m p l e m e n t a r y h e a l t h strategies.” The report also specifically touts the benefits of spinal manipulation stating, “ C o m p l e m e n t a r y a n d alternative therapies for back and neck pain (e.g., acupuncture, massage, and spinal manipulation) can reduce pain and disability.”

☆☆☆

Harvard Establishes "Principles of Conservative Prescribing"Researchers from Harvard and the University of Illinois at Chicago have publ ished Principles of Conservative Prescribing in the Archives of Internal Medicine.

They state:

" T h e c o n c e p t s u m s u p lessons from past experience as well as from recent studies d e m o n s t r a t i n g t h a t medications are commonly u s e d i n a p p r o p r i a t e l y, overused, and associated with significant harm -- suggesting the need to more

thoughtfully weigh claims for drugs, especially new drugs.. . .These pr inc ip les urge clinicians to

(1) think beyond drugs (consider non-drug therapy, t r e a t a b l e u n d e r l y i n g causes, and prevention);

(2) practice more strategic prescribing (defer non-urgent d r u g t r e a t m e n t ; a v o i d unwarranted drug switching; b e c i r c u m s p e c t a b o u t unproven drug uses; and start treatment with only one new drug at a time);

(3) mainta in heightened vigilance regarding adverse e f f e c t s ( s u s p e c t d r u g reac t i ons ; be aware o f withdrawal syndromes; and educate patients to anticipate reactions);

(4) exercise caution and skepticism regarding new drugs (seek out unbiased information; wait until drugs have sufficient time on the market; be skeptical about surrogate rather than true clinical outcomes; avoid stretching indicat ions; avoid seduction by elegant molecular pharmacology; beware of selective drug trial reporting);

(5) work with patients for a shared agenda (do no t automatically accede to drug r e q u e s t s ; c o n s i d e r nonadherence before adding drugs to a regimen; avoid r e s t a r t i n g p r e v i o u s l y unsuccessful drug treatment; discontinue treatment with

unneeded medications; and r e s p e c t p a t i e n t s ' reservations about drugs); and

(6 ) cons ide r l ong - te rm, broader impacts (weigh long-term outcomes and recognize that improved systems may outweigh marginal benefits of new drugs)."

☆☆☆

Financial Conflicts of Interest Linked to Outcomes“Randomized controlled trials involving the payment of author consultancy fees are more likely to generate a pos i t i ve ou t come when compared with trials that do not involve such conflicts of interest”, according to a recently presented study. The findings ... demonstrated that 91% of randomized controlled trials that recorded these conflicts of interest achieved positive results. Around 66.7% of similar trials without the confl ic ts were found to achieve positive results.

“ T h e n u m b e r o f pharmaceutical treatment options ... has increased remarkably in recent years, partly as a result of increased funding from pharmaceutical companies,” lead study author Nasim A. Khan, MD, stated .... “Our study has shown that certain [financial conflicts of interest] among study authors

27 Texas Journal of Chiropracticwww.chirotexas.org

have an increased likelihood of positive outcomes favoring the sponsor's drug.”

“The study authors searched Medline and the Cochrane Central Register of Controlled fo r e l i g ib le randomized controlled trials from 2002 to 2003 and 2006 to 2007. They disclosed financial conflicts of interest by at least one author in 55 of the 103 eligible trials. They found that 49 authors w e r e e m p l o y e d b y t h e industry sponsor, 29 received consulting fees or honoraria, 14 received research grants and 13 owned shares in the pharmaceutical company."

"The correlation of positive o u t c o m e r e p o r t i n g a n d financial conflicts of interest in the study was found to only be present in one group: those authors who received consulting fees or honoraria f r o m t h e i n d u s t r y. T h e f r e q u e n c y o f p o s i t i v e outcomes – 72% in the overall study and approximately 90% for randomized controlled trials receiving consultancy fees, honoraria or a research grant from the industry – could potentially indicate ethical issues..."

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Chiropractic a Concise HistoryT h e A m e r i c a n M e d i c a l Association HERE REPORTS on the History of Medicine.

Dr. Steve Agocs, D.C. reports i n a n a r t i c l e t i t l e d Chi roprac t i c ' s F igh t fo r Legitimacy that "although the chiropractic profession now o c c u p i e s a l a r g e l y mainstream place in the health care spectrum of the United States, this has not always been the case. From its formation in 1895 by founder Daniel David (D. D.) Palmer, the chiropract ic profession faced a plan of containment and elimination by the American Medical Assoc ia t i on (AMA) tha t continued for nearly a century. It took an antitrust lawsuit filed against the AMA in 1976 to reveal the magnitude and scope of the AMAʼs plan. Desp i t e gene ra t i ons o f organized medical opposition, chiropractors did what most other groups of professionals failed to do: they maintained a separate and distinct identity from the practice of medicine while growing in an otherwise hostile environment created b y t h e A M A a n d i t s c o m p o n e n t s t a t e associations."

"During the 1800s, there were a variety of medical sects vying for market share in the United States. Homeopaths, eclectics, naturopaths, and osteopaths, as well as the so-called “regular” orthodox

medical practitioners, all had a s take in shap ing the d o m i n a n t h e a l t h c a r e paradigm.”

“The medical practitioners organized the Amer ican Medical Association in 1847 with the primary goals of s t a n d a r d i z i n g m e d i c a l education and instituting a program of medical ethics. By 1849, the AMA had taken on the role of investigating the various competing sects of medicine and challenging them on the basis of their ethics.”

“The AMA took the position that the other forms of medicine, including the newly d i scove red ch i rop rac t i c profession, were unethical and “unscient ific.” Many authors, however, have made the argument that the AMAʼs in ten t was to decrease compet i t ion for financial reasons rather than to protect the public from unethical practitioners.""Medical doctors from this fledgling group broadcast the message that their practice alone was scientifically based, despite the fact that their approach to medicine was no more scientific than that of the p r o f e s s i o n s t h e y w e r e competing with. This claim, however, was an important first step in marginalizing o t h e r p r o f e s s i o n s a s “ u n s c i e n t i fi c ” o r “pseudoscientific” and allowed this sect of medicine to organize and professionalize quickly and eventually exert a massive influence on all

28Texas Journal of Chiropractic www.chirotexas.org

TCA…Helping chiropractic professionals

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aspects of health care policy in this country for generations. Not coincidentally, the AMAʼs e f f o r t s r e s u l t e d i n t h e transformation of American medicine from a modest, even menial profession into one of sovereignty, power, and financial affluence."

" B y c o n v i n c i n g s t a t e l e g i s l a t o r s t h a t t h e i r profession was scientific while all others were not, the AMA and its state member associations were able to gain protection in the form of endorsement for educational programs and laws that limited “irregular” practice.”

“The system of schools and hospitals, as well as the legislation protecting them, led to a “golden age of doctoring” that lasted until the 1 9 7 0 s . O r t h o d o x , o r “allopathic” medicine enjoyed virtually complete dominance of the health care market in the United States. With the exception of chiropractors, competing professions shrank to nonexistence or were absorbed into the orthodox medical profession, as in the case of osteopaths."

" F r o m i t s i n c e p t i o n , chiropractic was looked upon as a menace by medical authorities. Palmer ʼs first chiropractic patient was a partially deaf janitor named Harvey Lillard, whose hearing improved dramatically under Palmerʼs care. Following his development of chiropractic, Palmer used both incredible claims of cures as well as an

an t imed ica l p la t fo rm to advertise his practice. Neither endeared him to the medical authorities in Iowa or Illinois."

"Palmer intended to keep chiropractic techniques a family secret, but a near-fatal railroad accident caused him to change his plans, and he e s t a b l i s h e d t h e fi r s t chiropract ic school, now known as Palmer College of Chiropractic, in 1897. A good number of Palmerʼs early s t u d e n t s w e r e m e d i c a l doctors or had been trained in other health care disciplines prior to learning chiropractic. Palmer established a unique theory about the nature of disease and emphasized the role of the patientʼs body and its innate healing ability, rather than doctorsʼ treatments, as the key to health."

"Chiropracticʼs first challenge as a profession was the licensure laws that protected medical practice. While there were provisions in some states for chiropractors to practice as “irregulars,” in

most states chiropractors faced the possibility of arrest a n d i m p r i s o n m e n t f o r “practicing medicine without a license.” D. D. Palmer himself spent 23 days in Scott County jail ... in Iowa in 1906.”

“Recognizing the need for a protective organization of t he i r own , ch i rop rac t i c l e a d e r s f o u n d e d t h e Universal Chiropractors ʼ Association in 1906, primarily t o p r o v i d e l e g a l r e p r e s e n t a t i o n f o r chiropractors facing legal persecution."

"In 1907, however, Wisconsin v. Morikubo found the first gap in organized medic ine ʼs a r m o r . C h i r o p r a c t o r Shegataro Morikubo was a r r e s t e d f o r p r a c t i c i n g osteopathy and medicine without a license. ... The trial e n d e d i n t h e l e g a l establishment of chiropractic as a separate and distinct profession from medicine and osteopathy, largely on the basis of chiropracticʼs unique philosophy."

"Despite this legal precedent, thousands of chiropractors throughout the country were arrested and jailed for the practice of “medicine without a license” over the next several decades. Records exposed during the discovery phase of the Chester C. A. Wilk et al. v. AMA et al. case showed that medical doctors were encouraged by the AMA to accuse chiropractors of ethical violations. There was

29 Texas Journal of Chiropracticwww.chirotexas.org

the additional problem that no state had established an o f fi c i a l l i c e n s e f o r chiropractors, so in many cases chiropractors were harassed fo r p rac t i c ing without a license that did not exist."

"This changed in 1913, when Kansas became the first state to estab l ish a separate chiropractic board and fully legal ize the pract ice of chiropractic. Other states quickly moved in the same direction. By the end of the 1920s, more than half of the s t a t e s h a d l e g a l i z e d chiropractic. Louisiana was the last state to do so in 1974. Even the state chiropractic boards, however, were not safe from the pressures of the medical associations. State boards were routinely challenged and sometimes dissolved due to pressures on state legislators from the AMA and its state member associations. All the while, the AMA waged an ongoing c a m p a i g n a g a i n s t chi ropractors, us ing the popu lar med ia , med ica l journals, and any other source that could be used to describe chiropractic as a 'cult'."

"Now that chiropractors could legally practice in most states, the AMA advocated adoption o f “ b a s i c s c i e n c e ” examinations that all doctors had to meet to qualify for a license. These exams were biased heavily toward those with standard medical training—since chiropractors received n o t r a i n i n g i n m e d i c a l

procedures such as surgery and obstetrics. Chiropractors found it nearly impossible to pass the exams or gain licenses in states that adopted them. ... It was not uncommon for chiropractors to practice without licenses in states with such restrictions, creating additional opportunities for charges against them."

" M o r r i s F i s h b e i n , A M A secretary and editor of the Journal of the American Medical Association from 1924 to 1949 adopted a relentless antichiropractic stance. Fishbein described chiropractors as “rabid dogs, playful and cute, but killers”. In 1932, Louis Reedʼs The Healing Cults stated, “Eight years ago officials of the American Medical Association met in secret conclave in Chicago and adopted the slogan, ʻChiropractic must die.ʼ They gave themselves t e n y e a r s i n w h i c h t o exterminate it”.

"The AMAʼs plan to “contain and eliminate” chiropractic became even more organized with the establishment of the Committee on Quackery in 1963. This committee put its antichiropractic plan into writing as the “Iowa Plan,” the mission of which was “first the containment of chiropractic and, ultimately, the elimination o f c h i r o p r a c t i c ” . T h e committee set about doing this by lobbying for the denial of chiropractic inclusion in Medicare, lobbying to prevent the approval of a national ch i rop rac t i c acc red i t i ng

agency, and encouraging further separation of the main n a t i o n a l c h i r o p r a c t i c organizations, the American Chiropractic Association and the International Chiropractors Association."

"AMA writers ghostwrote television and movie scripts, as well as Ann Landersʼ w ide l y read newspape r column and any other media outlet that could be used to tarnish the reputation of chiropractic in the public eye. The AMA even encouraged t h e d i s t r i b u t i o n o f antichiropractic materials to h i g h s c h o o l g u i d a n c e counselors so they would dissuade interested students from pursuing careers in it."

"The massive scope and methodical nature of this plan were exposed in hundreds of thousands of pages of AMA documents that were brought to light in the 1976 trial Chester C. A. Wilk et al. v. AMA et al. The trial and its appeals were an 11-year battle that concluded in 1987. F e d e r a l J u d g e S u s a n Getzendanner found the AMA and its codefendants guilty of v i o l a t i n g t h e S h e r m a n Antitrust Act. In her decision, Getzendanner asserted that “the boycott was intended to contain and eliminate the e n t i r e p r o f e s s i o n o f chiropractic” and that it was the AMAʼs “intent to destroy a competitor”. The ruling forced the AMA to l i f t i ts ban, allowing medical practitioners to interact professionally with chiropractors without the risk

30Texas Journal of Chiropractic www.chirotexas.org

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o f b e i n g o s t r a c i z e d o r p e n a l i z e d f o r e t h i c a l violations.”

"The great irony of this long story of persecution at the hands o f t he Amer i can Medical Association is that it is questionable, particularly from the 1960s and forward, w h e t h e r t h e A M A ʼ s antichiropractic stance was even representative of the c o m m o n m e d i c a l professionalʼs attitude. Since the Wilk et al. trial concluded, the chiropractic profession h a s e n j o y e d g r e a t e r collaboration with other health professions, but the fight for equal rights as primary care providers continues to this day."

A s a n e x a m p l e i t i s REPORTED HERE  by the Texas Medical Association "Thanks to the hundreds of physicians, medical students, and TMA Alliance members ... and aggressive advocacy by TMA ʼs l obby team, the association won a major scope battle."

One of the TMA's chief concerns was reported to be " A s a p p r o v e d b y t h e committee ... Senate Bill 1001 by Sen. John Carona (R-Dallas) would have prevented the Texas Medical Board from taking legal action to stop an individual chiropractor from violating the Medical Practice Act if the chiropractic board said the chiropractor was practicing within his or her scope."

P e r h a p s t h e p r i m a r y motivator for TMA's fear, however was their opinion that "the bill also would have circumvented current insurance code provisions c o n c e r n i n g nondiscrimination against n o n p h y s i c i a n s , w h i c h would allow more than 30 nonphysician health care groups to get paid for more services ... And lastly, the bill would have allowed a number of these groups to create partnerships and other professional structures with physicians..."Heaven forbid that DCs and M D s s h o u l d b e c o m e "partners" in healthcare! H e a v e n f o r b i d t h a t discrimination against "non-MDs" should cease. These statements from the Texas Medical Association itself d e m o n s t r a t e t h a t discrimination is alive and well.

The Texas Tribune reported, “After a fierce fight, the stateʼs leading physician groups won a change in legislation backed predominant ly by Texas c h i r o p r a c t o r s … . Unfortunately the end of the legislative session occurred

be fo re t he ch i r op rac t i c sponsored non-discrimination bills could be finally voted upon. Therefore medical discrimination continues, and m e d i c a l - c h i r o p r a c t i c p a r t n e r s h i p s a r e " s t i l l forbidden."

☆☆☆

Chiropractic Care Most Valuable for Work Related Back PainA study administered by med ica l and hea l thcare professionals outside the c h i r o p r a c t i c p r o f e s s i o n concluded that “chiropractic care had more effectiveness for common work related low back pain in comparison to treatments by physicians or physical therapists. In total c h i r o p r a c t i c p a t i e n t s demonstrated lower medical expenses, less disabil i ty recurrences and shorter initial periods of disabilities."

T h e s t u d y H e a l t h Maintenance Care in Work-Related Low Back Pain and Its Association with Disability Recur rence, appears in Journal of Occupational a n d E n v i r o n m e n t a l Medicine, April 2011, volume 53.

Researchers had compared incidents across health care providers who treat claimants with new incidents of work related lower back pain. The

32Texas Journal of Chiropractic www.chirotexas.org

conclusion reached: “that preventive healthcare, mainly and specifically recommend by doctors of chiropractic, is linked with lower disability recurrences. As defined in this study recurrent disability is the renewa l o f a t l eas t 15 c o n s e c u t i v e d a y s o f temporary total disabil ity payments after the health maintenance stage which is the period after a patientʼs recovery and patient restored to optimal health."

In this study ten percent of the worders endured recurrent disability due to lower back pain. Researchers compared the recipients care: “Those who had been treated mainly by chiropractors had shown frequently better outcomes, less use of opioids (narcotic pain relievers), had less surgeries along with lower medical expenses."

Notes this medical Journal "Chiropractors treat a host of numerous d iseases and conditions besides back pain. Among them are arthritis, c rohn ʼs d isease, carpa l tunnel, spinal curvatures, RA, h e a d a c h e s , m i g r a i n e s , premenst rua l syndrome, scoliosis and fibromylagia.” The Center for Disease Control and Prevention had noted “that a minimum of three percent of all children in the United States now have regular chiropractic care. Many parents are adding chiropractic care to their regular childrenʼs wellness checkups. Chiropractic care

does not replace pediatricians but in all reality work well together to provide children overall good health. They aide childrenʼs health in many areas including asthma, bed wetting, sports injuries and more. Chiropractic care has also benefited children with l e a r n i n g d i s o r d e r s a n d dyslexia.""Chiropractic care not only relieves back pain during pregnancy but has been demonstrated to decrease the average time spent in labor. One of the greatest benefits a ch i ropractor can g ive a woman during pregnancy is that regular chiropractic care provides a properly balanced and open pelvis. This allows for greater room in which the fetus can turn into the correct position that eases labor."

"Chiropractic care is over a hundred year old profession, is safe, effective and boosts the immune system. There is ongoing mounting evidence in science to prove the abilities of chiropractic care."

☆☆☆

New Vitamin D GuidelinesPatients who may be at risk for vitamin D deficiency -- including the obese, African Americans, and pregnant women -- should be screened for the condition, according to a newly released guideline." W e d o n ' t r e c o m m e n d screening for the general

p o p u l a t i o n , b u t w e recommend it for adults and children who are at risk for deficiency...."

"That also includes lactating w o m e n , p a t i e n t s w i t h malabsorption problems, and pat ients on ant i -se izure medications..."".... to prevent vitamin D d e fi c i e n c y i n a t - r i s k populations, the guidelines suggest that infants up to a year old should get 400 IU per d a y, a n d c h i l d r e n a n d adolescents through age 18 should get 600 IU per day. However, doses as high as 1,000 IU may be needed to achieve those higher serum levels, the researchers said."

"Adults ages 19 to 50 should get at least 600 IU per day, although, again, higher doses -- up to 1,500 to 2,000 IU a day -- may be necessary to get levels consistently above 30 ng/mL."

"Patients ages 50 to 70 should get 600 IU a day, and those above than 70 need 800 IU, with the same caveat as in younger adults for increased doses to achieve higher levels."

"Pregnant and lac ta t ing women should get 600 IU per day (or 1,500 to 2,000 for higher serum levels), while obese patients and those on a n t i c o n v u l s a n t s , glucocorticoids, antifungals, and AIDS medications need two to th ree t imes the standard dose for their age group."

33 Texas Journal of Chiropracticwww.chirotexas.org

" I n t e r m s o f t r e a t i n g deficiency, the guidel ine suggests that children and adolescents should get 2,000 IU per day for at least six weeks, while adults need 50,000 IU once a week for eight weeks."

"Again, obese patients, those with malabsorption problems, and those on medications that affect vitamin D metabolism need two to three times the dose for their age group.""For both treatment and prevention, the guidelines suggest using vitamin D2 or D3."

"The guideline committee also c o n c l u d e d t h a t t h e r e ' s sufficient evidence to suggest that vitamin D be prescribed to prevent falls. On the other hand, there's not enough ev idence to recommend higher doses of the vitamin to protect against cardiovascular disease."

☆☆☆

Parker University Launches Intern Program with Cancer Treatment Centers of AmericaParker University, College of Chiropractic has partnered w i t h C a n c e r Tr e a t m e n t Centers of America (CTCA) at S o u t h w e s t e r n R e g i o n a l

Medical Center in Tulsa, Ok lahoma to p rov ide a student internship program for Parkerʼs chiropractic students w h e r e t h e y w i l l w o r k a l o n g s i d e d o c t o r s a n d specialists to provide expert care for the patients they serve. Representatives from CTCA held a ceremony to i n t r o d u c e t h e n e w collaboration between the two i n t e g r a t i v e h e a l t h c a r e leaders.

“This new internship program provides Parkerʼs students with a unique educational experience through exposure to a diverse cancer patient popu la t ion , ” sa id S teve Mackin, president and chief executive officer of CTCA at S o u t h w e s t e r n R e g i o n a l Med ica l Cen te r. “We ʼ re pleased to offer these learning experiences to future doctors interested in integrative health care approaches.”

CTCA provides integrative

cancer care all under one roof, combining conventional treatments such as radiation therapy, chemotherapy and surgery w i th suppor t ive t h e r a p i e s l i k e p a i n m a n a g e m e n t , n u t r i t i o n , chiropractic care, naturopathic medicine, and more. CTCA has board-certified physicians w h o h a v e e x t e n s i v e experience in treating all cancer t ypes , inc lud ing advanced-stage diseases, as

wel l as phys ic ians who specialize in other fields, such a s p u l m o n o l o g y , g a s t r o e n t e r o l o g y, a n d neurology. Parker students participating in the 11-week rotating internship will be exposed to these treatments as well as the hospitalʼs cutting-edge technology.“Internship opportunities like this are extremely important in furthering the education of our students,” said Dr. Fabrizio Mancini, president of Parker U n i v e r s i t y . “ C T C A ʼ s commitment to developing customized treatment plans f o r e a c h p a t i e n t i s i n alignment with what we teach at Parker and what we provide in our chiropractic wellness clinics, which is a n o t h e r r e a s o n t h i s partnership is such a great fit.”

In addition, students will work closely with Dr. John Sibley, a chiropractor at CTCA and private-practice owner in Tulsa, where they will shadow h im and ga in hands-on experience with patients from his practice and at CTCA.

“Through the internship at CTCA, students will acquire insight of how chiropractic care benefits cancer patients and will have the opportunity to see the results firsthand,” said Dr. Sibley.

Chiropractic care can be beneficial to many cancer patientsʼ overall health. The CTCA chiropractors help cancer patients find relief from the pain and discomfort related to cancer treatments

34Texas Journal of Chiropractic www.chirotexas.org

and provide care to help reduce stress and increase mobility, flexibility, strength, function, as well as improve quality of life.

“This internship is designed to best prepare Parker students for clinical practice within i n t e g r a t e d h e a l t h c a r e settings,” said Dr. Patrick Bodnar, assistant dean of clinics at Parker University. “It

will expand the clinical portion of the studentʼs education and w i l l b e n e fi t t h e m tremendously.”

☆☆☆

Palmer Rugby Qualifies for USA Rugby Final FourThe Pa lmer Co l l ege o f Chiropractic Menʼs Rugby team made school history Sunday, May 22, when it qualified for the USA Rugby Final Four championship for the second year in a row. Unfortunately they were knocked out of the finals after a defeat in the last minutes of their hard fought game.

☆☆☆

AMA Membership Drops, Fewer MDs Choose AMAT h e A m e r i c a n M e d i c a l Association lost about 12,000 members or 5% of its total membership this past year.

"Individual membership in the AMA continues to plummet as physicians see less value in their AMA membership, and increasingly perceive the AMA to be a less responsive organizational bureaucracy..." the Distr ict of Columbia d e l e g a t i o n w r o t e i n a resolution it introduced to reorganize the group's House of Delegates.”

Like it or not, the AMA is the voice of doctors, at least in the minds of the public, and they're better off having their v o i c e s h e a r d . T h e organization should have a diversity of opinions. If more keep quitting, the AMA "will just be a bunch of people who think exactly the same," one medical doctor noted.

The AMA repor ted tha t membership dues revenue decreased by $4.2 million in 2010 -- down nearly 10% from 2009. Annual dues for active physician members are $420.

Despite the drop in revenue from dues, AMA brought in an additional $5.2 million in total revenue in 2010, largely due to stronger publishing and business revenues, such as royalties paid by ALL health

care providers for insurance coding books.

I n a n a s s o c i a t e d Medpagetoday.com editorial by Dr. George Lundberg he wonders "I am trying to figure out why so many American physicians say that they hate t h e A m e r i c a n M e d i c a l Association and act out their f ee l i ng by no t be ing a member."

"The AMA's percentage of U.S. MDs who are members is at an all-time low and has dropped every recent year. Are the AMA haters unhappy because the AMA successfully fought off national health i n s u r a n c e i n 1 9 4 8 , unsuccess fu l l y opposed M e d i c a r e i n 1 9 6 6 , o r successfully supported the Affordable Care Act of 2010?"

"Are they upset because the A M A c o l l a b o r a t e d w i t h pol i t ic ians f rom tobacco growing states to successfully block anti-tobacco legislation for decades as a trade-off for Congress going easy on physicians, or because the AMA participated actively in successful anti-tobacco efforts in the 1980s and '90s?"

"Are they angry because physician average income rose from three times to only seven times that of average U.S. workers after enactment of Medicare and then the corporatization of medicine, b u t r o s e u n e v e n l y b y specialty?"

35 Texas Journal of Chiropracticwww.chirotexas.org

"Perhaps many physicians believe that an effective AMA should have been able to p r e v e n t o r s o l v e t h e malpractice problem after all these years."

"Could i t be that many physicians blame the AMA for longstanding disparities of r e p r e s e n t a t i o n b y a g e , gender, and ethnicity in the medical workforce, or blame it for promoting equality of access fo r a l l qua l i fied persons to medical school and for patients?"

"Maybe some AMA haters are angry that the AMA was in cahoots with Big Pharma for decades so as to ga in advertising mega-dollars for their journals and newspaper, or angry because those dollars were not enough to keep annual dues low."

"Maybe they reject the ethic that physicians should care for all in need, regardless of their ability to pay, an AMA position since 1846."

"Who knows? I don't."

"That leads to the next logical question. Why are so many Amer ican phys ic ians so angry?"

Good question.

☆☆☆

Practices Behind in Crucial ICD-10 Transition StepMany medical groups have no t comple ted so f tware upgrades, nor have they scheduled testing with health plans regarding transitioning to the new 5010 protocol for e l e c t r o n i c t r a n s a c t i o n s standards. The 5010 protocol, required to be in place by Jan. 1, 2012, is necessary to a c c o m m o d a t e t h e n e w ICD-10 codes, which must be implemented by Oct. 13, 2013.

A mere 29% of respondents said their current practice management system software would permit them to use version 5010; 50.3% indicated a need to upgrade their current software, and 4.5% need to replace it. Fully 14.5% of respondents didn't know the status of their system.

M o r e t h a n 4 0 % o f r e s p o n d e n t s s a i d t h e i r vendors would charge them to upgrade or replace their current system. Yet, 35.5% of practices indicated they have not yet been contacted by their vendors regarding the change to version 5010.

Only 2% of practices reported c o m p l e t i n g 5 0 1 0 implementation, while 45.2% have not even started, with the remaining 45.9% having p a r t i a l l y c o m p l e t e d implementation.

Practices also need to test their systems internally and with their major health plans to iron out any bugs before the deadline. Yet, less than 10% of respondents had started internal testing of their system. And nearly half ( 4 9 . 7 % ) i n d i c a t e d t h a t external testing had not yet been scheduled with major health plans.

☆☆☆

Few High School Kids Meet Exercise TargetsOnly about 12% of teens get a sufficient combination of a e r o b i c a n d m u s c l e -strengthening exercise to meet the physical activity g o a l s o f t h e f e d e r a l government's Healthy People initiative, CDC researchers have found.

Although 51% of high school students did enough muscle toning, just 15% got the requisite levels of a moderate-intensity workout.

For high school students, H e a l t h y P e o p l e 2 0 2 0 recommends at least 60 minutes of aerobic exercise every day and musc le -strengthening exercises on at least three days. The initiative sets percentage goals for achieving the two types of exercises and a combination of the two.

36Texas Journal of Chiropractic www.chirotexas.org

Researchers "found that a total of just 15.3% of high school students met the target for aerobic exercise; boys were more likely to do so than girls (21.9% versus 8.4%). Younger students were also more likely to attain them: 18.5% of freshmen did, 15.3% of sophomores 13.3% of juniors, and 13.1% of seniors. Whites were more likely to reach the goal than Hispanics (16.9% versus 11.8%) as were more normal weight or o v e r w e i g h t s t u d e n t s compared with obese ones (16.3% and 16.5% versus 10.7%)."

Students fared better on the recommendation for muscle toning activities, with just over half -- 51% -- getting requisite levels. Again, more males than females achieved the goal (65% versus 36.6%), as did more younger students and normal and overweight ones. But only 12.2% of the students met goal in both types of activity.

☆☆☆

Medical Screening Fails to Lower MortalityWhile "preventive screening" is widely touted as the next m e d i c a l m i r a c l e , M e d p a g e T o d a y . c o m REPORTS HERE  that "Dual screening for ovarian cancer failed to reduce women's risk of death from the disease ....

In fact, patients screened annually with CA-125 antigen test ing and transvaginal ultrasound had a slightly h i g h e r o v a r i a n c a n c e r mortality risk as compared with usual care."

"Moreover, screening was associated with increased use of invasive procedures and avo idable compl icat ions related to workup following f a l s e - p o s i t i v e r e s u l t s , investigators reported here at the American Society of Clinical Oncology (ASCO) meeting."

"It is possible that even an optimized program of annual screening may be insufficient to detect cancers ear ly enough to reduce mortality. ... Evidence from model ing suggests that aggressive cancers progress rapidly through the early stages, limiting the ability to detect these cancers with yearly screening."

"Screening led to detection of 2 0 % m o r e c a n c e r s , 'suggesting that some of the additional cancers detected by screenings were not clinically important and, if left undetected, may never have caused any symptoms or affected the women during their lifetimes.'"

"Screening yielded false-positive results for 3,285 women, of whom 1,080 subsequent ly underwent surgical follow up. ... authors found that 163 (15%) women

had at least one serious complication attributable to the surgical intervention."

☆☆☆

New Evidence for Innate KnowledgeIt is REPORTED HERE that  "We have known for a long time that neuronal circuits become established and get reinforced via experience – itʼs a phenomenon known as “synaptic plast ici ty.” For e x a m p l e , t h i s i s h o w memories become anchored in the brain."

Now, however, "the team working on the Blue Brain Project ... however, is offering radically new evidence that this may not be the whole story. The researchers were able to demonstrate that small clusters of pyramidal neurons in the neocortex interconnect a c c o r d i n g t o a s e t o f immutable and relatively simple rules."

"These clusters contain an estimated fifty neurons, on average. The scientists look at them as essential building blocks, which contain in

37 Texas Journal of Chiropracticwww.chirotexas.org

t h e m s e l v e s a k i n d o f f u n d a m e n t a l , i n n a t e knowledge – for example, representations of certain s imp le work ings o f the physical world. Acquired knowledge, such as memory, would involve combining these elementary building blocks at a higher level of the system. “This could explain why we all share similar perceptions of physical reality, while our memories reflect our individual experience."

"The principle determining the f o r m a t i o n o f t h e s e microcircuits is astonishingly simple. Basically, when two neurons are each connected to the same neighboring neuron, the probability that they are also interconnected is greater than average. The researchers were able to build a statistical model based on this observation. When the scientists tested in vitro neuronal circuits from different rats, they all presented very similar characteristics. If the circuits had only been formed from the experiences lived by the different animals, the values should have diverged c o n s i d e r a b l y f r o m o n e individual to the next. Thus, the neuronal connectivity must in some way have been programmed in advance."

"There is no question that knowledge, in the sense that we typically understand it ( r e a d i n g a n d w r i t i n g , recogniz ing our f r iends, learning a language), is the result of our experiences. But t h e E P F L t e a m ʼ s w o r k

demonstrates that some of o u r f u n d a m e n t a l representat ions or basic knowledge is inscribed in our g e n e s . T h i s d i s c o v e r y redistributes the balance between innate and acquired, and represents a considerable advance in our understanding of how the brain works."

☆☆☆

Olive Oil Protects Against StrokeConsuming copious amounts of olive oil may dramatically reduce stroke risk for older a d u l t s , a c c o r d i n g t o a popu la t ion-based s tudy. “Heavy use in cooking and dressings was associated with a 41% lower stroke incidence compared with never using olive oil..."

"The top one-third on intake by serum measures had a 73% lower stroke risk than those in the bottom third among older adults living in three cities in France."

"Because these resu l t s controlled for other dietary and stroke risk factors, olive oil may be considered a major protective component of the M e d i t e r r a n e a n d i e t f o r stroke...."

"Intensive olive oil intake could find a place alongside more fruits and vegetables and less salt in the dietary recommendations to prevent

s t r o k e i n e l d e r l y populations ...."

"Moderate intake showed a 20% reduced incidence of stroke compared with no olive oil intake but the association was not significant."

☆☆☆

38Texas Journal of Chiropractic www.chirotexas.org

The world of chiropractic is

changing. New lawsuits regularly challenge the

profession; new research regularly demonstrates the effectiveness of the chiropractic profession and also demonstrates the lack of effectiveness for more “popular” health

care approaches.

Rules are changing;laws are changing; yet

the ever present discrimination against a minority profession that

seeks to focus upon health rather than

pathology does not seem to be changing.

Who is your voice?Who keeps you informed?

Who supports your profession so that you

may support your family and your patients?

Are you a part of your professional association?

Texas Chiropractic Association

Serving Texas Chiropractors and their patients for nearly 100 years!

Check out our ONLINE Texas Journal of Chiropractic UDATED DAILY!

Just go to www.chirotexas.org and click on the link:

Texas Journal of Chiropractic

A New Day is Dawning!

Texas Chiropractic Association

Serving Texas Chiropractors and their patients for nearly 100 years!

Are YOU supporting YOUR profession?Are YOU supporting YOUR Doctor of Chiropractic?

www.chirotexas.org

1122 Colorado, Suite 307Austin, TX 78701

Phone: 512 477 9292Fax: 512 477 9296