Texas Chiropractic Association

Texas Journal of Chiropractic

Volume XXIV, Issue 3 Fourth Quarter 2010

TCA’s New Chiropractic Advocacy Group“Let Chiropractors be Doctors”Chiropractors Appeal TMA v TBCETBCE Issues Statement on DiagnosisTCA Objects to Rule ProposalGovernment says: “Vaccines may result in Autism”

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Texas Chiropractic Association

Texas Journal of ChiropracticVolume XXIV, Issue 3 Fourth Quarter 2010

Inside

TMA v TBCE LAWSUIT IS APPEALED! 5The Court’s Opinion in TMA v TBCE 5Judge Rules in TMA v TBCE 7Coming Events 7TBCE Issues Statement on Diagnosis 9TCA Objects to TBCE Rules Proposal 9CCE Proposes Revisions to Accreditation Standards 12CCGPP Reports Its Progress 13Chiropractic Professor to Oversee VA Health Administration Chiropractic Care 14

CMS Proposes Fingerprints Under New Regulations 14Newspaper States: "Let Chiropractors be Doctors" 15Setting Staffing Salaries 16Vaccines Don't "Cause" Autism, but can "Result in” Autism 17Meet ACA's New Executive VP 18Legal Challenge to Healthcare Reform Marches On 19Malpractice Costs Less than 2.5% of National Health Care 19New Federal Health Offices are on their Way 20An "Alternative" for Back Pain? 21North American Spine Society Joins AMA’s SOPP 22Pharmacists Develop Vaccine Practices 23Letter to the Editor 24Communicate With Confidence 24

COLLEGE NEWS SECTION 27Other News Too! 34

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 2010 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: Ed Fritsch D.C.

President Elect: Jorge Garcia D.C. Secretary: Jack Albracht D.C.

TCA StaffExecutive Director: Patte Kent

Communications Director: Chris Dalrymple D.C.

Legislative Director: Chip Kent

Board of DirectorsDistrict 1! Dan Petrosky 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! Robert Hoffman D.C.District 9! James Welch D.C.District 10! Shane Parker D.C.District 11! Ed Kieke D.C.District 12! Yvonne Landavazo D.C.

PoliciesAnnual 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.

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TMA v TBCE LAWSUIT IS APPEALED!

It is not yet over!

The judge's decision in the matter of TMA v TBCE has been appealed. On Friday afternoon of October 1, 2010, the TBCE announced that it had filed its Notice of Appeal in this legal matter. Later that same afternoon the Texas Chiropractic Association also filed its notice of appeal.

Neither party has announced just what portion of the j u d g m e n t t h e y w i l l b e appealing, but the Notice of Appeal notifies the court that the intention to appeal exists.  Both parties will have some weeks to p repare the i r appeals. 

At this point the judgment regarding MUA, Needle EMG, and the matter of "limited diagnosis" for chiropractic doctors is: • s t a y e d f r o m b e i n g

enforced;• will be continued heard in

the court systems;• will continue to require

s u p p o r t f r o m t h e chiropractic profession AND ITS SUPPORTERS.

Watch www.chirotexas.org for t h e l a t e s t i n f o r m a t i o n r e g a r d i n g t h e T M A ’ s a g g r e s s i v e a t t a c k o n chiropractic.

The Court’s Opinion in TMA v

TBCEOn August 17, 2010, the trial court issued a letter that concludes that doctors of chiropractic may diagnose, but that the authority to diagnose is not unlimited.

The court states that doctors of chiropractic are:

“authorized to provisionally identify, to the extent possible g iven the professional ’s expertise and permissible tools, any disease or condition t h a t w o u l d b e a c o n t r a i n d i c a t i o n t o t h e professional’s authorized treatment for the limited purpose of referring the patient to a professional authorized to confirm or rule out the identification. To warn o f p o s s i b l e h a r m , t h e professional is impl ici t ly authorized to provisionally identify any other disease or condition apparent in the course of examination for the same limited purpose.”

The court, however, also concluded that the TBCE rule

75.17(d) is invalid because it does not contain sufficient limitations.

75.17 (d) concerns Analysis, D i a g n o s i s , a n d O t h e r Opinions and states:

    (1) In the practice of chiropractic, licensees may render an analysis, diagnosis, or other opinion regarding the findings of examinations and evaluations. Such opinions could include, but are not limited to, the following:       (A) An analysis, diagnosis or other opinion regarding the biomechanical condition of the spine or musculoskeletal system including, but not limited to, the following:(i) the health and integrity of

t he s t ruc tu res o f the system;

(ii) the coordination, balance, e f fi c i e n c y, s t r e n g t h , conditioning and functional health and integrity of the system;

(iii) the existence of structural p a t h o l o g y, f u n c t i o n a l p a t h o l o g y o r o t h e r abnormality of the system;

(iv) the nature, severi ty, complicating factors and effects of said structural p a t h o l o g y, f u n c t i o n a l p a t h o l o g y , o r o t h e r abnormality of the system;

(v) the e t io logy o f sa id s t r u c t u r a l p a t h o l o g y, functional pathology or other abnormality of the system; and

5 Texas Journal of Chiropractic

(vi) the effect of said structural p a t h o l o g y, f u n c t i o n a l p a t h o l o g y o r o t h e r abnormality of the system o n t h e h e a l t h o f a n i n d i v i d u a l p a t i e n t o r population of patients;

    (B) An analysis, diagnosis or other opinion regarding a subluxation complex of the spine or musculoskeletal system including, but not limited to, the following:(i) the nature, sever i ty,

complicating factors and effects of said subluxation complex;

(ii) the e t io logy o f sa id subluxation complex; and

(iii) t h e e f f e c t o f s a i d subluxation complex on the health of an individual patient or population of patients;

(C) An opinion regarding the treatment procedures that a r e i n d i c a t e d i n t h e therapeutic care of a patient or condition;        (D) An opinion regarding the likelihood of recovery of a patient or condition under an indicated course of treatment;        (E) An opinion regarding the risks associated with the treatment procedures that are indicated in the therapeutic care of a patient or condition;        (F) An opinion regarding the risks associated with not rece iv ing the t rea tment procedures that are indicated in the therapeutic care of a patient or condition;

        (G) An opinion regarding the treatment procedures that are contraindicated in the therapeutic care of a patient or condition;        (H) An opinion that a patient or condition is in need of care from a medical or other class of provider;       (I) An opinion regarding an individual's ability to perform normal job functions and activities of daily living, and the assessment o f any disability or impairment;    (J) An opinion regarding the biomechanical risks to a patient, or patient population from various occupations, job duties or functions, activities of daily living, sports or a t h l e t i c s , o r f r o m t h e e r g o n o m i c s o f a g i v e n environment; and

  (K) Other necessary or a p p r o p r i a t e o p i n i o n s consistent with the practice of chiropractic.    (2) Analysis, diagnosis, and other opinions regarding the findings of examinations and evaluations which are outside the scope of chiropractic include:  (A) incisive or surgical procedures;  (B) the prescript ion of c o n t r o l l e d s u b s t a n c e s , dangerous drugs, or any other d r u g t h a t r e q u i r e s a prescription;    (C) the use of x-ray therapy or therapy that exposes the body to radioactive materials; or    (D) other analysis, diagnosis, and other opinions that are inconsistent with the

Texas Journal of Chiropractic 6

practice of chiropractic and with the analysis, diagnosis, and other opinions described under this subsection.In specific, the court indicated that with the definition of subluxation complex, “an authorization to diagnose neuro-physiological aspects of the system is not consistent with the explicit authorization t o d i a g n o s e o n l y t h e ‘biomechanical condition’ of it.”

It was reported by the TBCE that it appears that it was the specific language “...but not limited to…” that the judge objected to. Steps to remedy this concern are already underway and the appeals process moves forward.

Judge Rules in TMA v TBCE

Dis t r i c t Judge S tephen Y e l e n o s k y s a i d t h a t chiropractors can diagnose “the biomechanical condition o f t h e s p i n e a n d t h e musculoskeletal system.” Ye t h is ru l ing p roh ib i t s chiropractors from performing two procedures that the medical association disputes

chiropractors MAY perform. On is manipulation of the spine while under anesthesia and the other is needle e l e c t r o m y o g r a p h y , a diagnostic test involving the insertion of a thin needle into a muscle to record the its electrical activity.

T h e T e x a s M e d i c a l Association and the Texas Medical Board initiated the suit and the Austin American Statesman reported that "the [medical] doctors argued that chiropractors can't diagnose patients because the word "diagnose" isn't mentioned in the law.

Judge Yelenosky, however, d isagreed. “The s ta tu te authorizes chiropractors to 'analyze, examine or evaluate' and therefore 'diagnose' certain condit ions…” the judge has said.

The Statesman reports:

"'When I saw that letter, that is a lot of what we contend,' said Jennifer Riggs, the attorney for the Texas Chiropractic Association, which joined in the case...."

"David Bragg, a lawyer for the Texas Medical Association, and officials with the medical board applauded the judge's decision. 'We got the relief we were looking for,' Bragg said. 'People who practice medicine should go to school and obtain a medical license, and the judge's rule helps protect that.'"

7 Texas Journal of Chiropractic

Coming EventsCheck the calendar at www.chirotexas.org

for more details

Veterans Day11.11.2010 - Thursday

TCA District 5 Meeting11.16.2010 - Tuesday

TCA District 5 Meeting12.07.2010 - Tuesday

TCA Day at the Capitol -- 01.25.2011 - Tuesday

TBCE Committees, and Board Meet02.10.2011 - Thursday

TCA Mid Winter Conference03.11.2011 - Friday

TCA Board of Directors Meeting03.12.2011 - Saturday

TBCE Committees meet, and Board Meeting05.19.2011 - Thursday

TCA Convention Weekend06.09.2011 - Thursday

TBCE Committees and Board Meet08.11.2011 - Thursday

TBCE Committees meet, and Board Meeting 11.17.2011 - Thursday

While the TMA seems to believe that new rules will be required for chiropract ic doctors to diagnose, Attorney Riggs disputed that a rule was required. The TBCE has a l r e a d y b e g u n w o r k t o improve the language of its r u l e s t o o v e r c o m e t h e reported objection of the j u d g e t o t h e p h r a s e “...includes, but is not limited to…” when determining scope of practice.

TBCE Issues Statement on

DiagnosisThe TBCE, on September 28, issued a Statement on the Status of Diagnosis. The statement says:

On September 7, 2010, a final judgment was issued in the Texas Medical Association's l awsu i t cha l l eng ing the Board's scope of practice rule.  Cur ren t l y, the Board i s e v a l u a t i n g i t s o p t i o n s regarding an appeal of the judgment.  The appeal deadline is October 7th.  If the Board does not appeal by then, the judgment will then become enforceable.  If the Board does appea l the judgment, the judgment will be stayed, and therefore unenforceable, until the merits of the appeal are finally decided.

Relating to diagnosis, the trial court's judgment provides only that: "...75.17(d)(1)(A) and (B), concerning diagnosis, are

hereby declared invalid and void."  The judgment does not disturb the other portions of the Board's rule relating to diagnosis nor does it alter the statutory authority of a doctor of chiropractic to render a diagnosis.  The judgment leaves in place ...75.17(d)(1) which reads as follows:

"In the practice of chiropractic, licensees may render an analysis, diagnosis, or other opinion regarding the findings o f e x a m i n a t i o n s a n d evaluations.  Such opinions could included, but are not limited to, the following;"  (emphasis added)

The judgment also does not disturb subparagraphs (C)-(K) of the rule which describe the s c o p e o f a n a n a l y s i s , diagnosis, or other opinon.  S e c t i o n 7 5 . 1 7 ( d ) ( 1 ) ( K ) provides that a doctor of ch i ropract ic may render " O t h e r n e c e s s a r y o r a p p r o p r i a t e o p i n i o n s consistent with the practice of chiropractic."

The Board's interpretation of its scope of practice rule in light of this judgment is that doctors of chiropractic retain the authority to diagnose a patient's condition and to bill under diagnostic codes.  The Board's interpretation is that there is no need for an emergency rule in response to the judgment.  The Board is evaluating the need to amend the scope of practice rule as indicated in the letter ruling issued by the District Court on August 17, 2010.  The Board's

Rules Committee will consider that issue at a meeting on October 1, 2010, and the Board will take up the issue at its next regularly scheduled meeting on November 4, 2010.

Please direct any questions that you may have regarding this statement to the Board's General Counsel, Mr. Hal ten Brink at 512-305-6715 or at hal.ten.brink@tbce.state.tx.us

TCA Objects to TBCE Rules

ProposalRecently the Texas Board of Ch i rop rac t i c Exam ine rs p u b l i s h e d f o u r r u l e s proposals .  The Texas Chi ropract ic Associat ion submitted its comments upon these rules.

Proposed rule 71.19 makes provisions that "a person may request the Board to issue a criminal history evaluation letter regarding the person's eligibility for a license.." and establishes a procedure for the implementation of such a letter. 

9 Texas Journal of Chiropractic

Proposed rule 75.7 is a "re-adoption" of the current TBCE licensing fee structure without change. 

Proposed rule 80.3 ads, in addition to the current fee structure for copying records, a s t a t e m e n t t h a t " A reasonable fee for completing and signing an affidavit or questionnaire certifying that the information provided is a true and current copy of the records may not exceed $15." 

It also ads that "reasonable fees may also include the actual costs paid by the l icensee to a notary for n o t a r i z i n g a n a f fi d a v i t , ques t i onna i re , o r o the r document." 

On each of these the TCA commented: "The Texas Chiropractic Association has reviewed the proposed rule and believes it to be in the best interest of the profession, the state, and the individuals that this rule would affect."

The TCA, however, objected to the implementation of proposed rule 73.3 that wou ld r equ i r e t ha t "a l l chiropractic licensees must complete at least eight hours of continuing education in coding and documentation for Medicare claims during either calendar year 2011 or 2012..."

The proposed rule further provided that "no licensee who was initially licensed in Texas prior to September 1, 2012, shall be allowed to renew his or her chiropractic

license at any time during calendar year 2013 unless he or she has completed the requ i red e ight hours o f continuing education in coding a n d d o c u m e n t a t i o n f o r Medicare claims during either calendar year 2011 or 2012..." and that "Licensees...must complete the eight hours of continuing education in coding a n d d o c u m e n t a t i o n f o r Medicare claims no later than one year after their initial licensure..." 

Even though "the eight hours o f r e q u i r e d c o n t i n u i n g education in coding and documentation for Medicare claims may be counted as par t o f the to ta l o f 16 continuing education hours required during the year in which the eight hours were c o m p l e t e d " t h e T C A comments that it "cannot s u p p o r t R u l e 7 3 . 3 a s proposed and respectfully requests a public hearing to be called pursuant to the Texas Administrative Code."

Said the TCA:  After review of the proposed amendment to the above captioned rule, the T e x a s C h i r o p r a c t i c Associat ion has several objections and comments and is unable to be supportive of the passage of this rule in its current state. Objections and comments are as follows:

1. D o c u m e n t a t i o n f r o m Medicare represents a small subset of diagnostic and treatment codes and processes in patient care. TCA has worked with the

Board in the past to require some continuing education a n n u a l l y t o i m p r o v e documenta t ion fo r a l l classes of patients, not a small limited subset. At the Board ’s reques t a f te r passage of a rule for that manda to ry con t i nu ing education, implementation of it was delayed for more than a year and it has only been the last year that it has been in place and able to take effect. The Board has not, as of yet, been in a position to measure the e f f e c t i v e n e s s o f t h a t r e q u i r e d a d d i t i o n a l c o n t i n u i n g e d u c a t i o n regarding documentation.

2. A significant percentage of the licensees of the state do not accept Medicare p a t i e n t s . R e q u i r i n g manda to ry con t i nu ing education of this specific subset of documentation styles and types would not benefit these licensees or their patients and would put unnecessary burden on t h e m r e g a r d i n g r e -licensure.

3. Subsequent to the OIG report in May of 2009, a significant percentage of the Doctors who do accept Medicare patients have already obtained additional continuing education as to Medicare documentation requirements for both the licensee and their staff. This was provided by TCA at its annual convention this past June. Requir ing these i n d i v i d u a l s t o o b t a i n additional education on top

10Texas Journal of Chiropractic

Giving Thanks for Health

of what they already have obtained is repetitive and burdensome.

4. The OIG report itself has been widely criticized as using faulty criteria and of being misrepresentative of Chiropractic claims. The report was based on claims from the year 2006 and from a nationwide sample, not specific to the State of Texas. Therefore, the report does not represent what will likely happen in 2011 or b e y o n d , n o r d o e s i t correspond to any problems specific to the State of Texas, thus the imperative nature for this Board rule is highly questionable.

5. Should this rule actually be formally adopted, the 8 h o u r r e q u i r e m e n t i s excessive. Licensees have excel lent t ra in ing and documentat ion through t h e i r C h i r o p r a c t i c education. The majority of D o c t o r s h a v e h a d s i g n i fi c a n t c o n t i n u i n g educat ion on updated d o c u m e n t a t i o n requirements, and the State of Texas already requires additional hours annually of c o n t i n u i n g e d u c a t i o n regarding documentation. It is our position that it would not take 8 hours to update licensees on the subset of M e d i c a r e c o d i n g a n d documentation. It could be included automatically in t h e 2 h o u r s a l r e a d y prescribed by the Board.

6. By Federal mandate, there is currently an on-going

significant shift to electronic health records which will again cause significant changes in documentation requirements and likely some changes in the future as to coding requirements. All Doctors, in order to meet t h e s e F e d e r a l requirements, will have to do significant training in documentation and coding as well as re-working their office systems. Mandating the “extensive training and coding and documentation of Medicare claims” is again d u p l i c a t i v e a n d burdensome.

7. Acco rd ing t o Fede ra l m a n d a t e , t h e l o c a l Medicare carriers through third parties have just begun an audit process of Chiropract ic c la ims to determine if they were paid appropriately. Payment of these claims will be based on the adequacy of the documentation provided by licensees. The results of this audit process may give a bet ter ind ica t ion o f whether in fact, there is a problem with Medicare coding in Texas that has not y e t b e e n a d d r e s s e d . P r o p o s a l a n d implementation of this rule prior to the results of this round of audits is at best premature and perhaps completely unnecessary.

The Texas Ch i rop rac t i c Association will continue its review of the rule and its impact and respec t fu l l y request a formal hearing regarding our concerns.

A t i t s Oc tober 1 , 2010 m e e t i n g , T h e R u l e s Committee of the Texas Board of Chiropractic Examiners moved that the Board NOT adopt the proposed rule.

CCE Proposes Revisions to Accreditation

StandardsThe Council on Chiropractic Education (CCE) is the only agency recognized by the U.S. Secretary of Education for accreditation of Doctor of C h i r o p r a c t i c d e g r e e programs. They have recently proposed revisions to their c u r r e n t S t a n d a r d s f o r Accreditation, to take effect January 2012.Among those p roposed revisions includes:

1. The removal of the term s u b l u x a t i o n a n d a n y references to it.

2. The statement "without the use of drugs or surgery" has been eliminated from their description of the focus of chiropractic.

3. The CCE has redefined the term "chiropractic primary care physician" as to no longer apply uniquely to chiropractors.

4 . The d ra f t s t anda rds recognize the "Doctor of Chiropractic Medicine" degree to be equivalent to the Doctor of Chiropractic degree. It was

12Texas Journal of Chiropractic

previously reported in August 2010 that National University of Heal th Sciences has already begun promoting such a degree program.

P a l m e r C o l l e g e o f Chiropract ic ut i l ized the official feedback process established by the Council on Chiropractic Education (CCE) related to the review of Draft #2 of the proposed 2012 CCE Standards. Said Palmer College:

“As part of its feedback to the council, Palmer objects to particular proposed changes to the standards language and will be asking the CCE to disclose its rationale for:

• R e m o v i n g t h e t e r m “subluxation,”

• Remov ing the phrase “without drugs or surgery” in reference to chiropractic practice,

• Adding language “DCP or its equivalent” without defining a n e q u i v a l e n t d e g r e e program, and

• R e m o v i n g m o d i f y i n g language from its definition of Chiropractic Primary Care Physician that distinguishes a chiropractor from other types of primary care physicians.

CCGPP Reports Its Progress

The Council on Chiropractic G u i d e l i n e s & P r a c t i c e Parameters (CCGPP) has

completed the original seven ( 7 ) a n a t o m i c l i t e r a t u r e syntheses and reports that the thoracic chapter wi l l be released soon.

Complete chapters include:

• Introduction• B a c k g r o u n d a n d

Methodology• Low back and leg

complaints• L o w e r e x t r e m i t y

conditions• Tendinopathy• Fibromyalgia• M y o f a s c i a l t r i g g e r

points and myofascial pain syndrome

• Nonmuscuoloskeletal conditions

Nearing Completion:

• Thoracic Spine - in final revision

• S i t e o f C a r e - i n process

• Completed Reports: • Imaging• Cervical spine

"The subluxation chapter (now called “Site of Care: Evidence as Indicator for Focus of SMT. Clinical Indicators for Locating Spinal Manipulation”) was launched earlier this year," the CCGPP reports. The CCGPP reports that "the c o s t o f c o m p l e t i o n i s estimated at $60,000....Core P r o d u c t s . . . i s w i l l i n g t o additionally donate 12 free pillows to each DC who commits to the President’s Club level of giving ($1,000 per year, or $84 per month).  [and CCGPP] encourages

every DC, especially the leaders in our profession, to become a member of the President’s Club. This project will impact any DC performing spinal manipulation, and will prove to be one of the most important projects completed by CCGPP."

Published papers:

Chiropractic Management of Low Back Disorders:Report from a Consensus Process.

As you know, JMPT already p u b l i s h e d t h e C C G P P guideline related to acute management of low back conditions,T h e D e fi n i t i o n s p a p e r , Consensus Terminology for S tages o f Care : Acute , Chron ic Recur ren t , and Wellness, is now “In Press.”

“Management of Chronic Spine-Related Conditions: C o n s e n s u s Recommenda t i ons o f a Multidisciplinary Panel” has b e e n s u b m i t t e d a n d enthusiastically accepted by JMPT will be published soon.

Continuing education:

CCGPP is exploring ways to advance our Dissemination, Implementation, Evaluation and Revision (DIER) process.

DCs around the world can now purchase the program t h r o u g h N o r t h w e s t e r n presented by Dr. Wayne Bennet entit led: CCG01: Chiropractic Management of

Texas Journal of Chiropractic13

L o w B a c k D i s o r d e r s - E v i d e n c e B a s e d Documentation. Cost: $30"

CCGPP is "a l so in the process of developing our “Train the Trainers” program, and “CCGPP Evidence-Based Certification” program, in which we will partner with state associations in an effort to educate their doctors on each chapter produced by CCGPP, along with the acute and chronic care guidelines, t h e D e fi n i t i o n s p a p e r , d o c u m e n t a t i o n , a n d instruction on how to translate all this evidence into clinical practice in an effort to provide better care and a stronger practice."

Chiropractic Professor to

Oversee VA Health Administration

Chiropractic CareAnthony J. Lisi, associate professor of clinical sciences at University of Bridgeport, has been selected to oversee chiropract ic care at the V e t e r a n s H e a l t h Administration, which serves more than 7.8 million enrolled veterans and is the nation’s largest health care system.

D r. L i s i w i l l g u i d e t h e improvement and expansion of the VHA chiropract ic p r o g r a m , w h i c h w a s e s t a b l i s h e d i n 2 0 0 4 i n response to legislation that r e q u i r e s a t l e a s t o n e

chiropractor at each of its 21 geographic regions. Currently 38 chiropractors work in 32 VHA sites, and the number is expected to grow.

“The chiropractic program can now provide another option in the management of our nation’s veterans health care,” said Dr. Lisi. who supervises the clinical training of interns f r o m t h e U n i v e r s i t y o f B r idgepor t ’s Co l lege o f Chiropractic who are assigned t o t h e C o n n e c t i c u t Department of Veterans’ Affairs, where he also serves as chief of chiropractic care.

CMS Proposes Fingerprints and

Background Checks Under

New RegulationsThe Centers for Medicaid and Medicaid Services (CMS) has proposed new regulation that makes Medicare providers who have a "high risk" of defrauding the government could be fingerprinted and undergo background checks.

The proposed rule “strikes a balance that will permit CMS to continue to assure that eligible beneficiaries receive appropriate services from qualified providers whose claims are paid on a timely basis while implementing e n h a n c e d m e a s u r e s t o p revent ou t r igh t f raud, ” according to the agency.

Says CMS the rule “will help assure that only legitimate providers and suppliers are e n r o l l e d i n M e d i c a r e , Medicaid, and [the Children's Health Insurance Program], and that only legitimate claims will be paid."

The rule is to help the agency transition from a "pay and chase" approach to fraud -- where providers are paid and then Medicare determines w h i c h p a y m e n t s w e r e fraudulent and then chases after the providers to get the money back -- to a strategy of fraud prevention.

The "pay and chase" system is not adequate when the fraud is committed by sham operations that provide no services or supplies and exist simply to steal from Medicare or Medicaid.

Under the rule, providers of services or supplies to the Medicare program would be classified under one of three categories relating to possible fraud: limited risk, moderate risk, and high risk:

14Texas Journal of Chiropractic

Limited-risk providers would h a v e e n r o l l m e n t requirements, license, and database verifications.

Moderate-risk providers would h a v e t o m e e t t h o s e r e q u i r e m e n t s - - p l u s unscheduled site visits.

High-risk providers would have to meet the init ial requirements and would also undergo unscheduled site visits, criminal background checks, and fingerprinting.

In the proposed regulation, the CMS notes that " in g e n e r a l , w e c o n s i d e r physicians, nonphysician practitioners, and medical clinics and group practices to pose limited risk because these professionals are State licensed and we are not aware of any recent studies or other evidence that indicates that these suppliers, as a category, pose an elevated risk to the Medicare program."

In add i t i on to t he new requirements for high-risk providers, other provisions of the proposed rule include:

Allowing Medicare to suspend payments to a provider as soon as a credible allegation of fraud exists

Allowing application fees to be i m p o s e d o n M e d i c a r e providers and suppliers

Requiring Children's Health Insurance Programs and M e d i c a i d p r o g r a m s t o terminate providers that have

defrauded the Medicare program

Medicare will be accepting comments on the proposed rule through November 16.

Newspaper States: "Let Chiropractors

be Doctors"The Austin Post, in an article co-authored by Dr Roxanne Sweney, offers a chiropractic perspective.  Says the article:

"You spent 4 years earning a d i fficu l t co l lege degree, focusing on the sciences. You then put in another 4,200 h o u r s o f c l a s s r o o m , laboratory, and clinical study to earn a doctorate degree.”

“Then you take a mandatory internship, serve 900 hours in a clinic, and pass 4 national

board exams to obtain your license. You also chose a post graduate specialty board certification with another 500 hours of practice and study and pass another board specialty exam.”

“You take the risk to open y o u r p r a c t i c e w i t h n o guarantee of paying your bills. You insure yourself so that people don’t sue you for everything you have. You treat p a t i e n t s e v e r y d a y understanding that if you m a k e a m i s t a k e y o u r reputation may be irreparably harmed."

Pretty standard stuff for a health care professional, yet the article points out "you are a Chiropractor. But you are not a “Doctor”, not an MD. That is what the American Medical Association (AMA) says."

The article notes that "having a government issued license is no guarantee of quality.  However, let’s just presume that the licensing laws remain in place. What problems do chiropractors face?"

"Imagine a patient comes to you with severe, debilitating pain. You have been trained with as many hours as an MD “Doctor” to recognize the symptoms and diagnose the problem. However, the laws of Texas don’t allow you to diagnose the problem.”

“You must send the patient to someone tha t t he AMA recognizes as a “Doctor” and

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have that person diagnose the problem. Most l ikely the “ D o c t o r ” p r e s c r i b e s a treatment that they have a legal monopoly to provide and you never see that patient again.”

“Just maybe the patient comes back to you to be treated as the “Doctor” has prescribed. You know that the “Doctor” cannot diagnose the real problem because they do not have your experience and t r a i n i n g . H o w e v e r, t h e government does not allow you to treat the patient properly, and therefore you cannot restore function and relieve their pain."

“This scenario is not as far fetched as it sounds, the Post notes, "this is not hypothetical. The AMA filed a lawsuit in Texas challenging the ability for chiropractors to diagnose their patients. The court ruling was that chiropractors can diagnose within limits, but also stated that the word “diagnose” is not currently mentioned in state law. That opens the door wide for AMA lobby is ts to push s ta te l e g i s l a t o r s t o l o c k o u t chiropractors with new laws preventing Chiropractors from diagnosing their patients."

"Why would the AMA do this?" the Post asks.  "It is obvious. What better way to put you competition out of work than to make their practice illegal? It would not be the first time that politicians created a legal monopoly for wealthy and

powerful friends that put them in office."

"The fact is that the traditional medical practices of MD “Doctors” don’t work for lots of people," the Post states.  "The principles of chiropractic go back to ancient times and have been proven affective over time.”

“Today you see chiropractic offices everywhere. Why? That would not be the case if patients were not getting successful treatment. The AMA would like to effectively kill the chiropractic profession to drive all of these patients to their office. That only means we will have to endure more pain."The Post then observes "should there be any laws restricting what doctors can do and what chiropractors c a n n o t d o ? W h a t i f ch i rop rac to rs cou ld no t perform invasive procedures that go below the skin, like surgery? Many chiropractors use acupuncture. What if ch i rop rac to rs cou ld no t p r e s c r i b e m e d i c a t i o n ? C h i r o p r a c t o r s r o u t i n e l y prescr ibe neut raceut ica l medicine as part of their treatment. As soon as you pass a law listing which procedures are allowed or prohibited, medical advances and new procedures appear t h a t r e n d e r t h e s e l i s t s useless. It is hard to imagine a reasonab le bas i s fo r prohibit ing patients from m a k i n g c h o i c e s a n d p roh ib i t i ng we l l t ra ined practitioners from providing

the best treatment for their patients."

"Let's also look at this from another angle. What if you were no longer allowed to choose the type of healthcare you desire? What if you were mandated to go directly to an MD “Doctor” before you we allowed to seek any other treatment? When laws limit the rights of well educated p r a c t i t i o n e r s l i k e Chiropractors to serve their patients in order to give political favors to the AMA, that is exactly where we are headed.”

“Shouldn't you be free to choose?  Let’s let patients r e c e i v e t h e c a r e a n d treatment they want....Let chiropractors be doctors."

We couldn't agree more.

Setting Staffing Salaries

Amednews.com REPORTS HERE that "as the health s y s t e m r e f o r m l a w i s implemented, and as the demand for medical services increases, medical practices are expected to step up their hiring. That, coupled with salary reviews that often fall t o w a r d t h e e n d o f t h e calendar year, will have many physicians contemplating matters of employee pay."

S a y s t h e A M A : " f a i r compensation should not be the only factor physicians consider when determining

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s a l a r y a n d b e n e fi t s . . . . Practices must determine a figure that ensures employee retention and offers flexibility to allow for future raises."

"Experts suggest following s e v e r a l s t e p s w h e n d e t e r m i n i n g a n i n i t i a l compensation package and a range of possible raises. These include assessing data, benchmarking salaries and benefits, and defining job requirements and goals."

Practice managers "really need to think about the roles and responsibilities of the various team members....Not all jobs are designed and created equal. Not every person delivers or meets expectations in the same way."

"Before salary and benefits are determined, experts a d v o c a t e t h a t p r a c t i c e managers step back and write job descriptions. These should be more than a job title and a list of duties and goals for a position. This should be the main tool that will be used in c o n j u n c t i o n w i t h benchmarking in data to determine a salary."

"Before they even get to the point of setting salaries, they r e a l l y n e e d g o o d j o b descriptions in place..."

"The next step is to assign a s a l a r y r a n g e t o a j o b description by assessing the benchmarking data available from various consulting firms a n d p r o f e s s i o n a l

organizations. For example, the 2010 sa lary survey released...by the Professional Assn. of Health Care Office Management..."

"Deg rees and yea rs o f experience also may affect how much a staffer is paid.Experts caution not to set the initial salary too high. This can r e d u c e f u t u r e r a i s e s , nega t i ve l y a f f ec t i ng an employee's motivation to perform well."

"Compensation should not be set too low, because this makes it more likely that employees will find another job. Job mobility decreased during the recession, but it is expected to increase when the economy improves."

"If you don't set salaries appropriately, turnover will eat you alive..."

"Significant salary differences a m o n g p e o p l e d o i n g essentially the same job can create conflict in the office if this information leaks out."

"Medical practices also should think about the benefits they offer. Benefits are generally 30% of a compensat ion package. According to the survey by the Professional Assn. of Health Care Office M a n a g e m e n t , 9 1 % o f practices provided employees with health insurance, but only 41% supp l ied d isab i l i t y coverage. Less-common benefits include cell phones, gasoline allowances, parking spaces and memberships to a

warehouse club, such as Costco."

"To make it more likely that employees will recognize the value of their benefits as well as their salaries, practice managers recommend issuing a n n u a l s t a t e m e n t s documenting the cost of paid time off, health insurance and other perks. This can take time but can come from data pulled from W-2s and bills charging for benefits. Those who do this say it's worth it."

"Staff place a lot of emphasis on the salary alone, so we issue an end-of-the-year benefits statement outlining what it takes to keep them here: taxes, their time off, holiday pay, profit sharing..."

Vaccines Don't "Cause" Autism, but can "Result

in” AutismThe first court award in a vaccine-autism claim is a big one. CBS News reported that “the family of Hannah Poling will receive more than $1.5 million dollars for her life care; lost earnings; and pain and suffering."

Says CBS News "Hannah was described as normal, happy and precocious in her first 18 months. Then, in July 2000, she was vaccinated against nine diseases in one doc to r ' s v i s i t : meas les , m u m p s , r u b e l l a , p o l i o ,

17 Texas Journal of Chiropractic

varicella, diphtheria, pertussis, tetanus, and Haemophilus influenzae." " A f t e r w a r d , h e r h e a l t h d e c l i n e d r a p i d l y . S h e deve loped h igh f eve rs , stopped eating, didn't respond when spoken to, began showing signs of autism, and began having screaming fits. In 2002, Hannah's parents filed an autism claim in federal vaccine court. Five years later, the government settled the case before trial and had it sealed. It's taken more than two years for both sides to agree on how much Hannah will be compensated for her injuries."

"In acknowledging Hannah's injuries, the government said vaccines aggravated an unknown mitochondrial disorder Hannah had which didn't "cause" her autism, but "resulted" in it. It's unknown how many other c h i l d r e n h a v e s i m i l a r undiagnosed mitochondrial disorder. All other autism "test cases" have been defeated at trial. Approximately 4,800 are awaiting disposition in federal vaccine court."

"Time Magazine summed up the relevance of the Poling case in 2008: ...(T)here's no denying that the court 's decision to award damages to the Poling family puts a chink -- a question mark -- in what had been an unqualified defense of vaccine safety with regard to autism. If Hannah Poling had an underlying condit ion that made her

vulnerable to being harmed by vaccines, it stands to reason that other children might also have such vulnerabilities."

"Then-director of the Centers for Disease Control Julie Gerberding (who is now President of Merck Vaccines) stated: "The government has made absolutely no statement indicating that vaccines are a cause of autism. This does not represent anything other than a very specific situation and a very sad situation as far as the family of the affected child."

Reported by CBS News

Meet ACA's New Executive VP

The American Chiropractic Association (ACA) recently h i r e d E x e c u t i v e V i c e P r e s i d e n t W i l l i a m K . O’Connell.

O'Connell 's qualifications include:

• He is an undergraduate of t h e

University of California at Berkeley, has a master ’s d e g r e e i n b u s i n e s s admin is t ra t ion f rom the University of San Francisco, and a master’s degree in

public administration from Northern Illinois University.

• He was the ass is tant executive director for the American Dietetic Association in Chicago for six years.

• He then went on to be the deputy director and chief financ ia l o ffice r fo r the A m e r i c a n O s t e o p a t h i c Association (also in Chicago) for 12 years.

• He became the number two executive officer for the A m e r i c a n B o a r d o f Anesthesiology based in Raleigh, N.C., for seven years.

• He eventually moved to Washington, D.C., and in the next five years, served as executive director of the Society for Advancement of Violence and Injury Research, and then executive director, government affairs at the National Safety Council.

“I was raised on the East Coast — Boston and New York — but after Catholic high school, I traveled to the West Coast determined to be of some public service,” says O’Connell.

“I was concerned with poor people’s civil rights and ended up joining the VISTA program as a community organizer for migrant workers in the San Joaquin Valley of California.”

At Berkeley, O’Connell he studied cultural anthropology while living in Oakland and

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commuting to college on a bicycle. To pay for school, rent, and food, he taught school.

"O’Connell attributes his initial interest in healthcare to his father, who was an executive w i t h p h a r m a c e u t i c a l companies."

Legal Challenge to Healthcare Reform

Marches OnA legal challenge to the new healthcare reform law filed by o ffic ia ls f rom 20 s ta tes appears to have legal legs. US District Judge Roger Vinson in Pensacola, Florida, suggested that he would dismiss some, but not all, of the counts contained in the multistate lawsuit that seeks to overturn the new law on constitutional grounds. He made these remarks after hearing oral arguments over a motion by the US Department of Justice (DOJ) to dismiss the lawsuit."

The lawsuit filed by the states takes specific aim at the requirement in the healthcare reform law for individuals to obtain insurance coverage or else pay a penalty.

The plaintiffs contend that by compelling individuals to buy goods or serv ices , and penalizing them if they do not, the law oversteps the power of the federal government under the const i tu t ion 's Commerce Clause, which

authorizes it to regulate in terstate commerce. In essence, the law punishes an individual for commercial inactivity.

The lawsuit also argues that the law unfairly imposes staggering costs on state governments by expanding Medicaid eligibility to include millions of individuals above the poverty line. The Medicaid program is funded jointly by s t a t e s a n d t h e f e d e r a l government.

The Department of Justice (DOJ) has countered that the individual mandate regulates economic behavior that has a major and dysfunctional effect on interstate markets in h e a l t h c a r e a n d h e a l t h insurance. The decision to forgo insurance, the DOJ maintains, is tantamount to many individuals getting a "free ride," because they receive medical care free of c h a r g e — i n h o s p i t a l emergency departments, for example. The cost of that care gets shifted to providers, insurers, governments, and ultimately, insured individuals and taxpayers.

"The DOJ also states the M e d i c a i d p r o v i s i o n s o f healthcare reform do not r e p r e s e n t g o v e r n m e n t coercion, as the plaintiffs maintain, because states have the op t ion o f no t participating in the program."

The attorney general of Virginia filed a similar suit in a Virginia federal court. The

judge in that case turned down a DOJ mot ion to dismiss it.

The Healthcare reform issue is more likely to appear on the Supreme Court docket if the 2 federal court cases reach conflicting endpoints — a loss for the federal government in 1 case, and a victory in the other.

Malpractice Costs Less than 2.5% of

National Health Care Tab

The costs associated with medical malpractice added about $55.6 billion to the nation's total health care costs in 2008 -- roughly 2.4% of a more than $2.3-trillion tab -- and most of that money went to pay for tests, procedures, and treatments associated with defensive medicine, according to an analysis by Harvard researchers.

A second paper analyzed the costs of defensive medicine across 35 medical specialties and concluded that “defensive medicine practices exist and are widespread, but their impact on medical costs is small.” So small, they wrote, that tort reform changes that w o u l d r e d u c e m e d i c a l malpractice premiums by 10% would only reduce the nation's total medical costs by 0.120% to 0.134%.

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Taken together, the papers suggest that promoting tort reform as a means to control hea l t h ca re cos t s runs contrary to the figures cited by supporters of tort reform.

Authors broke down the costs of malpractice this way:

Indemnity payments: $5.72 billion, of which $3.15 billion represen ts payment fo r economic damages, $2.4 b i l l i on fo r noneconomic damages, and $0.17 billion for punitive damages.

Administrative expenses: $4.13 billion, which includes $1.09 b i l l ion in fees to defense attorneys and $3.04 billion in overhead expenses.

Defensive medicine costs: $45.59 billion, of which $38.79 billion was estimated as the costs of hospital services and $6.80 billion as physician services.

Another $0.20 billion was added to the estimate to cover other costs, including lost physician work time -- the a u t h o r s e s t i m a t e d t h a t physicians lose 2.7 to 5 w o r k i n g d a y s f o r e a c h malpractice suit -- and the cost of "reputational and or

emot iona l harm" to the defendant physician.

New Federal Health Offices are

on their WayThe AMA repor ts in i ts September 16, 2010, AMA Health Reform Insight E-mail Newsletter that

"The Department of Health

and Human Services (HHS) has created several new o ffices and s ign ificant ly increased its staff in order to execute provisions enacted in the [Health reform law]. Information about relevant HHS regulations and health system reform implementation efforts can be found on HHS's new HealthCare.gov website."

"The Centers for Medicare & Medicaid Services (CMS) has also undergone realignment

to more readily advance the Med ica re and Med ica id delivery reforms being piloted and tested as required by the [Health reform law]."

" T h e H H S O f fi c e o f Consumer Information and Insurance Oversight (OCIIO) is tasked with implementing all private insurance reforms enacted in the [Health reform law]....According to HHS, the "office is responsible for ensuring compliance with the new insurance market rules, such as the prohibitions on rescissions and on pre-existing condition exclusions for children that take effect this year. It will oversee the new medical-loss ratio rules and will assist states in reviewing insurance rates. It will provide guidance and oversight for the state-based insurance exchanges. It will also administer the temporary high-risk pool program and the early retiree reinsurance program, and compile and maintain data for an internet portal providing information on insurance options."

"...the Office of Insurance E x c h a n g e s w i t h i n t h e OCIIO....wil l oversee the implementation of the state-based hea l th insurance e x c h a n g e s , w h i c h a r e required to be operational in 2014."

"The HHS Office of Delivery System Reform will oversee HHS efforts to promote new p r o p o s e d p a y m e n t a n d delivery reforms, such as a c c o u n t a b l e c a r e

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Check www.chirotexas.org and click on “Online Journal” to go to our Journal website!

o r g a n i z a t i o n s ( A C O s ) , bundling and the medical home. While these pilots and demonstrations will be directly implemented by CMS, the Secretary has wide discretion on many key aspects of these reforms."

" T h e C M S C e n t e r f o r Medicare and Medicaid Innovation (CMMI) was established by the [Health reform law] to test innovative payment and service delivery models that reduce program expenditures and preserve or enhance the quality of care. In choosing models to study, the Center is charged with giving preference to those that improve coordination, quality and efficiency of health care services to Medicare and Medicaid beneficiaries."

"In approximately the next 90 days, the CMMI is expected to announce i t s p l ans f o r providing technical assistance d i rec t ly to phys ic ians—specifically those in smaller pract ices—to help them participate in ACOs. This effort is separate from and in addition to the ACO/shared s a v i n g s p i l o t p r o g r a m authorized in the [Health reform law]."

" . . . C M S a n n o u n c e d a n organizational realignment that includes the creation of a new Center for Medicare. This Center combines the operations of the Medicare fee- for-serv ice program, Medicare managed care and the Medicare prescription drug benefit....The Center for

Medicare is responsible for t h e C M S p r o p o s e d rulemaking on the shared savings/ACO pilot that will begin in 2012. It is anticipated that a draft regulation setting forth the parameters of this pilot will be released late this fall."

"...CMS created its Center for Strategic Planning....The Center oversees the Office of Research, Development, and Information (ORDI), which is r e s p o n s i b l e f o r C M S demonstration projects such as the ongoing acute care e p i s o d e b u n d l i n g d e m o n s t r a t i o n a n d t h e physician group practice demonstration. ORDI will oversee new payment and d e l i v e r y d e m o n s t r a t i o n projects authorized by the [Health reform law], such as bundling and the medical home."

An "Alternative" for Back Pain?

Dr. Patrick Massey of the Chicago Daily Herald shares a column and points out several interesting facts:

"Nontraditional" medicine is the most common form of medical therapy used for back pain.

T h e m o s t c o m m o n "nontraditional" therapy used was chiropract ic, and i t achieved the best response among patients.

Over half of the patients using "nontraditional" medicine also made use of t radi t ional medicine.

Traditional medicine is more e x p e n s i v e t h a n "nontraditional" medicine.

Patients want the best of ALL therapies regardless of their origins.

When a healing art such as chiropractic is so widely used; when it achieves such great success; when its education is the same or greater than "traditional medicine"; when it must integrate its care and management of patients with "traditional" or mainstream medicine should it really be c o n s i d e r e d " a l t e r n a t i v e medicine?" Should it really be considered an "outsider" to "traditional" medicine? Or should it be viewed as a p a r t o f " m a i n s t r e a m medicine", albeit a minority member.

T h e D a i l y H e r a l d . c o m REPORTS HERE that "the most common reason for using nontraditional medicine is back pain. Annually, 30 percent of the U.S. population experiences back pain severe enough to require medical therapy. Approximately 60 percent of the population uses some form of nontraditional medicine to relieve their pain. This makes nontraditional medicine the most common form of medical therapy used for back pain."

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"All back pain is not the same, however. It may be that persistent relief can be found i n b o t h t r a d i t i o n a l a n d nontraditional medicine. A number of years ago, it was hypothesized that people who used nontraditional therapies for back pain did not believe in t rad i t i ona l med ic ine . C o n v e r s e l y, t h o s e w h o b e l i e v e d i n t r a d i t i o n a l m e d i c i n e d i d n o t u s e nontraditional treatments. A r e c e n t n a t i o n a l s u r v e y demonstrates that it is not that simple."

In a 2002 "study, the most common nontradit ional t h e r a p y u s e d w a s chiropractic manipulation followed by massage, herbal therapies yoga, tai chi and finally acupuncture. As far as p e r c e i v e d b e n e fi t s b y p a t i e n t s , c h i r o p r a c t i c m e t h o d s w e r e fi r s t . Massage, yoga, tai chi and qi gong tied for second with acupuncture coming in third. However, the differences between the various methods were very small."

"What was interesting is that 53 percent of the respondents used traditional medicine and non t rad i t i ona l med ic ine t o g e t h e r s u g g e s t i n g a perception that both forms of medicine were beneficial and could easily be integrated."

"Unfortunately, the study did no t address some very i m p o r t a n t p i e c e s o f information, such as overall cost and long-term outcomes. For persistent back pain,

traditional medicine is often more expensive than the nontraditional approaches..."

"Unfortunately, insurance companies are slow to cover t h e c o s t s o f m a n y nontradi t ional therapies, which are not inexpensive."

"Even with good medical evidence, traditional medicine has been slow to integrate m a n y o f t h e e f f e c t i v e t h e r a p i e s f o u n d i n nont rad i t iona l medic ine. Patients, however, want the b e s t o f a l l t h e r a p i e s , regardless of their origins, and are integrating traditional and nontraditional approaches and benefiting from them."

Multidisciplinary North American Spine Society Joins AMA's

Scope of Practice Partnership

The North American Spine S o c i e t y ( N A S S ) , w h i c h produces The Spine Journal and includes chiropractic d o c t o r s a m o n g i t s membership has "approved a

recommendation from its Health Policy Council and Advocacy Committee to join t h e S c o p e o f P r a c t i c e P a r t n e r s h i p ( S O P P ) , petitioned the AMA and was subsequently approved for membership.”

The "Scope of Pract ice Partnership," is an entity developed by the American Medical Association in 2004 with a mission "to monitor and investigate scope-of-practice issues involving non-MD/DO health care professions."

According to a NASS press release, the SOPP 'is a coalition of 50 state medical societ ies, more than 25 national specialty societies, the American Osteopathic Association and the AMA. The coalition works to address concerns regarding training a n d e d u c a t i o n , s t a t e r e g u l a t i o n s , l e g i s l a t i v e licensure efforts by non-phys ic ians and genera l scope-of-practice issues.”

The release also states that t h e N A S S A d v o c a c y Commi t tee w i l l oversee legislative and regulatory activities related to scope of practice, and “urges members to contact the committee with any concerns regarding a scope of practice initiative in your state."

Said the North American Spine Society, "NASS is joining the American Medical Assoc ia t i on ' s Scope o f Practice Partnership to learn more about scope-of-practice

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issues and to allow all of its members to cont inue to provide the high-quality spine care they are trained to deliver to patients. NASS will evaluate scope-of-practice issues on a case-by-case basis and weigh in on these issues based on the merits of the information presented on the issues at hand."

" N A S S w i l l r e m a i n a n independent and reasonable voice for high-quality spine care, and will continue to serve as a voice, where appropriate, for all of its m e m b e r s . S p i n e c a r e providers, regardless of specialty, should continue to become members of NASS in order to join their colleagues in ensuring that patients receive the highest possible level of care for spinal disorders."

Pharmacists Develop Vaccine

PracticesPharmacist.com reports that " p h a r m a c y - b a s e d Immunization delivery is an innovative and interactive training program that teaches p h a r m a c i s t s t h e s k i l l s necessary to become a primary source for vaccine i n f o r m a t i o n a n d administration." "The program teaches the basics of immunology and f o c u s e s o n p r a c t i c e implementation and legal/regulatory issues."  It offers

"three components to the certificate training program: 12 hour...self-study modules w i t h c a s e s t u d i e s a n d assessment exam;  8.0 hour live seminar with final exam; Hands-on assessment of i n t r a m u s c u l a r a n d s u b c u t a n e o u s i n j e c t i o n t e c h n i q u e , " a n d o f f e r s a d d i t i o n a l s e l f - s t u d y resources.”

"The goals of the certificate

training program a r e t o :  P r o v i d e comprehensive immunization educa t ion and t ra in ing ; Provide pharmacists with the k n o w l e d g e , s k i l l s , a n d resources necessary to establish and promote a successfu l immunizat ion service; Teach pharmacists to i d e n t i f y a t - r i s k p a t i e n t p o p u l a t i o n s n e e d i n g i m m u n i z a t i o n s ; Te a c h

pharmacists to administer immunizations in compliance with legal and regulatory standards."

The study modules include:

"Module 1. Pharmacists as Vaccine Advocates"

"Module 2. Immunology" After which one will be able to "explain the basic concepts of immunology; Explain the differences between active a n d p a s s i v e i m m u n i t y ; Describe how vaccines elicit a n i m m u n e r e s p o n s e ; Describe the differences between live and inactivated v a c c i n e s ; D i s t i n g u i s h vaccines available on the U.S. market as liveattenuated or inactivated.

" M o d u l e 3 . V a c c i n e -Preventable Diseases"

"Module 4. Implementing an Immunization Practice"

" M o d u l e 5 . V a c c i n e Administration"

"A Certificate of Achievement is awarded to participants who successfully complete all activity requirements, which i n c l u d e t h e s e l f - s t u d y component, l ive training seminar, and the injection t e c h n i q u e a s s e s s m e n t . Successful completion is defined as a score of 70% or better on both the self-study a n d l i v e s e m i n a r assessments."

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Letter to the

EditorT h e r e i s a n e w a n d i n s i d i o u s threat to many D.C.’s who bill insurance or participate in M e d i c a r e . I t i s c a l l e d r e c o u p m e n t s . I t fi r s t happened to me about two years ago when Blue Cross s e n t m e a n a s t y g r a m demanding about $300.00 back on a patient because during the time they paid a few claims they actually had dropped their coverage. Incredulously, i t was for services over two years prior.  Services signed, sealed and delivered and in the bag. Taxes paid, I’ve moved on.

No, they wouldn’t take my eloquent explanation about good faith and such and demanded their morsel of my flesh. Wi th 25 years of practice under my belt, it s e e m s t o m e t h a t t h e landscape keeps changing.

Blue Cross would not take no for an answer so on a current claim they simply deducted $300.00, on a current and unrelated claim, and called it a “recoupment.” A new and mysterious term that is a new form of clawback. Warfare, if y o u w i l l , t o p u t m o r e resources in their account and less in yours. I could always e lect to d iscont inue my

participation in the plan if I didn’t like it.

Aetna has a research tool as well to look at billings far into the past. Even the IRS only goes back three years for auditing purposes and seven for fraud. Could a plan go back ten years and decide that electrical stimulation was unnecessary for a select set of diagnosis because there is a new study out as part of the ODG that confirms it is a w a s t e o f t i m e a n d n o t indicated? Is it far fetched to think that group health and even Medica id /Medicare w o u l d w a n t t o i m p o s e O c c u p a t i o n a l D i s a b i l i t y Guidelines retroactively or some shady s tudy tha t discriminates against spinal manipulation?

Most everyone is cautious and concerned with Medicare. They have the u l t imate clawback called taking away everything you own and putting you in jail for federal charges of insurance fraud. E v e r y i n s t a n c e o f a manipulation that should have been considered maintenance but was billed for active i s s u e s c o u l d , i n s o m e b u r e a u c r a t s t w i s t e d understanding, be considered fraud of some kind. Maybe he would just ask for $30,000 because he was in a position to extrapolate his recoupment demand based on ten patient files. These concerns should be of deep concern to anyone that sends in a bill. With cash only there is great simplicity and usually much lower gross

income but maybe much less gross uneasiness.

We almost need some kind of legislative rule that a company can only go back one year and any recoupments and d e m a n d s c a n h a v e a reasonable hearing where a practitioner can be judged by a panel that includes one or more of his peers. Just dreaming but I have heard of a practitioner that has had something on the order of $100,000 demanded back from a large insurer. Usually it is small, but it certainly can easily become a growing and real threat to any and all of us.

William Leff D.C.El Paso, TX 79903

Communicate With Confidence

Doctors need to communicate confidence in order to achieve better outcomes through deeper understanding. 

Author Bharon Hoag reports:

" W h a t a r e o u t c o m e s ? Essentially, they are the cumulative results of your treatments."

"What is compliance? It is the degree to which patients accept and follow through on your recommendations — such as the number and f r e q u e n c y o f v i s i t s ; performance of prescribed out-of-office activities; and the willingness to adjust habits and lifestyle practices that

24Texas Journal of Chiropractic

may have contributed to the existing problem or which potentially might block the treatment’s efficacy."

"One reason a patient enters your reception area in the first place is because he or she hurts and wants to end the pain. Unfortunately, many patients don’t comprehend that chiropractic is not a one-way process; that while you can skillfully diagnose and treat conditions, they also have a role to play — and that m e a n s k e e p i n g t o a n appointment schedule and following recommendations for growth, change, and recovery."

"There is a clear breakdown in logic when someone goes to a clinic seeking relief and then fails to do what is necessary to achieve that relief — what you call outcomes."

"There can be fault on both sides, and often it relates to you not understanding some of your patients’ key issues and how to balance these with the patient’s responsibilities a n d t h e i r o w n recommendations. In dealing with the problem of patient compliance, the two greatest noncompliance drivers are time and money."

"Address the taboo time and money issues at the outset. E s t a b l i s h y o u r v a l u e proposition, which should equate the patient’s improved physical (and often mental and emotional) well-being through the treatment you

provide. And be firm about their need to commit to a schedule of visits and the i m p o r t a n c e o f t i m e l y , consistent payment."

Hoag says be "clear about the value you are delivering. You absolutely must deal from a posture of confidence, and confidence is communicable."

"Many doctors feel they must bring patients to their level in order to establish understanding. That is incorrect. You need to go to the patient’s level, and tell them what they want and need to hear."

"Do not talk in terms of subluxations, sympathetic/p a r a s y m p a t h e t i c , o r autonomic charts — that is doctor talk. Talk to your patients in a language they understand: You have a backache, you got it when you s l ipped/ fe l l / tw is ted /s lep t wrong/had an accident, here is what happened, and here is what we are going to do about it.

If you have a clinical software system that features graphical displays, sit them down and

show them a spine, tell them a little about what it does, and s h o w t h e m w h a t i s amiss... .visual aides are p o w e r f u l t o o l s a n d dramatically reinforce your diagnosis, as well as your patients’ ability to understand the physical issues."

"Tell them what you do will alleviate the problem and what you recommend they do between visits that support the in-office treatment .… Explain that treatment and recovery occur in parallel."

"Compliance has much, if not e v e r y t h i n g , t o d o w i t h understanding. And often, u n d e r s t a n d i n g i s b e s t conveyed in pieces....The constant should be, 'You’re here because you can’t do something, and we want to get you back. Here’s what I’m going to do, and here is what you must do. You must do it so you don’t undo what we achieve in the office and after you’re well, here’s how you can avoid repeating the problem.'”

"You have your own way of p r e s e n t i n g , b u t t h e fundamentals are solid. Don’t shy away from the ticklish issues of money and time; instead, build understanding .… Communicate confidence in the efficacy and value of your treatment and allow the pat ient to share in that confidence. When you do, you are more likely to have a compliant patient, and the patient is more likely to have a successful outcome."

25 Texas Journal of Chiropractic

Bharon Hoag, chief consultant of ACOM Health Chiropractic Consulting Group, has worked in the chiropractic profession for 11 years and taught for eight, developing his unique “nondoctor” approach through ownership of four clinics and management of up to nine. He can be reached through www.acomhealth.com.

The Language of Health Care

" C h i r o p r a c t o r s a r e making a quiet , but significant contribution to our nation's health. Why q u i e t ? F e w p e o p l e outside of our profession know how much public health work we do every d a y i n c h i r o p r a c t i c practice. And how would they know? Chiropractors tend to speak 'chiro-ese.'"

"...we would be doing our profession a huge favor if we l e a r n e d a n d u s e d t h e language of health when speaking about what we do.

"The Practice Analysis of Chiropractic 2010 (formerly t h e J o b A n a l y s i s o f Chiropractic) is compiled by t h e N a t i o n a l B o a r d o f Chiropractic Examiners every five years. It offers a summary of what is happening in chiropractic practice, what kinds of patients we see, what techniques we use, what additional interventions we do, etc. This document says a lot about the important public

health work that chiropractors do every day in practice."

"Another important document comes from the "Healthy People" project in the form of Healthy People 2000, Healthy People 2010, and the draft H e a l t h y P e o p l e 2 0 2 0 documents. For those of you who haven't reviewed the

Healthy People documents, they are considered the main "road map to health" in America. They list the main indicators of our nation's health, what our goals are to improve in these top areas, and how we might get there."

The article then provides a "contrast between what we are doing in practice and how we tell others about our contribution to health in A m e r i c a , u s i n g t h e s e documents as resources."

What We Do in Practice-- the Language of Health to Describe It

Teaching patients to avoid hurting their backs--Injury prevention

Recommending changes in lifestyle--Health promotion

Taking a patient's blood p r e s s u r e - - P r e v e n t i v e screenings

R e c o m m e n d i n g t h a t patients quit smoking--S m o k i n g c e s s a t i o n recommendations

"Of course, first and foremost, chiropractors adjust the spine and other joints of the body (depend ing on the i r state's scope of practice and the chiropractor's p h i l o s o p h y ) . O n e important impact of this chiropractic care is the

reduction of back pain. Back pain is one of the top health concerns listed in the H e a l t h y P e o p l e 2 0 1 0 document and will reappear as a major health concern in the Healthy People 2020 document.""But are we speaking the language of health? The language that al l health professionals speak and the context in which health policy d e c i s i o n s a r e m a d e ? Obviously and unfortunately, not so much. Unless we speak of chiropractic care as contributing to the Healthy People goals, no one will know that we have a role to play."

"Beyond the chiropractic adjustment, it gets even more

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imperative that we learn to speak the language of health. According to the Practice Analysis of Chiropractic, DCs are doing the very activities recommended in the Healthy People goals. For example, one objective listed in HP 2010 is to increase the proportion of physician office visi ts for chronic health diseases or conditions that i n c l u d e c o u n s e l i n g o r e d u c a t i o n r e l a t e d t o exercise....According to the P r a c t i c e A n a l y s i s o f Chi ropract ic 2010, 96.5 percent of chiropractors recommend physical activity to their patients. It seems we are "walking the walk," but we may not be letting people know that chiropractors are significant contributors to m e e t i n g t h i s i m p o r t a n t Healthy People goal. By speaking the language of health, particularly with other health care professionals, we position ourselves to be i n c r e a s i n g l y v a l u e d a s important members of the health care team.""Another excellent example relates to the topic of nutrition or healthy dietary practices. A b o u t 9 5 p e r c e n t o f chiropractors in the Practice Analysis report that they give advice on nutrition to their patients. Healthy People sets this goal for our nation: Increase the proportion of physician offices visits that i n c l u d e c o u n s e l i n g o r education related to nutrition or weight."

"...participating in positive public health practices are so

s e c o n d - n a t u r e t o chiropractors that we fail to realize what a big deal it is. The pressures that managed care has placed on medical professionals has severely limited the amount of time that d o c t o r s c a n s p e n d o n p r o m o t i n g h e a l t h a n d wellness. While chiropractors have also felt the financial squeeze of functioning within this health care system, we continue to do a great deal of health promotion with our p a t i e n t s . S i n c e h e a l t h promotion and prevention practices are increasingly valued in health care, it is time for chiropractors to speak out loudly and clearly..."

"Here are some simple steps to help our profession become a more recognized contributor to the nation's health efforts:  Chiropractors must familiarize themselves with nationally k n o w n p u b l i c h e a l t h documents, l ike Healthy People 2010, Healthy People 2020 (when it comes out), and t h e G u i d e t o C l i n i c a l Preventive Services.

"We should speak about what we do in chiropractic practice in the context of these health documents."

"We must become fluent in the language of health"

"We must conduct research on the depth and impact of our health promotion and p r e v e n t i o n e f f o r t s i n chiropractic practice..."

"We must write about what we do."

"We must become active members in national health organizations such as the Amer ican Pub l ic Hea l th Association."

COLLEGE NEWS

Logan College Institutes Free Care for First Responders

P r e s i d e n t G e o r g e A . Goodman, DC, FICC, has a n n o u n c e d t h a t L o g a n Col lege of Chiropract ic /Un i ve r s i t y P rog rams i s “instituting a First Responders Chiropractic Care Program t h a t w i l l p r o v i d e complimentary chiropractic care to first responders who work in the St. Louis area." "First responders are police o f fi c e r s , fi r e fi g h t e r s , e m e r g e n c y m e d i c a l ambulance technicians and returning military soldiers (since 9/11). These free chiropractic services will be

27 Texas Journal of Chiropractic

o f fe red a t Logan ’s five suburban health centers, located in Chesterfield, south St. Louis County, Webster Groves, St. Charles and St. Peters." "According to Goodman, the initial clinic visit by a first responder wil l include a consultation and review of patient health history, physical examination, five X-ray views a n d i n t e r p r e t a t i o n ( i f indicated), urinalysis and complete blood count (if indicated) and a report of find ings w i t h t r ea tmen t recommendations. In addition to the chiropractic adjustment a n d o f fi c e v i s i t , fi r s t responders will also be able to take advantage of Logan’s wellness program services."

"There are approximately 255 sen ior in te rns cur ren t ly working through the Logan hea l t h cen te r s sys tem. Patients receive direct care that is provided by these highly trained students who are familiar with the newest discoveries in chiropractic health care and work under the direct supervision of experienced clinicians who are doctors of chiropractic and members of the teaching

faculty at Logan College of Chiropractic."

Palmer College, Port Orange, Set

to ExpandThe Dayton Beach News Journal REPORTS HERE  that "Palmer Col lege of Chiropractic in Port Orange is planning to expand. The col lege's board recent ly approved constructing a $4 million, two-story, 14,000-square-foot building on its campus starting in early 2011 after site plan approval by the city. The plan was made as a response to growing needs on the campus, off City Center Parkway, which has more than 750 students."

"The addit ion of a third building, college officials said, will include a cafeteria and student lounge on the first floor and a campus bookstore that will be double or triple the size of the current cafeteria and store."

"Robert Lee, Palmer College vice chancellor for support services at its campuses here; Davenport, Iowa; and San Jose, Calif., said the second floor will have a multipurpose

area for graduation events, annual homecoming and alumni reunions, as well as partitions to subdivide the area."

"When officials planned for the Port Orange campus, which opened in 2002, it anticipated the college would grow to about 500 to 600 students. But it has exceeded those estimates."

"In the next few months, Palmer also will finish an e s t i m a t e d $ 6 0 0 , 0 0 0 renovation to leased clinic space inside the Allen Green Civic Center. Patients are still being seen and new treatment rooms are being added while other areas are renovated."

"...the college has a long-term lease with the city for land the college sits on in addition to the lease at the nearby civic center."

Palmer Establishes Dr.

George Goodheart Collection

P a l m e r C o l l e g e o f Ch i roprac t i c , Davenpor t h o n o r e d D r . G e o r g e Goodheart with the addition of Dr. George J. Goodheart Collection to the David D. Palmer Heal th Sciences Library.

"Mrs. JoAnn Goodheart, wife of Dr. Goodheart, generously d o n a t e d m u c h o f D r .

28Texas Journal of Chiropractic

Goodheart's memorabilia, which is now on permanent display and available for reference, to the David D. Palmer Heal th Sciences Library. It was not a difficult decision for Mrs. Goodheart to choose the Palmer College of Chiropractic, Davenport for t h e h o u s i n g o f D r . Goodheart’s collection. “The ve ry t hough t t ha t "The Goodheart Collection" would be permanently housed with the archives of D.D. Palmer, the founder of chiropractic, made that decision easy.”

" . . . s e v e r a l g e n e r o u s In ternat ional Col lege of Applied Kinesiology-U.S.A. ( I C A K - U . S . A . ) d o n o r s contributed a bust of Dr. Goodheart to the library."

"Dr. Goodheart graduated from the National College of Chiropractic in 1939 as a s e c o n d g e n e r a t i o n chiropractor. Shortly after he began his profession as a chiropractor, Dr. Goodheart was called to join the United States Air Force in World War II and became the youngest, at that time, to achieve the rank of Major at the age of 26. Throughout his life he made m a n y n o t e w o r t h y achievements."

"In 1964, Dr. Goodheart discovered a relationship between the strength of muscles and specific organs o r g l a n d s . W i t h t h i s b r e a k t h r o u g h , A p p l i e d Kinesiology (AK) was born and is currently practiced by

thousands in the medical field."

"In the winter of 1980, Dr. Goodheart became the first Doctor of Chiropractic to be appointed to the United States Sports Medicine Committee at the winter Olympics in Lake Placid, N.Y. Dr. Goodheart was nominated in 1988 by M e m b e r s o f t h e U . S . Congress for the Presidential Meda l o f F reedom, the h i g h e s t c i v i l i a n a w a r d bestowed by the President on behalf of the nation."

"In 2001, Dr. Goodheart was featured in an article in TIME magazine entitled Alternative Medicine Innovators, A Breed of Healers."

Parker College Alumni

Association Elects New Board Members

T h e P a r k e r A l u m n i Association "has elected four members to serve on its board of directors. Dr. Steve Brooks ('99), Dr. Bart Patzer ('93), Dr. Vincent Scheffler ('07), and Dr. Mary Warren '00 will work to continue the

vision, leadership, and legacy that has been established throughout the years."

"For more than 10 years, Dr. Brooks has been practicing in San Angelo, Texas at Sunset Chiropractic. He has earned the award of San Angelo Favorite Chiropractor each year from 2004 to 2009. He specialized in golf fitness and i s Ti t l e i s t P e r f o r m a n c e Institute (TPI) certified. Dr. Brooks has served on several local and national boards including the Make-A-Wish Foundation, Boys and Girls C lub , and c i t y counc i l -appointed boards. He has co-authored numerous books including his most recent, The Healthy Alternative."

"Dr. Patzer, a third-generation upper-cervical doctor, has been practicing at Patzer Family Chiropractic in Austin, Texas, for 16 years. He is part of the Upper Cervical Health Centers (UCHC) team and serves as a district franchise manager. He's certified in chiropractic spinal trauma. Dr. Pa tzer i s a member o f n u m e r o u s c h i r o p r a c t i c associations including the International Chiropractic Association, Chiropractic Society of Texas, Texas Chiropract ic Associat ion, World Chiropractic Alliance,

29 Texas Journal of Chiropractic

a n d T r a v i s C o u n t y Chiropractic Society."

"Dr. Scheffler current ly p r a c t i c e s a t R e a g a n ChiroSport Center in Dallas. He spec ia l izes in spor t specific rehabil itation for athletes as well as techniques like diversified and Graston. Dr. Scheffler is also a certified strength and conditioning specialist and a certified chiropractic sports physician. He discovered his passion for t r e a t i n g a t h l e t e s w h i l e attending Parker College. As a student, he attended the 2006 Central American and Caribbean Games, where he w o r k e d w i t h n u m e r o u s athletes and doctors. He has experience treating various athletes including the players of the Association of Volleyball P r o f e s s i o n a l s a n d professional cycling teams.

"Dr. Warren practices at Vital Force Wellness in Dallas, where he meets patients' needs through myofacial and sacro-occipital technique (SOT). She is also involved in Toastmasters International and the American Veterinary Chi ropract ic Associat ion (AVCA). Dr. Warren has continued to give back to her alma mater. Since 2000, she has been a guest lecturer for several classes at Parker College including differential diagnosis, pediatrics, and professional development. She has also hosted students for an After Hours Clinic Visit Program."

"Membership in the Parker Alumni Association is all-inc lus ive and welcomes Parker graduates, doctors of chiropract ic, chiropract ic a s s i s t a n t s , m a s s a g e therapists, corporations, and wellness supporters to join them in their pursuit of e x c e l l e n c e . I n a l l i t s endeavors, the Parker Alumni Association strives to support and encourage all members to achieve the highest level of success in their relative fields."

Parker College Awards Research

Grants" P a r k e r C o l l e g e o f Chiropractic has awarded three chiropractic research grants of $4,000 each. The grant rec ip ients inc lude C l e v e l a n d C h i r o p r a c t i c College, University of Kansas Medical Center, Southern California University of Health Sciences, and Osher Clinical Cen te r a t B r igham and Women’s Hospital."

"For the past two years, P a r k e r h a s g e n e r a t e d resea rch f unds f o r t he profession in order to provide expanded grant programs and research opportunities. The second annual Parker Gala, which was held during Parker Seminars Las Vegas, is the funding source of the grants. The purpose is to advance the

sc i en t i fi c know ledge o f chiropractic." "C leve land Ch i rop rac t i c College and the University of Kansas Medical Center will research the central effects of spinal manipulation in patients with chronic low back pain."

" S o u t h e r n C a l i f o r n i a University of Health Sciences will research the effect of an in tegra t i ve approach o f chiropractic and acupuncture care on low back pain."

"The Osher Clinical Center at B r i g h a m a n d W o m e n ’ s Hospital will conduct a pilot study of chiropractic care and acupuncture for the treatment of lumbar spine stenosis."

"Award recipients will also be recognized during Parker Seminars Las Vegas 2011 at the third annual Parker Gala, Jan. 14, 2011. In addition to the $4,000, Parker will provide each research investigator complimentary registration to Parker Seminars Las Vegas 2011."

Parker College Weighs in on CCE

RevisionsDynamic Chiropractic reports that "Parker College recently provided feedback and took an official position on the proposed revision of the CCE standards. The college found the process constructive and insightful. Parker thoroughly a n d c a r e f u l l y r e a d t h e

30Texas Journal of Chiropractic

Wishing You Joy, Health

and Wholeness

standards and found some revisions that they feel will be beneficial to the profession and some areas of concern that they felt needed further clarity."

"First, Parker commends CCE for the revisions that will strengthen the institution and t h e p r o f e s s i o n . T h o s e standards include faculty involvement in the admissions process, the inclusion of m a n d a t e d p o l i c i e s a n d procedures governing career placement, standards relating to faculty development, and addit ional clari ty on the necessity of a college master plan.…

"Some of the areas on which Parker would like to see additional clarity or further e x p a n s i o n i n c l u d e t h e following:"

"Student admissions (pg. 19) - GPA admissions requirement increase to 3.0. Parker's average entrance GPA is 3.0 or higher for most of its entering cohorts; however, Parker recommends a phase in period scale that will allow C C E a n d i t s m e m b e r institutions the opportunity to evaluate the impact of an increased GPA requirement on admissions. A drastic change could negatively impac t adm iss i ons and i n s t i t u t i o n s n e e d t h e opportunity to mitigate this change through other means. Perhaps an incremental step f rom 2.5 to 2.75 final ly reaching 3.0 over the course

of three to five years would be a feasible solution."

"Facu l ty invo lvement in admissions (pg. 17) - Parker is in favor of actively engaging faculty in the admissions p r o c e s s ; h o w e v e r , t h e standards are not specific on t h e a m o u n t o r t y p e o f involvement the council would like to see. Are there specific requirements or is the level of involvement at the discretion of the institution?"

"Licensing for jurisdictions (pg. 19) - Informing applicants of regulatory requirements for each state jurisdiction could place an undue burden on the institution. While Parker feels it is important to apprise applicants of the general regulatory requirements, it will be challenging to apprise applicants of jurisdictional requirements in all states. States makes adjustments to these regulatory requirements and the institutions are not always informed in a timely manner. A feasible alternative to this requirement would be to inform applicants where the information can be found and to assist in the search of the i n f o r m a t i o n w h e n e v e r necessary. Applicants should also be informed of their responsibility to frequently confirm these requirements throughout their doctor of chiropractic matriculation."

"Doctor of chiropractic degree programs or equivalent as determined by CCE (pg. iii) - This statement needs stated criteria under which CCE

would identify a doctor of c h i r o p r a c t i c d e g r e e equivalent. While this would be a beneficial practice for foreign institutions, without s o m e g u i d e l i n e s f o r equivalency the determination could be too subjective and thus compromise the integrity of the doctor of chiropractic p rog ram. I t i s Parke r ' s expectation that the only terminal degree for the chiropractic profession would r e m a i n t h e d o c t o r o f chiropractic (DC) degree."

"Subluxation - The proposed standards have removed all use of this term. Parker feels that the inclusion of this term in the examination, treatment, and diagnosis of patients is imperative to the chiropractic profession. It is crucial that t h i s t e r m b e i n c l u d e d t h r o u g h o u t t h e C C E standards, glossary, and policies and procedures."

"Parker is appreciative for the o p p o r t u n i t y t o p r o v i d e feedback and looks forward to reading continual revisions of these s tandards as the college strives to develop ch i roprac t ic educat iona l standards that will serve the b e s t i n t e r e s t o f t h e ch i ropract ic ins t i tu t ions, profession, and those Parker serves."

32Texas Journal of Chiropractic

Happy Holidays!

TCC Donates Lab Equipment to San

Jac CollegeThe Deer Park Broadcaster reports that "as a result of restructuring curriculum, the lab associated with a TCC microbiology course was eliminated, which allowed for the donation of thousands of items, such as test tubes, racks, trays, incubators, culture counters, cabinets, wash bottles, dropper bottles, s p e c i m e n b o w l s , a n d reagents. Dr. Martha Friesen, professor in the division of basic sciences who teaches m i c r o b i o l o g y , h a d accumulated much of the materials and equipment th roughou t 11 years o f instruction at TCC. Friesen previously served as a SJC i n s t r u c t o r t e a c h i n g microbiology, zoology, botany, anatomy and physiology, prior to joining faculty at TCC."

"When we realized we needed to find a good home for some of our microb io logy lab e q u i p m e n t , D r. M a r t h a Friesen quickly suggested our

friends down the road, and it was an easy decision to make the offer," said TCC President Dr. Richard G. Brassard. "We always enjoy opportunities to help out our neighbors, and San Jacinto College has been a great neighbor of ours for many years."

"Texas Chiropractic College and San Jacinto College hold an articulation agreement that creates a seamless transition for students and graduates seeking a Bachelor of Science degree. The chiropractic c o l l e g e u n c o n d i t i o n a l l y accepts SJC students if they meet a cumulative GPA of 3.0; 2.5 GPA on prescribed course work; and 90 undergraduate credit hours, including the prescribed course work."

TCC Opens Digital Imaging Center

Chiroeco.com reports that "on Sept. 14, members of the president's cabinet, Moody Health Center (MHC) interns and radiology staff and faculty unveiled the new digital radiology center at Texas Chiropractic College (TCC). The new equipment, a CR 30-X, allows interns and doctors at MHC to move from the analog film based image processing for X-rays to a digital imaging system."

"Not only will students and the doctors at MHC benefit from this new technology, but also the patients treated at the clinic. The X-ray process will be much quicker saving more

time for treatment and less time waiting on X-rays."

"Digital Radiology allows us to c o m m u n i c a t e interprofessionally with great ease for enhanced patient care and eliminates the need fo r phys ica l s to rage o f radiographs," Dean of Clinics Dr. Rahim Karim said. "Digital Imaging is a key element of an electronic health record system, a future direction for Texas Chiropractic College."

TCC Welcomes New Faculty

MembersChiroeco.com reports that Texas Chiropractic College (TCC) recently welcomed Will Evans, DC, and Stacey Till to its faculty.

"Evans joins the faculty as the director of research," the article reports and "...is a fourth generation chiropractor from Eufaula, Ala. and a 1986 graduate of Logan College of Chiropractic. He has more than 20 years of practice experience and was most recent ly the d i rec tor o f wellness initiatives at Parker College Research Institute."

"Stacey Till joins TCC most recently from Devry University in Phoenix, where she was the director of admissions. Till takes a new position as the director of student services for TCC. She holds a Masters of Science in Education in Counseling and is an NCC

33 Texas Journal of Chiropractic

certified counselor. She will be working closely with students in academic counseling and much more."

Chiropractic Efficacy Studies

The ChiroCode Inst i tute reports that "the past 12 months have been good - v e r y g o o d - f o r t h e chiropractic profession in terms of data supporting the efficacy of chiropractic care."

"the Wellmark pilot study that suggests chiropractic reduces both costs and need for surgery;"

"the Milliman USA analysis that concludes, "[S]pinal patients who seek chiropractic coverage have materially lower health care costs than those who do not";"

"the Consumer Reports reader survey that found "hands-on" therapies, led by chiropractic care, were the top-rated treatments for back p a i n s u f f e r e r s , w i t h chiropractic receiving the highest satisfaction-with-care ratings (significantly higher than MDs);"

"the "Mercer Report" that s u g g e s t s c h i r o p r a c t i c compares favorably to most therapies covered by health benefit plans and is "likely to achieve equal or better health outcomes";"

"and the final report on the Medicare demonstration

project, which notes that 87 percent of patients surveyed gave their DC a satisfaction score of 8 or higher and 56 percent gave a perfect 10."

Reports ChiroCode, "the latest thumbs-up comes courtesy of a survey analysis published in the June 2010 issue of the Journal of the American Board of Family Medicine . The analysis, based on data from the 2002 National Health Interview Survey, revealed that 60 percent of U.S. adults utilizing CAM therapies for back pain reported "a great deal" of benefit. Chiropractic was used most frequently (74 percent of respondents) and had the highest success rate (66 percent reporting significant benefit).""Massage was a distant second in terms of patient use for back pain (22 percent of respondents reporting use) and perceived benefit (56 percent reporting "a great deal" of benefit for their back pain). The percentage of r esponden ts pe rce i v i ng similar benefit for the other CAM the rap ies was as follows: 56 percent for yoga / tai chi / qigong; 42 percent for acupuncture; 32 percent for herbal therapies; and 28 p e r c e n t f o r r e l a x a t i o n techniques."

" T w o f a c t o r s w e r e independently associated with greater perceived benefit from CAM use for back pain: better self-reported health status a n d a n i n d i c a t i o n t h a t ' c o n v e n t i o n a l m e d i c a l

treatment would not help.' The factor most associated with less benefit from CAM for back pain was 'referral by a conventional practitioner.'"

"If there is a difference, and it can be shown that it did impact perceived benefit, it suggests that MDs need to have a better understanding of which CAM providers to refer to for back pain. Given that chiropractic continues to have the highest level of patient satisfaction, MDs who choose other CAM providers would want to ensure that they are not making that c h o i c e b a s e d o n f a l s e assumptions. This difference also might ultimately lead to more specific referral criteria for MDs referring to CAM providers for back pain."

Weight Loss May Release Stored

Toxins"Environmental pollutants trapped in fat cells could be

34Texas Journal of Chiropractic

released back into circulation when people shed a lot of weight, researchers said.”

“According to data collected from among 1,099 adult participants age =40 in the CDC's National Health and Nutrition Examination Survey ( N H A N E S ) , s e r u m c o n c e n t r a t i o n s o f s i x persistent organic pollutants were significantly correlated with weight change..."

"Compared with participants who reported large weight gains over the previous decade, those claiming large losses had serum levels of the six pollutants that were about 50% higher..."

" A s p e r s i s t e n t o r g a n i c p o l l u t a n t s m a i n l y bioaccumulate in adipose tissue, weight change can affect serum concentrations," they explained. Lee and colleagues also noted that some smal l longi tud ina l studies have already found evidence that these chemicals are released from fat tissue after short-term weight losses.The researchers suggested that such re leases may account for some adverse outcomes seen in people undergoing large weight losses, including increased ra tes o f ca rd iovascu la r d isease, dement ia , and death."

"Pathogenesis of some health outcomes may be more affected by the change of adipose tissue mass, while pathogenesis of other health

outcomes may be more affected by the change of serum concentrat ions of persistent organic pollutants, they argued."

" H o w e v e r, p e n d i n g t h e outcome of such fu ture studies, 'researchers and clinicians need to consider lipophilic xenobiotics such as persistent organic pollutants that bioaccumulate in adipose tissue as well as obesity itself when they study or manage obesity issues because such xenobiotics may work against what we generally expect from weight loss or gain."

Rare Fractures Tied to Bone

Drugs"A task force of the American Society of Bone and Mineral Research (ASBMR) is asking the FDA to change the labels of bisphosphonate drugs to include new information about an apparent increased risk of atypical femur fractures in a small number of patients."

"The task force made the recommendation for a label change based on its review of 310 cases of atypical femur fractures. That review...found

that 94% of patients (291) who had experienced such f r a c t u r e s w e r e t a k i n g bisphosphonates for more than five years."

"But the task force also cautioned that atypical femur fractures are rare -- 1% of hip and thigh fractures overall."

"Since they were approved in 1995, millions of people -- mainly women -- have been treated with bisphosphonates and their derivatives, including a lendronate (Fosamax) , i b a n d r o n a t e ( B o n i v a ) , risedronate (Actonel) and zoledronic acid (Zometa), w h i c h r e d u c e b o n e remodeling and resorption."

"Although many people who experience atypical femur fractures have no warning signs, the task force noted that more than half of the patients had reported groin or thigh pain for weeks or months before the fractures actually occurred, and more than a quarter of those who experienced atypical femur fractures in one leg suffered a fracture in the other leg as well."

" W e k n o w t h a t bisphosphonates prevent m a n y , m a n y c o m m o n fractures. For this reason, we want to emphasize that patients should not stop taking these drugs because they are afraid of the much m o r e u n c o m m o n f e m u r fractures. They should talk to their health professionals about their concerns and

35 Texas Journal of Chiropractic

should let them know if they experience any new groin or thigh pain. Patients can also report any side effects of these medications to the FDA by phone or online..."

Radiologists Say Cut Back on

ImagingMedpageToday.com reports "part of the explosion in medical imaging over the past t w o d e c a d e s m a y b e attributable to overutilization, and steps need to be taken to cut back, a review suggested. Initiatives to do that include rewriting the fee-for-service system, curbing physician self-referral practices, and creating e v i d e n c e - b a s e d appropriateness criteria for imaging..."

"Imaging services and their costs have grown at about t w i c e t h e r a t e o f o t h e r technologies in healthcare including lab procedures and pharmaceuticals...In addition to increasing costs, overutilization also exposes the public to unnecessary radiation."

"The authors summarized recommendations from an Augus t 2009 summi t on medical imaging called by the American Board of Radiology Foundation. Delegates from 60 groups, including accreditation o r g a n i z a t i o n s , h o s p i t a l systems, and governmental agencies, outlined key factors influencing the rising costs, as well as steps to mitigate them."

" A l a r g e d r i v e r o f overutilization...is the current fee-for-service model, which reimburses on a per-procedure basis, yielding more revenue f o r b o t h p h y s i c i a n a n d institution the more procedures are done. Real igning the system so that it rewards evidence-based care would be a better alternative..."

"Another cost-driver is the practice of self-referral. When t h e p h y s i c i a n b e n e fi t s financially from the service, re fe r ra l s inc rease . Such referrals present a conflict of interest -- and is banned by Medicare -- and managing the practice would be beneficial.""Defensive medicine also contributes to the problem, as does pat ient demand for imaging studies that they've read or heard about."

"The paper. . .cal led for a national effort to develop e v i d e n c e - b a s e d appropriateness criteria for imaging, so that physicians can make greater use of practice guidelines in requesting and conducting imaging studies."

" I t a lso cal led for better e d u c a t i o n f o r r e f e r r i n g physicians and patients" on the "merits and l imitations of various imaging studies for patients with specific signs and symptoms."

"Physicians should also ask patients about imaging studies they've previously had done, so as not to dupl icate work unnecessarily. Greater sharing

with electronic records could facilitate that..."

"They added that there's also a need for accreditat ion of imaging facilities."

" W h i l e m u c h o f t h i s r e s p o n s i b i l i t y f a l l s o n physicians, radiologists have a role to play too...Often, they fail t o r e v i e w r e q u e s t e d e x a m i n a t i o n s f o r appropriateness before they are conducted or to consult with referring physicians about procedures that are being requested...Many, however, prefer the role of "consultant" rather than "gatekeeper," and few would have time for such a role. Nor do they typically have sufficient information about the patient."

"Still, it "would be appropriate" for radiologists to approve certain studies before they are conducted, including expensive high-tech studies..."

" B e c a u s e many factors contribute to overutilization, the radiology c o m m u n i t y cannot "heal i tse l f , " they wrote. They c a l l e d f o r collaboration w i t h t h e i r "physics and o n c o l o g y c o l l e a g u e s , r e f e r r i n g p h y s i c i a n s , h e a l t h c a r e s e r v i c e

36Texas Journal of Chiropractic

payers, patient and public interest groups, and imaging equipment vendors."

Kaiser Reverses Adverse CMT PolicyThe American Chiropractic Association reports that "Kaiser Permanente Mid Atlantic States and Mid-Atlantic Permanente Medical Group (Kaiser) has suspended its decision to exclude cervical Chiropractic Manipulative Treatment (CMT) from coverage. The change came after the American Chiropractic Association (ACA) outlined in a letter to Kaiser the s c i e n t i fi c e v i d e n c e t h a t documents that cervical spinal manipulation is both clinically effective and safe."

"ACA took swift action in August when it learned that K a i s e r h a d r e v i s e d i t s Chiropract ic Manipulat ion Medical Coverage Policy. Along with the letter outlining the large body of clinical research supporting the effectiveness a n d s a f e t y o f c e r v i c a l manipulation, ACA President Rick McMichael, DC, noted at the time in a public statement that, if allowed to stand, the restriction would be harmful to chi ropract ic pat ients and doctors. "

"Kaiser responded to ACA’s a c t i o n s w i t h a l e t t e r acknowledging that further consideration was needed and stating that the policy would be suspended. The insurer also recognized (in the letter) the

value of keeping its Mid-Atlantic policies consistent with the other Kaiser regions, which do not have such a restriction on CMT services provided by chiropractic physicians."

"ACA will remain in touch with Kaiser to ensure that their future policies are based on the best available evidence. There is just no scientific evidence suggesting that a visit to a chiropractic physician for CMT causes any higher incidence of stroke than a typical visit to a p r i m a r y c a r e m e d i c a l physician.”

Medicare, CALL TO ACTIONThe American Chiropractic Association reports that on June 25, 2010, President Obama signed into law the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.” This law delayed the scheduled 21% Medicare Physician Fee Schedu le dec rease un t i l November 30, 2010. If no Congressional action is taken by November 30, the 21% fee decrease wil l be applied. Fur the r aggrava t ing th i s already dire situation, an additional 6.5 percent fee cut will be applied beginning Jan. 1, 2011, unless Congress steps in. ACA is working with its congressional contacts to halt the implementation of these reductions; however, we need your support.

In 2010, doctors saw Congress repeatedly implement short

term delays in fee cuts. These short term delays caused great uncertainty in the healthcare p rov ide r commun i t y and caused administrative problems within healthcare provider practices. Numerous times in 2010, in an effort to provide Congress with additional time to deliberate, the Centers for M e d i c a r e a n d M e d i c a i d Services (CMS) repeatedly had to hold claims until some sort of final Congressional action on the Medicare Physician Fee Schedule was taken.

C o n g r e s s r e t u r n s t o Washington to start a series of “lame duck” sessions, where vital issues like this need to be addressed. Tell Congress that a long term solution to the problems associated with the Med ica re Phys i c i an Fee Scedule is clearly needed. Please visit the ACA Legislative Action Center so you can quickly and easily create an e-mail message to send to your congressional representatives to urge them to block the implementation of drastic fee cuts and develop a long term solution to the fee schedule problems. Please make your voice heard today on this very important matter.

Texas Journal of Chiropractic 37

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