Texas Chiropractic Association
Texas Journal of Chiropractic
Court s Render in nt Judgme BCE T . v A M T
Volume XXIV, Issue 2 October 2010
Texas Chiropractic Association
CHIROPRACTIC DEFENSE FUND
1122 Colorado Street; Suite 307 Austin, TX 78701 PHONE
The TCA is working to inform you about the assaults of organized medicine against the practice of chiropractic and other healing arts providers. You’ll find links to this news at www.chirotexas.org . Here is what others are saying: •"IF THE TMA PREVAILS, the TMA’s position would make it impossible for a DC to treat patients without an order from a Medical Doctor." --Jennifer Riggs, Attorney •"...physicians, with the help of AMA model legislation, plan to push lawmakers to establish state scope-of-practice review panels to evaluate plans by nonphysician health professionals..." --American Medical Association, through www.amednews.com •"...complains of the 'the refusal of ... ALJ [Administrative Law Judge] and the trial court to consider and decide the [scope-of-practice] issue.'" --Justices PATTERSON, PURYEAR and PEMBERTON; Court of Appeals of Texas, Third District, Austin.
"...the court reserves judgment regarding 'diagnosis' as it relates to scope of practice." --Judge Stephen Yelenosky
"The issue is not the word, but the scope of practice--diagnosis of what and for what purpose." --Judge Stephen Yelenosky
"The TMA [Texas Medical Association] also has constitutional claims pending, specifically, that the Texas Constitution prohibits anyone other than medical doctors from “diagnosing” medical conditions." --Jennifer Riggs, Attorney
The Texas Chiropractic Association has established a Chiropractic Defense Fund to combat these assaults and the American Chiropractic Association deems the case of nationwide importance and is assisting with financial support. Chiropractic must continually prepare to defend our rights from those who would dictate the lives of others.
We urge you to go to www.chirotexas.org and click on the links to donate directly to the Defense Fund. If you prefer, fax or mail this form back to the address above. DATE: _____________ TCA Member No:_______________ OR TX DC License No: ___________ TCA MEMBER NAME: __________________________________ TELEPHONE:_______________ Chiropractic Defense Fund Type of Payment: Visa
Name on Card: ____________________________ Card Number: ___________________________ Credit Card Billing Address:
Exp date: ______ Security code on back ______
Texas Chiropractic Association
Texas Journal of Chiropractic October 2010
Volume XXIV, Issue 2 Texas Journal of Chiropractic
The Ofﬁcial Publication of The Texas Chiropractic Association
1122 Colorado, Suite 307 Austin, TX 78701 Phone: 512 477 9292 Fax: 512 477 9296
E-mail: firstname.lastname@example.org www.chirotexas.org Executive Ofﬁcers
President: Ed Fritsch D.C. President Elect: Jorge Garcia D.C. Secretary: Jack Albracht D.C.
Executive Director: Patte Kent Communications Director: Chris Dalrymple D.C.
Legislative Director: Chip Kent District 1!! District 2!! District 3!! District 4!! District 5!! District 6!! District 7!! District 8!! District 9!! District 10! District 11! District 12!
Board of Directors
Dan Petrowsky D.C. Jon Blackwell D.C. Jason Clemmons D.C. Mark Bronson D.C. Dr. John Quinlan!D.C. Cody Chandler D.C. David King D.C. Robert Hoffman D.C. James Welch D.C. Shane Parker D.C. Ed Kieke D.C. Yvonne Landavazo D.C.
Annual subscription to the Texas Journal of Chiropractic is included in TCA membership dues. Contact the TCA for subscription rates for non members. The print Texas Journal of Chiropractic is published up to four times per year by the Texas Chiropractic Association under the supervision of the TCA Publication Committee. Opinions expressed are those of the contributors and do not necessarily reﬂect the policy of the Texas Chiropractic Association or the Texas Journal of Chiropractic.
Judge Issues Ruling in TMA v TBCE!
Texas Journal of Chiropractic Returns !
What’s on the Web?!
Joint Commission Recognizes Chiropractors as Physicians ! ! ! ! !
TDI Recoups Income Lost by Doctors!
Medical Physicians Average 95% Malpractice Rate!
Congress to Consider D.C.s as Commissioned U.S. Public Service Ofﬁcers! ! !
"The Auditors are Coming, the Auditors are Coming!"! !
TCA District 8 Challenges Other Districts !
NIH Builds Network to Study Health Inequality !
! ! !
10 ! 10
Smartphone Health Apps on Government Website!
Whistle-Blowers Settle for $750K!
Wellness Certiﬁcation for DCs!
Are There Too Many Chiropractors? Could be.!
“On Drugs, the Survey Says…”; Consumer Reports Survey ﬁndings
Preparing the Chiropractic Profession for…! !
Insurance is Being Targeted by Government! !
Setting Stafﬁng Salaries ! !
Meet ACA's New Executive VP!
Chiropractic Efﬁcacy Studies!
The American Drug Culture!
Legal Arguments Move Forward Over Health Reform !!
Electronic Health Records Incentives !
UT Dallas Granted $1.7 Million for Tinnitus Research! !
Medicare Cuts Medical Consultation Codes! !
Other news….. ! !
An "Alternative" for Back Pain?!
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
Judge Issues Ruling in TMA v TBCE Recently the court hearing the case of TMA v TBCE rendered its ﬁnal judgment. The Final Judgment states: “It is therefore ordered that: 1) TMA’s and TMB’s motion for summary judgment challenging [legal citation] concerning manipulation under anesthesia is GRANTED. TBCE’s and TCA’s motion for summary judgment as to manipulation under anesthesia is DENIED.” “2) TMA’s and TMB’s motion for summary judgement challenging [legal citations] concerning needle e l e c t r o m y o g r a p h y, i s GRANTED. TBCE’s and TCA’s motion for summary judgment as to needle electromyography is DENIED.” 4) TMA’s and TMB’s Second Motion for Partial Summary Judgment challenging the scope of diagnosis authorized by [legal citation] is GRANTED.” “It is further ordered:
anesthesia is declared invalid and void. 6) [Legal citation] concerning needle electromyography is declared invalid and void. 7) Legal citation] concerning diagnosis is declared invalid and void.” “It is further ordered: 8 ) All relief not granted in this Judgment is DENIED. 9) This Judgment is ﬁnal...and is appealable.” As the judge notes, this is an appealable ruling. The TCA and other parties involved are taking all strategies into consideration. At this point in time we remind you that ALL speculation as to “what this means” is just that-SPECULATION.
Texas Journal of Chiropractic Returns For many years the extremely high cost of printing and postage prompted the Texas Chiropractic Association to dispense with its print media communications. About three years ago the TCA Board of Directors began to investigate brining the printformat Journal back. About ten months ago the association initiated its communications development project and has produced both web-based and e-mail communications for the profession in Texas. Earlier in 2010 the association even produced a printed and mailed Journal. The result of this project demonstrates that, indeed, the cost of printed and posted communication is exorbitant. But the print-format Journal
The only certainty at this point is that the judge has rendered his ﬁnal decision and now the parties involved must determine whether to appeal and seek legislative remedies or to solely seek legislative remedies. Read more online at www.chirotexas.org
5) [Legal citation] concerning manipulation under 3
Texas Journal of Chiropractic
has long been desired by association members.
mail, or contact the TCA to become a member.
With this in mind we have discovered and implemented our print-format Journal that can be electronically delivered, printed from your own printer, or even have the opportunity to order a “printon-demand” version delivered to your mailbox.
Periodically we may e-mail the Journal directly to nonmembers for whom we have an address, so we encourage all chiropractic professionals to share their e-mail addresses with the TCA.
We realize that these measures are not as convenient as having it delivered for free into your mailbox so that you may thumb through it at your leisure, but we must wisely make use of the resources which are entrusted to us. Since more than 90% of all chiropractors are renewing their chiropractic licenses via the internet we know that at least 90% of the profession has access to a computer with an internet connection. The time has come to make our Journal be as efﬁcient and cost effective as possible. We hope that you will enjoy the print-format Journal that will be distributed approximately every other month.
We will post the print-format Journal as a TCA members only web page at the TCA website where members may go and read the Journal online at their leisure--a virtual library of Journals. If you desire, you may order a Journal printed and delivered to your mailbox for between $5 to $8 at a special link So we’ll e-mail it to you, we’ll put it on our web site, we’ll even provide you a link where you can order it printed for your archives. Anyway you receive it, we hope that you will enjoy the print-format Te x a s Journal of
Chiropractic. We invite you to participate by sharing your own news and views with email@example.com.
What’s on the Web? Oh boy! Have we got a BUNCH of stuff on the web. You can ﬁnd current health care information 24/7/365.
Let’s Start with the Texas Journal of Chiropractic, Online Here you will ﬁnd our online version of this Texas Journal of Chiropractic. It is updated with 3 to 5 articles daily, which means you get reports on, and links to, the most current information available. At the TJOC, Online you will ﬁnd a daily newspaper format in three columns. The far left column is the headline and
There are multiple ways to access the print-journal format. We will e-mail it directly to TCA members who have an e-mail address on ﬁle with us. Please make sure that your e-mail address is current! Just go to www.chirotexas.org, log in with your e-mail address and password and set your e-mail address to your current eTexas Journal of Chiropractic
abstract of the most recent articles posted. Red “latest” ﬂags indicate articles posted within the past 24 hours. In the middle column you will ﬁnd the “Sections of the n e w s p a p e r. ” We h a v e Highlighted news, TCA Association news, Clinical news, World news, Federal Health Reform, Federal news, State news, College news, and Editorials and Opinions sections. In this column you may read the headlines of the recently posted articles. Click on a headline and you will open the article to read. Click on a news section title and you will open that “section of the paper.” In the third column you will ﬁnd a quick “Sections” link to take you directly to the section that interests you most. You will also ﬁnd the top rated stories that others found interesting. You can vote for you favorite stories by giving them a “green thumbs-up” or a “red thumbs-down”. A weather link and our editorial columns are found at the bottom of the home page. But there is more than just news. Click on “Articles by Month” in the top menu and you can look at the articles posted by the month that they were posted. Click on the “Litigation” menu button to be taken directly to the TCA Litigation pages for information on the lawsuits in 5
which our profession is engaged. “TCA Website” will take you directly to www.chirotexas.org the TCA home page.
Calendar displays a LIST format calendar of upcoming events. Districts can submit events for publication using the “submit event” button on the calendar page. All events are reviewed prior to publication. The “Featured News” button on the menu will take you directly back to the front page of the Journal. Wander around the Texas Journal of Chiropractic, Online and enjoy what you ﬁnd. Let us know how we can make it better. In the future there are other features that we may ad. The easiest way to access the TJOC,Online is by going to
w w w. c h i r o t e x a s . o r g a n d clicking on “Online Journal”, but you can go directly by typing (no www.): http:// texasjournalofchiropractic.eznuz.com
What can I ﬁnd at
www.chirotexas.org? www.chirotexas.org, the home website for the TCA, is your one stop to ﬁnd what you need quickly. Here everyone will ﬁnd headline news stories on the front page; news pertaining to litigation events; a calendar of chiropractic events; information on chiropractic, its history, and the TCA and its organization and history; Upcoming Continuing Education Seminars; a “Find a D.C.” locator; information on becoming a TCA member and the various levels available; classiﬁed advertisements; and on-line dues payment forms and donation forms. There is also displayed a list of the Texas Journal of Chiropractic
upcoming events on the calendar for the next two weeks. Want to know whats coming up? Check here. BUT for TCA members who log in using their e-mail address and password there is so much MORE! Members will see a separate menu in the right column with “News from the TCA” which contains upcoming board meetings; the latest changes to the web site (so you can see what has changed since your last visit); and news feeds from other sources-currently health feeds from a wide variety of sources, the Associated Press and the Centers for Disease Control. TCA member obituaries are also listed here. There is a “Litigation Information” menu selection which has the basic information as the public page, but ALSO has pdf ﬁles of the actual court documents that you may download. There are menu selections for the use of the TCA districts, their reports and schedules; for the TCA Departments and their reports and projects. There is even a “TCA Resource Bookshelf” which contains copies of our Constitution; Policy Manual; Code of Ethics; and a project ,currently in development, to excerpt the book The Ofﬁcial History of Chiropractic in Texas by Dr. Walter Rhodes. Texas Journal of Chiropractic
TCA members will also ﬁnd a place for Polls, for Forums and so much more! If you need information, it is most likely found on the website. We know that the site can be made better and more useful and we ask for you to help us make it so. If you see a need for the website please just drop an email to firstname.lastname@example.org and we work to make our website as useful as possible. We encourage: TCA members to submit e d i tor ials for the online Journal and reports for the web sites; TCA district ofﬁcers to report the events, the needs, and the plans of your district to email@example.com so that we may share your needs and ideas with others in the TCA. Please submit your meeting calendar and a brief synopsis of your meeting actions and we’ll polish up a report to your liking. We don’t wish to report your actual minutes, because while our website is “private” it is not “secure” so conﬁdential information should not be published. TCA Department Coordinators should plan to make use of the websites and Journal to share the information that they wish to make public, and to promote their projects and report their actions.
TCA State Directors, be sure to let firstname.lastname@example.org know of your district plans and actions, and of the information that you would like to see reported. TCA Executive Ofﬁcers, we’d love for the membership to get to know you and about your plans for the TCA. Please share your communication with us for publication to the public or to t h e T C A m e m b e r s o n l y. Remember...no conﬁdential information please. We have A LOT to communicate, and we have A LOT of resources to do it! Public Journal Public Website Private Website E-mail communication to members and non-members alike. We have the tools, now tell us what you want to share with the profession and with TCA members.
exas.org t o r i h .c ww Check w ck on “Online and cli our to go to ” l a n r u f Jo ournal o Texas J c, Online acti Chiropr
Joint Commission Recognizes Chiropractors as Physicians The Joint Commission, the largest credentialing body for hospitals and health care organizations in North America, has recently changed its stance on the recognition of chiropractors. This organization now recognizes chiropractors as physicians. This is a major policy change from decades ago, when the commission published an article entitled The Right and Duty of Hospitals to Exclude Doctors of Chiropractic. The Joint Commission (JC) was one of the organizations named in the Wilk antitrust lawsuit for allegedly restricting the profession of chiropractic. The JC is no longer simply a private policeman for the health care industry; it now considers itself a partner in health care. This is evident in its new motto: Helping Health Care Organizations Help Patients. The current list of JCrecognized physicians includes medical doctors, dentists, podiatrists, optometrists and chiropractors. Chiropractors and optometrists are recent additions. The Joint Commission, formerly the Joint Commission 7
provides leadership, guidance and education to the hospitals it credentials. JC values interdisciplinary collaboration greatly and likes to see evidence of patient-focused teamwork.
on Accreditation of Health Care Organizations (JCAHO, pronounced jay-co), is a nonproﬁt private organization that accredits health care organizations. JC credentials 17,000 different health care entities. It provides a feebased credentialing process, in which hospitals participate. Even though submitting an application to this private organization for credentialing is technically voluntary, from a practical perspective, failure to have JC accreditation would very likely lead to the closure of a hospital. Joint Commission credentialing is the standard that all successful hospitals, including government facilities, attain. JC has changed in recent years from being an inspection and credentialing institution to being a proactive partner in improving health care. The new JC identiﬁes particular patient safety needs and educates participating organizations about how to optimize treatment and
The JC has wide-sweeping impact on health care in North America, and inﬂuences Medicare, Medicaid, the DOD, the Veterans Administration, the Public Health Service and virtually every hospital in the United States. This private organization will have a monumental impact in the future on how all the other players in health care perceive and treat chiropractors.
TDI Recoups Income Lost by Doctors The Insurance Committee of t h e Te x a s C h i r o p r a c t i c Association reports that the Te x a s D e p a r t m e n t o f Insurance (TDI) wants to remind you that you may complain about insurance practices, and that the Texas Department of Insurance has a simple web complaint form for all forms of complaints at http://www.tdi.state.tx.us/ consumer/complfrm.html. It was reported by the TDI that "year to date, TDI has received only 20 or so complaints against insurance companies from doctors of chiropractic. Last year’s total was more than 100." Texas Journal of Chiropractic
It was further reported that "complaints year to date with workers compensation have been 59 and resulted in an additional $15,000 paid out to D.C.’s after the complaints." The committee notes that if you experience problems with PIP insurance, complaints need to be ﬁled with the TDI at the above link." If you have a PIP carrier that paid the patient rather than the doctor even though an assignment of proceeds had been ﬁled with the carrier, the TDI solicits your complaints. The Insurance Committee notes that "If you have a complaint, they need to be ﬁled to get them on record." This is something that the TDI is requesting from us, and not something we are making up. It only takes a minute to ﬁle your complaint." You need to ﬁle them by the dozens if you have that many complaints. The insurance industry certainly doesn't hesitate to complain to your regulatory agency.”
Medical Physicians Average 95% Malpractice Rate The American Medical Association (AMA) reports that among physicians surveyed, there was an average of 95 medical liability claims ﬁled for every 100
Texas Journal of Chiropractic
physicians, almost one per physician. The report also found that nearly 61 percent of physicians age 55 and over have been sued, and that the number of claims per 100 physicians was more than ﬁve times greater for general surgeons and obstetricians/ gynecologists than it was for pediatricians and psychiatrists. "Before they reach the age of 40, more than 50 percent of obstetricians/gynecologists have already been sued," the AMA reports. "Ninety percent of general surgeons age 55 and over have been sued." " The vast majority of claims are dropped or decided in favor of physicians the AMA reports. "The number of medical liability claims is not an indication of the frequency of medical error," says the AMA," "as the physician prevails 90 percent of the time in cases that go to trial.” The AMA reports that 65% of the claims are dropped or dismissed. Average defense costs per medical malpractice claim ranges from a low of over $22,000 among claims that are dropped or dismissed to a high of over $100,000 for cases that go to trial, the AMA states.
Congress to Consider D.C.s as Commissioned U.S. Public Service Ofﬁcers The American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC) commended Rep. Gene Green of Texas a n d R e p . L e e Te r r y f o r introducing legislation in the U.S. House of Representatives that calls for the appointment of doctors of chiropractic as ofﬁcers in the U.S. Public Health Service Commissioned Corps.
The bill, H.R. 6032, would include DCs in the Regular Corps and the Ready Reserve Corps, and would require the president, in consultation with the Surgeon General and the 8
U.S. Secretary of Health and Human Services, to appoint no fewer than six DCs to the Commissioned Corps. Although the Commissioned Corps includes representatives from many diverse health care professions, no doctors of chiropractic have ever been appointed to serve. The Commissioned Corps is an elite team of more than 6,000 well-trained, highly qualiﬁed public health professionals dedicated to delivering the nation’s public health promotion and disease prevention programs and advancing public health science. Ofﬁcers in the Corps provide health care services in a variety of locations and venues, including care to members of the U.S. Coast Guard and at community health centers. H.R. 6032 has been referred to the House Committee on Energy and Commerce, which has jurisdiction over the USPHS. Reps. Green and Te r r y s e r v e a s s e n i o r members of that committee. Contact your Representative and urge them to cosponsor H.R. 6032.
"The Auditors are Coming, the Auditors are Coming!" The Centers for Medicare & Medicaid Services is working to expand its recovery audit contractor (RAC) program to all of Medicare and to the Medicaid program by the end of the year. RACs are third-party auditors hired by CMS to comb through Medicare claims to identify improper payments. A permanent, nationwide RAC program is now in operation, but provisions of the new health system reform law mandate a permanent expansion by Dec. 31. RAC executives said they welcomed the additional workload and would be ready to work with CMS on
expanding the p r o g r a m . Auditors are paid based on the dollar amount of any i m p r o p e r payments they uncover. “This may sound selfserving, but we are ready to take on more work,” said Lisa Im, CEO of Performant Financial Corp., a ﬁrm based in Livermore, Calif., that worked with CMS on the demonstration project. A March report from the Government Accountability Ofﬁce concluded that the Medicare agency had used auditors to identify payment system vulnerabilities that lead to overpayments, but it had not implemented corrective actions for 60% of the most signiﬁcant vulnerabilities. Those systemic problems represented $231 million of the roughly $1 billion in improper payments discovered by the contractors. CMS said in response to the report that it was taking steps to resolve coordination issues and address payment system vulnerabilities through the national, permanent RAC program. Congress directed CMS to have permanent RACs in place by 2010 to review Medicare claims from Texas Journal of Chiropractic
all 50 states, a goal the agency said has been met. Every audit ďŹ rm is now required to hire a physician medical director, which she said gives doctors additional assurance that reviews of claims based on medical necessity are handled properly. Physician organizations have been critical of the RAC program. They say it is particularly burdensome for physician practices to comply with the audits even when the reviews turn up little or no evidence of Medicare overpayments. Some physicians said some reviews appeared to be ďŹ shing expeditions.
TCA District 8 Challenges Other Districts TCA District 8 State Director Robb Hoffman recently announced that TCA District 8 has elected Dr. Shawn Isdale to serve as the State Director of District 8. The District also elected a new vice-director, secretary/ treasurer, and three district directors." These names were not immediately available." Dr. Hoffman announced that he will work with Dr. Isdale and make the leadership transition at the Leadership Conference scheduled for October. Texas Journal of Chiropractic
At the election meeting it was also reported that a District 8 member, Dr. John Carlson, challenged the district membership in attendance to pledge to the Legal Defense fund." It is reported that "more than ten" stood to respond to the challenge and that all of those pledges, and more besides, had already been received." Further, District 8 reports that thousands of additional dollars had been donated directly to the litigation fund. District 8 issued a challenge t o o t h e r T C A D i s t r i c t s :" "District 8 just raised [nearly $20,000] with more pledged to be coming in." I'd like the 'big boys' Districts 4, 5 and 11 to double our pledges within this month...beat us for a good cause!"
NIH Builds Network to Study Health Inequality The National Institute of Health has launched a network of professionals from multiple disciplines to identify, understand, and develop models for eliminating health disparities in different population groups. The Network on Inequality, C o m p l e x i t y, a n d H e a l t h (NICH) will apply systems science from scientists in economics, biology, computer science, education, sociology, mathematics, and epidemiology to characterize health inequality. One of the primary goals of the network is to use data pooled from these various
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Upcoming Events COLUMBUS DAY 10.12.2010 - Tuesday TCA Board of Directors Meeting 10.16.2010 - Saturday TCA Leadership Conference 10.16.2010 - Saturday TCA District 7 Meeting 10.23.2010 - Saturday Halloween (All Hallows Eve) 10.31.2010 - Sunday ELECTION DAY--GO VOTE! 11.02.2010 - Tuesday TBCE Committees meet, and Board Meeting 11.04.2010 - Thursday DAYLIGHT SAVINGS--(Fall Back) 11.07.2010 - Sunday Veterans Day 11.11.2010 - Thursday THANKSGIVING WEEKEND 11.25.2010 - Thursday CHRISTMAS HOLIDAYS 12.25.2010 - Saturday Check out the latest current events listings in the calendars at both www.chirotexas.org or at the Texas Journal of Chiropractic, Online at (no w’s) http://
disciplines to ﬁnd potential causes of inequality in patient populations and predict outcomes of possible intervention into the disparity through computer simulations. The NICH is the ﬁrst network to apply systems science to researching disparity in health and is a joint effort between the NIH's Ofﬁce of Behavioral and Social Sciences Research (OBSSR) and the University of Michigan's School of Public Health. Research will explore a number of areas which may have some impact on differences in patient health, including access to programs, environment, education, physiology, and genetics as possible factors inﬂuencing disease development.
Smartphone Health Apps on Government Website The federal government is launching it own online store for smartphone applications. The government's website provides a virtual store of apps or links to mobile websites where smartphone users can receive a variety of information and tools on the go. Apps are available for the iPhone, Android and BlackBerry. In the health and wellness category, there is an
app to calculate body mass index; an app to ﬁnd recalled products, including food and drugs; a mobile web version of Medline Plus; a mobile web version of "My Food-a-Pedia," a calorie counting web tool developed by the Dept. of Agriculture; and an app that allows users to check the UV index and air quality ratings of their locations (apps.usa.gov/). The government is soliciting suggestions for new apps to offer the USA.gov website links users to the appropriate app store or mobile website. Most are free, but some cost a small fee. This is the second app store project launched by the government.
Whistle-Blowers Settle for $750K Two nurses who lost their hospital jobs and endured criminal prosecution after reporting a physician to the Texas Medical Board over patient safety concerns will each receive $375,000 in a settlement of a federal lawsuit they had ﬁled against their f o r m e r e m p l o y e r, t h e physician, and other parties. In Kermit, Texas, with a population of 5714 and the county seat of Winkler County, last year two employees of Winkler County Memorial Hospital, sent an anonymous letter along with patient ﬁles to the Texas Medical Board alleging that another hospital Texas Journal of Chiropractic
employee, a medical doctor, was practicing substandard medicine. The nurses were charged in a state court with felony misuse of ofﬁcial information after the sheriff, at the medical doctors request, managed to trace the anonymous letter back to the two employees. The hospital then ﬁred both nurses. The local prosecutor dropped the criminal charge against one but took the case against the other to trial contending that she had reported the doctor out of personal animosity. The jury found the employee not guilty in less than 1 hour. The two nurses then sued the medical doctor, their former employer and its administrator, Winkler County, the county sheriff, and other government ofﬁcials in federal court. The nurses contended that the defendants had subjected them to malicious prosecution and violated their free speech rights as well as the state whistleblower law. All parties to the federal lawsuit settled out of court. The defendants will pay $750,000 — or $375,000 apiece — to the two nurses, who in turn will dismiss all claims against the defendants. The settlement agreement stipulates that nothing in it shall be construed as any admission of fact or liability. Texas Journal of Chiropractic
The Texas Department of State Health Services has proposed a $15,850 ﬁne on Winkler County Memorial Hospital for related violations. The medical doctor still has to deal with the Texas Medical Board, who charged the doctor with poor medical judgment, nontherapeutic prescribing, failure to maintain adequate records, overbilling, witness intimidation, and other violations.
Wellness Certiﬁcation for DCs The American Chiropractic Association (ACA) has partnered with the National Wellness Institute (NWI) to offer a wellness certiﬁcation program for doctors of chiropractic in 2011. After completing the 40-hour program, participants can become Certiﬁed Chiropractic Wellness Specialists through NWI, a well-respected organization both inside and outside of the chiropractic profession. The certiﬁcation will last ﬁve years and will also include a membership to NWI. The program consists of four, 10-hour modules and will integrate principles of wellness coaching, health promotion and disease prevention into current practices.
Founded in 1977, the National Wellness Institute Inc. (NWI) works to promote the understanding of the dynamic factors that contribute to health and well-being as they emerge through research and practice. Contact Marie Escobar at email@example.com for more details.
Are There Too Many Chiropractors? Could be. Historically our profession has held that there are “not too many chiropractic doctors because there are still too few chiropractors to service the un-chiropractic population.” While there is a signiﬁcant percentage of the population who do not entrust their health care to the chiropractic doctors. A new study seems to indicate otherwise. Based upon an August 2010 study of California chiropractors, it was found that 20 to 25% are leaving practice within ten years of graduation. The authors of the report believe that an oversupply of chiropractors and decreased income are two of the many factors that contribute to the exodus. The found that from 1970 to 1998 there was an increase in the number of active 12
California licenses from 4,274 to 11,637. Said the authors: “the 170% growth rate in chiropractors during the study far exceeds the 65.1% increase in residential population.” Other regional studies in North America also document the direct impact of supply on income. A study of Canadian chiropractors in Ontario shows that accompanying a substantial increase in the number of chiropractors there was a dramatic drop in income. This research discovered a 50% drop in annual income from 2002-2003. Overall the data that does exist suggests a decline in both gross and net chiropractic incomes. In California the report notes that "the 10-year attrition rate rose from 10% for those graduates licensed in 1970 to a peak of 27.8% in 1991. The 10-year attrition rate has since remained between 20-25% for the doctors licensed between 1992-1998." For comparison the study report that the annual attrition from emergency medicine clinical practice. The overall annual attrition rate from emergency medicine clinical practice, including estimated death rate, was approximately 1.7%. Another paper evaluates the chiropractic manpower status in Ontario, Canada. "Between 1990 and 2004, the total 13
number of chiropractic registrants in Ontario doubled, with an average annual rate of growth of about 5.4%; however, recent data suggest that the number of nonpracticing chiropractors is increasing, whereas the number of new registrants is decreasing. The rate of applications to a chiropractic institution rose sharply and peaked in 1996-1997, thereafter declining but leveling off in 2002-2003. Despite the continued growth in the number of practicing chiropractors, the utilization of chiropractic services among the Ontario population has remained relatively stable, resulting in a decline in the average net annual incomes adjusted for inﬂation to 2002 dollars. Says this study: "our results support previous reports projecting an oversupply of chiropractors and suggest that the chiropractic profession in Ontario is in long-run oversupply. Competition from other providers, changing population demographics, and the recent loss of public funding for services may present signiﬁcant future challenges to current practitioners. Opportunities related to participation in multidisciplinary environments and accessing unmet population health needs may contribute to inﬂuencing the demand for chiropractic services. A concerted effort by professional and educational institutions is required."
“On Drugs, the Survey Says…”; Consumer Reports Survey ﬁndings
Many patients taking prescription drugs believe that pharmaceutical companies have too much inﬂuence over their physicians' prescribing practices, according to a new survey reported by Consumer Reports. They found that the majority of those currently taking medications -- 69% -- had such concerns." About half of the medication-users believed that their doctors were too eager to write a prescription when other non pharmacological options are available. Almost half of the patients taking medications who were surveyed (47%) thought that gifts from pharmaceutical companies inﬂuenced their doctor's choice of drugs. Most of them (81%) were concerned that physicians Texas Journal of Chiropractic
engaged in practices that resulted in being rewarded by pharmaceutical companies for writing lots of prescriptions for the company's drugs. Surveyed patients were also worried about their physicians acting as paid spokespersons for drug companies (72%), speaking at industry conferences (61%), and getting free meals (58%). Says the report, "their fears may not be unfounded -given that pharmaceutical companies are increasingly targeting primary care doctors rather than high-proﬁle academicians to spread the word about their drugs....pharmaceutical companies are increasingly turning to eloquent community physicians, partly because academic doctors 'are asking too many questions.' ...the physician "who works in the community may not be as informed about the drugs and might be more willing to follow the line of the pharmaceutical company in telling others how to use those drugs." "Indeed, 66% of patients reported receiving free samples of prescription medications, and 41% felt their doctors prescribed newer and more expensive drugs over proven generics." The survey found that monthly out-of-pocket patient spending is around $68 -- and 14% of patients spend more than $100 of their own money Texas Journal of Chiropractic
every month on prescription drugs.
practice for chiropractic physicians."
"More than half of patients feel that their doctors don't consider their ability to pay when they prescribe, and 64% of survey respondents didn't learn how much the prescription would cost them until they picked it up at the pharmacy. Only 6% were informed of the costs of prescription drugs while in their doctor's ofﬁce.”
"They seek new laws and regulations that would allow chiropractic physicians to prescribe a limited range of medications in order to help their patients in a more c o m p r e h e n s i v e m a n n e r. These include medications that are common to conditions frequently seen by chiropractic physicians, such as anti-inﬂammatory drugs and drugs that treat ailments such as osteoporosis and arthritis."
"About 20% of patients reported asking their doctor for a drug they saw advertised on television. And physicians complied with those requests 59% of the time." The article notes that it's "reasonable for patients to ask their physicians what, if any, arrangements they have with outside vendors, and what that relationship is. If the physician will not discuss it then it is time to ﬁnd another physician," says the report.
Preparing the Chiropractic Profession for... Chiropractic Economics recently reported that "the United States is experiencing a shortage of primary care family doctors. That’s why more than the last eight to 10 years, chiropractic associations in states with severe shortages of primary care physicians have sought to expand the scope of
"By granting them the ability to prescribe select medications, specially trained and licensed DCs can help a signiﬁcant number of patients who would otherwise be forced to seek simultaneous care from an already overburdened and limited pool of MDs in general practice." The article reports that some state chiropractic associations have contacted experts at National University of Health Sciences (NUHS) in Lombard, Ill. and asked them to assess what additional training would be required to prepare chiropractic physicians to have a license to prescribe from a limited formulary of drugs. Says the article, "top NUHS faculty in pharmacology and chiropractic medicine examined and compared curricula from allopathic medical schools in addition to a wide range of medical 14
specialty schools, such as: osteopathic medical schools, schools of podiatry, dentistry, psychology and those training nurse practitioners. Each of these professions has also recently been granted authority to prescribe medications from a limited formulary." "NUHS determined that chiropractic physicians would need 90 hours of pharmacology in addition to the prerequisite physiology and biochemistry courses already required by accredited chiropractic education programs. (The DC program at NUHS already provides students with these 90 hours in pharmacology, but such requirements are not representative of all chiropractic institutions.)" NUHS has launched an accredited masters of science degree program in advanced clinical practice, in anticipation that an expanded scope of chiropractic care would be part of the future. This program incorporates the 90 hours of advanced pharmacology coursework as
part of its degree requirements. New Mexico, has already passed new regulations allowing chiropractic physicians with the right licensure qualiﬁcations to prescribe drugs from a limited formulary. The New Mexico Chiropractic Association asked NUHS if it would be willing to offer post-graduate coursework in Albuquerque delivering a 90-hour program in pharmacology to chiropractic physicians wanting to practice under the new expanded scope of care. At the end of each module, the physicians must pass an e x a m i n a t i o n ." At the conclusion of the course, they must also pass a comprehensive examination given by the state association in order to be eligible to apply for a license and a DEA number. The physicians in the New Mexico program also receive training in injectable nutrients and drugs as more states are thinking about expanding the scope of practice for chiropractic physicians.
TCA NEEDS YOUR CURRENT E-MAIL ADDRESS Every few weeks the TCA regularly sends updates, headline news and the Texas Journal of Chiropractic via e-mail. Please insure that the TCA has your CURRENT e-mail address
“Chiropractic physicians are already licensed as primary care doctors in most states,” the article reports. “As health care policy-makers wrestle with the scarcity of general practice physicians, expanding the scope of chiropractic care to qualiﬁed chiropractic physicians makes good economic and strategic sense….we anticipate that more states will see the wisdom in this as well.”
Insurance is Being Targeted by Government The American Medical Association reports that "as part of health system reform, insurance companies are facing limits on how much they can deduct executive pay from their taxes..." Until the enactment of the Health Reform measures passed by Congress health plans, like other companies, could deduct up to $1 million in salaries paid to top executives, with the Internal Revenue Service not touching stock options, deferred compensation and other noncash payments. Now, however, health plans can deduct only the ﬁrst $500,000 of what they pay executives and this now includes all the compensation, not just the cash part. In an exempliﬁcation of the extreme nature of insurance CEO compensation “the new
Texas Journal of Chiropractic
rule is expected to raise $651 million in the next 10 years for Medicare." That’s 65.1 million dollars per year folks. The top 10 publicly traded health plans paid out $228.1 million in 2009 compensation to their chief executives, up from $85.8 million in 2008, according to a report issued in August by Health Care for America Now, a health system reform advocacy group. That excluded stock option exercises, such as the $98.5 million earned in such a manner in 2009 by the UnitedHealth Group CEO. The new rule also applies to private insurers, and not just publicly traded companies. “The deduction limits apply to any company that collects health insurance premiums between 2010 and 2012. In 2013 and beyond, the limits apply to any company that collects 25% or more of its premiums for 'minimum essential coverage'." Not only will their compensation be affected, but starting next year, insurers will be required to spend 80% of the premiums they collect for individual and small-group policies on patient care and quality improvement -- 85% of premiums for large-group policies. If plans have not spent enough premium dollars on patient care, they will be required by the health reform Texas Journal of Chiropractic
law to provide rebates to subscribers. Health plans would not be able to consider fraud prevention and detection efforts when it calculates its medical expenses. In addition it has been proposed to exclude the costs of concurrent and retrospective utilization r e v i e w, w h i c h r e q u i r e s physicians or hospital staff to relay clinical information during or after the active management of patient conditions to insurers, who then determine if the administered care is covered. Prospective utilization review still would be considered a medical expense.
Setting Stafﬁng Salaries In the coming years it is expected that medical practices will step up their hiring. Says the AMA: "fair compensation should not be the only factor physicians consider when determining salary and beneﬁts.... Practices must determine a ﬁgure that ensures employee retention and offers ﬂexibility to allow for future raises." Experts suggest several steps when determining an initial compensation package and possible pay raises. Practice managers need to contemplate the roles and responsibilities of the various
team members, because not all jobs are designed and created equal. Experts suggest stepping back and writing a job description for each stafﬁng position. More than a job title and a list of duties and goals for a position, these should be the main tool that will be used to determine a salary. The next step is to assign a salary range to a job description by assessing data from various consulting ﬁrms and professional organizations. Degrees and years of experience also may affect how much a staffer is paid. Experts caution not to set the initial salary too high. This can reduce future raises, negatively affecting an employee's motivation to perform well. But likewise, compensation should not be set too low, because this makes it more likely that employees will ﬁnd another job. Job mobility is expected to increase when the economy improves. Practices should consider the beneﬁts they offer. Beneﬁts ar e gener ally 3 0% of a compensation package. According to the survey by the Professional Assn. of Health Care Ofﬁce Management, 91% of practices provided employees with health 16
insurance, but only 41% supplied disability coverage. Less-common beneﬁts include cell phones, gasoline allowances, parking spaces and memberships to a warehouse club. To make it more likely that employees will recognize the value of their beneﬁts as well as their salaries, issue annual statements documenting the cost of paid time off, health insurance and other perks.
Meet ACA's New Executive VP The American Chiropractic Association (ACA) recently hired William K. O’Connell to serve as its Executive Vice President. “ACA’s board of governors, its staff, and grass roots support of chiropractors throughout the country have worked for years on the inclusion of chiropractic as an equal m e m b e r o f t h e n a t i o n ’s healthcare providers,” says O’Connell. “What has been achieved is a major step forward, but anyone familiar with the regulatory process understands, once legislation 17
becomes law, this is just the beginning of the beginning. In fact, the real work now begins. And it may take up to six years to sort things out as all the various professional disciplines in the healthcare community vie for ensuring they beneﬁt most by how the regulations of the law are promulgated,��� says O’Connell.
and then executive director, government affairs at the National Safety Council."
O'Connell's qualiﬁcations include:
“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.”
• "He is an undergraduate of the University of California at Berkeley, has a master’s degree in business administration from the University of San Francisco, and a master’s degree in public administration from Northern Illinois University." • "He was the assistant executive director for the American Dietetic Association in Chicago for six years." • "He then went on to be the deputy director and chief ﬁnancial ofﬁcer for the American Osteopathic Association (also in Chicago) for 12 years." • "He became the number two executive ofﬁcer for the American Board of 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,
“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.
At Berkeley, O’Connell studied cultural anthropology while living in Oakland and 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 with pharmaceutical companies.
Chiropractic Efﬁcacy Studies The past 12 months have been very good in demonstrating the efﬁcacy of chiropractic care. We encourage you to read this story in the Texas Journal of Chiropractic, Online in order to view the active links to these studies. The Wellmark pilot study suggests that chiropractic Texas Journal of Chiropractic
reduces both costs and need for surgery.
highest success rate (66 percent reporting signiﬁcant beneﬁt).
The Milliman USA analysis concludes, "[S]pinal patients who seek chiropractic coverage have materially lower health care costs than those who do not."
Massage therapy 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).
A Consumer Reports reader survey found "hands-on" therapies, led by chiropractic care, were the top-rated treatments for back pain sufferers, with chiropractic receiving the highest satisfaction-with-care ratings (signiﬁcantly higher than MDs).
The percentage of respondents perceiving similar beneﬁt for the other CAM therapies was as follows: 56 percent for yoga / tai chi / qigong; 42 percent for acupuncture; 32 percent for herbal therapies; and 28 percent for relaxation techniques."
The "Mercer Report" suggests chiropractic compares favorably to most therapies covered by health beneﬁt plans and is "likely to achieve equal or better health outcomes." The ﬁnal report on the Medicare demonstration project notes that 87 percent of patients surveyed gave their DC a satisfaction score of 8 or higher and 56 percent gave a perfect 10. The June 2010 issue of the Journal of the American Board of Family Medicine published and analysis, based on data from the 2002 National Health Interview Survey, that 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 Texas Journal of Chiropractic
Two factors were associated with greater perceived beneﬁt from CAM use for back pain: 1) better self-reported health status and 2) an indication that 'conventional medical treatment would not help.' The factor most associated with less beneﬁt from CAM for back pain was “referral by a conventional practitioner.” Given that chiropractic continues to have the highest level of patient satisfaction, those who choose CAM providers will want to ensure that they are not making that choice based on false assumptions.
The TCA Leadership Conference "
Austin Holiday Inn Towne Lake 20 N. IH 35, Austin, Tx 78701 888-615-0509. State Directors are expected to attend."Vice Directors and others are encouraged to attend." Litigative, Legislative, and Positive Public Relations training will be offered. Friday, October 15, 2010 6:00 p.m." Meet in hotel lobby." 6:30 p.m." Dinner at a location to be announced " Saturday, October 16, 2010 8:00 a.m. to 10:00 a.m. --" TCA Board Meeting 10:00 a.m. to 5:00 p.m." --" Leadership Conference 18
The American Drug Culture Nearly half of all Americans -48% -- took at least one prescription drug in a onemonth period in 2007-2008. "Among those 60 and older, 88.4% took at least one Rx medication, as did nearly a quarter of those under 12 (22.4%)...The 10-year jump was a signiﬁcant increase that translates to "millions of people..." The report found that the percentage of those who use two or more prescription drugs rose from 25% to 31% over the decade from 1999 to 2008, and those using ﬁve or more jumped from 6% to 11%." More than three-quarters of those 60 and older used two or more prescription drugs and 36.7% took ﬁve or more. The report found that: "certain drugs were used more commonly by different age groups. Among children younger than 12, 5.7% were on bronchodilators for asthma. A similar percentage of those 12 to 19 were on central nervous system drugs, most often to treat attention deﬁcit hyperactivity disorder (ADHD)." "For those 20 to 59, antidepressants were the most commonly prescribed drug, with 10.8% of this population taking them, followed closely by analgesics 19
(10.1%) and cholesterollowering agents (8.4%)." "That latter class was the most commonly taken by those 60 and older, with 44.9% on a lipid-lowering drug. Beta-blockers and diuretics to treat high blood pressure and heart disease ranked second and third, respectively (26.4% and 19.9%)." The researchers also found that women were more likely to use prescription drugs than men -- “53.3% compared with 43.2%." "Overall, total spending on prescription drugs in the U.S. was $234 billion in 2008 -more than double the amount spent in 1999, the researchers said." Find the source of this report in the Te x a s Journal of Chiropractic, Online under the article of the same name.
Legal Arguments Move Forward Over Health Reform A U.S. judge has ruled that the state of Virginia could proceed with its challenge to the new health reform law. U.S. District Judge Henry Hudson refused to dismiss the state's lawsuit, which argued the requirement that its residents must have health
insurance is unconstitutional and conﬂicts with state law. Hudson, who noted that his ruling was only an initial step, decided the issue the state raised -- “whether forcing residents to buy something, namely healthcare, is constitutional -- had not been fully tested in court and was ripe for review.” “The congressional enactment under review -- the Minimum Essential Coverage Provision -- literally forges new ground and extends (the U.S. Constitution's) Commerce Clause powers beyond its current high watermark," Hudson said. Virginia's lawsuit is one of several arguing that it is an unprecedented seizure of power by the federal government. Virginia also argued that since the Constitution does not allow the government to force a person to purchase something, the federal government is powerless to Texas Journal of Chiropractic
levy a penalty or tax for failing to buy healthcare coverage. The Obama administration has countered that the government can levy taxes and that the Constitution places the federal government's powers over the states. It has also said that Virginia does not have legal standing to sue on behalf of its citizens. Legal analysts say there is a good possibility the matter will reach the U.S. Supreme Court, but most say there is only a slim chance the states would prevail.
Electronic Health Records Incentives Early in 2009, Congress passed the American Recovery and Reinvestment Act (ARRA) which created a $19 billion subsidy program to help physicians and hospitals purchase electronic health records (EHR) systems. In order for physicians to receive the Medicare incentive payments they must be a "meaningful user" of a "certiﬁed" EHR. For Medicare, physicians are eligible for up to $44,000 over ﬁve years starting in 2011 and incentives are predicated on 75 percent of the physician's Medicare allowed Part B charges. Texas Journal of Chiropractic
For Medicaid, the incentives are based upon a physician's patient volume. For most physicians a Medicaid patient volume of at least 30 percent is required; for pediatricians it is 20 percent. Under the Medicaid program, physicians are eligible for up to $63,750 over six years beginning in 2011. So how does one go about acquiring a "government approved" Electronic Health Record system and qualify for the up to $44,000 reimbursement?" If DCs were to apply today, none would actually qualify given their current health information software. In a recent Chiropractic Economics article "Roger Gooden, owner of Softworx Solutions, says 'Many chiropractors may ﬁnd this incentive to be more than they bargained for simply because they will be required to complete excess work they would otherwise be unaccustomed to doing. 'Does the chiropractor collect vitals (height, weight, blood pressure, etc.) on a consistent basis? How about recording current prescriptions or medication allergies? These are some of the items that a chiropractic ofﬁce will be required to perform to be considered for the collection of the $44,000. For some ofﬁces, the extra burden may not be worthwhile. It may require hiring an additional
staff person that offsets any gains.'” "Ken Schenley, vice president of Quick Notes Inc., agrees....'The chiropractor will have to meet meaningful use, and there are 15 core items and another ﬁve menu items that will be required. Many of these items fall outside the scope of practice for a chiropractor. The practice will have to purchase a certiﬁed EHR to be able to request the incentive, at a very high ﬁnancial cost, even though many of the features will be essentially unused." "Chiropractors must use a certiﬁed EHR solution, manage Medicare payments, and complete an application for the incentive with CMS,” says Mark Firmin, senior vice president for ACOM Health. “An EHR solution must be certiﬁed by a testing agency that has, itself, been accredited by the government. We understand that two such entities are in the review process at this time. We expect these testing agencies to begin testing and certifying EHR solutions in late summer and early fall.” "Paul B. Bindell, DC, president of Life Systems Software goes on to say, 'To qualify for the maximum stimulus income, you must have certiﬁed EHR software in place by the end of 2010.'” "As for time, Greenwood says it could take three to six 20
months to incorporate a full digital solution from scratch." “ U n f o r t u n a t e l y, n o t a l l chiropractic ofﬁces will qualify for the incentive program. If your ofﬁce is a cash-only ofﬁce and you do not accept Medicare patients, then you would not qualify for the program under the guidelines,” says Gooden. “The incentive program payments are only available through Medicare and Medicaid programs; however, chiropractors only fall under the Medicare portion." “The payments are actually a bonus based on the billings that you do for these types of patients. To collect the full amount, a chiropractic ofﬁce must bill a minimum of $24,000 to Medicare to reach the maximum potential incentive money.” “The reason a DC must accept Medicare to qualify is because the amount a DC receives is based on 75 percent of their Medicareallowed charges for a given period of time,” says Kraus. “The maximum cap is $18,000 for 2011, followed by $12,000 for 2012, and continuing to decrease each of the following years. The total maximum amount available over ﬁve years is $44,000.” "Both Norworth and Short, however, say cash-based practices may not totally be left out. 'By law, ‘cash’ practices must still submit 21
Medicare claims for patients with Medicare (to ensure those patients are reimbursed),” says Norworth. 'Thus, with regard to this program, there’s little difference between a practice that bills payers and one that bills patients.' Short agrees, saying “there is no provision that a chiropractor must be a p a rti cipating pr ovider to register for the EHR incentive program. As such, the cash p ra ctice that is tr eating Medicare beneﬁciaries on a nonparticipating basis should qualify.'” "At this point, no company has certiﬁed software, so be aware of any software company that claims they do." “If anyone is claiming that they already have the certiﬁcation, it is not true,” says Bindell. “The ONC [Ofﬁce of the National Coordinator] is now taking applications from companies that want to become software certiﬁcation agents. Qualifying EHR certiﬁcation will happen only later this year.” "For doctors who submit Medicare, payments can be expected as early as May 2 0 11 f o r t h e i n c e n t i v e p r o g r a m . To r e c e i v e payments, however, certain c r i t e r i a m u s t b e m e t ." According to Gooden, you must “register with the EHR Incentive Program website and be enrolled in the Medicare Fee-For-Service (FFS) or Medicare Advantage programs. You must have a
National Provider Identiﬁer (NPI) for your registration and be using a certiﬁed EHR technology to demonstrate m e a n i n g f u l u s e . F i n a l l y, attestation of Clinical Quality Measures has to be completed beginning in 2011.” For more information see: h t t p : / / w w w. c h i r o e c o . c o m / chiropractic/news/10111/1424/The$44,000-Question/
CMS is the federal agency establishing these incentive programs. The CMS Web site is the ofﬁcial federal source for facts about the Medicare and Medicaid EHR incentive programs. Get the facts from the federal source at: http://www.cms.gov/ EHRIncentivePrograms/
Parker College Opens Flower Mound Wellness Center Parker College of Chiropractic ofﬁcially opened their new state-of-the art 5,836 sq. ft. Chiropractic Wellness Center in Flower Mound, Texas on August 10. “A lot of visualizing, research and planning went into the reality of the Wellness Center,” said Dr. Mancini. " “This center represents three years of determining what is not only best for the citizens of Flower Mound, but in developing what we hope might be a prototype of" Texas Journal of Chiropractic
chiropractic wellness centers that provide a real-world learning experience for the students we serve,” says Dr. Mancini. " Money Magazine ranked Flower Mound as the 'Number One Place to Live In Texas.' Centrally located, it is geographically close to DFW International Airport and the Parker Campus. "" Not only does the Wellness Center have the latest in practice design and technology it is staffed with two doctors of chiropractic each with 20 years of experience. " The center will be led by Drs. Keith Johnson and Daniel Kurth. Dr. Johnson is a current resident of Flower Mound who practiced in the community for over 25 years before joining Parker College. " With over 20 years of e x p e r i e n c e , D r. K u r t h practiced in both Denver and Iowa before moving his family to Dallas , Texas , where he has been a member of the Parker team since 1997." " “It was our intent to change the paradigm of care,” says D r. M a n c i n i . " “ U s u a l l y chiropractic colleges operate outpatient centers that are overseen by doctors of chiropractic and where ﬁnalyear chiropractic students administer the care. Here we are ﬂipping the model for a different approach. Our doctors...care for the patients and our students assist.” Texas Journal of Chiropractic
demonstrating the example. This leadership spirit inspired others to get involved in CAT, and the CAT executive board is extremely grateful to each of their contributions to the chiropractic profession and to this expansion project for chiropractic’s future.”
" “In addition, the Wellness Center permits our ﬁnal-year students to become experienced in all aspects of running a chiropractic practice.”
Disaster Relief Organization Honors Dr. Mancini An emergency chiropractic support team, "the Chiropractic Action Team (CAT)...created to help relief workers in disaster situations, honored Dr. Fabrizio Mancini, president of Parker College of Chiropractic, with the 2010 CAT I Care Award during the Parker Seminar in Rome, Italy." The award was presented "for making a difference and setting an example for others in the profession." Dr. Jennifer Lovern, founder of CAT said that "by stepping up to the plate, [award recipients] lead not by force, but by living and
"Chiropractic care is a proven contributor of emergency relief operations for catastrophes and natural disasters. Continued emergency response experiences and disaster appeals occurring in so many countries have shown the necessity and the evolution of a new branch of the profession to enter into the realm of International Disaster Response. Spontaneous groups of dedicated doctors formed teams ready to serve..." "...several steps have already occurred to integrate the profession into the disaster relief arena. In 2009, CAT created a working relationship with the Italian Red Cross. Shortly after, Lovern met with the Dr. Mancini to discuss a proposal and plan. They agreed upon the creation of a Disaster Response Network (DRN), which allows the profession to equip our colleagues and students to deliver the most beneﬁcial procedures before, during, and after an emergency." "The DRN represents an organizational database of pre-screened chiropractors 22
who have the desire to serve in the emergency care arena."
a d m i n i s t r a t o r s o f Te x a s Chiropractic College (TCC) to ofﬁcially kick off the grand opening of the Erchonia Laser Healthcare Center at TCC’s Moody Health Center (MHC)."
“As we serve over 30 million patients in the United States alone, we would like to propose a long term collaboration involving disaster preparedness, blood collection, fundraising initiatives, and community education and outreach,” said Mancini.
Parker College Awards Research Grants "Parker College of Chiropractic has awarded three chiropractic research grants of $4,000 each. The grant recipients include Cleveland Chiropractic College, University of Kansas Medical Center, Southern California University of Health Sciences, and Osher Clinical Center at Brigham and Women’s Hospital." "For the past two years, Parker has generated research funds for the 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 scientiﬁc knowledge of chiropractic." " "Cleveland Chiropractic College and the University of Kansas Medical Center will 23
research the central effects of spinal manipulation in patients with chronic low back pain." "Southern California University of Health Sciences will research the effect of an integrative approach of chiropractic and acupuncture care on low back pain." "The Osher Clinical Center at Brigham and Women’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."
TCC Opens Laser Healthcare Center "the president of Erchonia Medical...recently joined the faculty, staff, students and
"The Erchonia Laser Healthcare Center is MHC’s newly renovated rehab room. Erchonia Medical, a leader in medical laser products based i n M c K i n n e y, Te x a s , generously donated several of their lasers and also the funds needed to expand and renovate the rehab facility." "...These lasers will allow our students to use the latest technologies to treat their patients at the Moody Health Center, “ TCC President Richard G. Brassard said. “At TCC, we strive to produce the best doctors of chiropractic possible, and by partnering with Erchonia Medical, we are providing an opportunity to those students to learn new techniques.” "The lasers will be used by doctors and their interns at TCC's outpatient clinic, MHC. Lasers are commonly used to treat pain in both acute and chronic musculoskeletal conditions."
TCC Honors Dr. Dorrie Talmage As Te a c h e r o f t h e Year "Dr. Dorrie Talmage was named the Texas Chiropractic Texas Journal of Chiropractic
College Faculty Member of the Year....Dr. Talmage has been a member of the TCC faculty since August 2007, teaching orthopedics and case management. She is cochair of the Quality Enhancement Plan Committee at TCC and is formerly the associate editor of the Journal of Chiropractic Education." "After earning her Doctor of Chiropractic degree April 1988 from Los Angeles College of Chiropractic Dr. Talmage went on to receive a master's degree in medical education from the University of Southern California and a diplomate in chiropractic orthopedics. Additionally, she just completed her bachelor's of science degree in nursing from Hardin Simmons University. Dr. Talmage has been teaching since 1991."
TCC Announces New Book Award "Texas Chiropractic College (TCC) is proud to announce the establishment of the Dr. Sandra K. Hughes Book Award, sponsored by Dr. Hughes, a TCC alumna, and her husband, and TCC Board of Regent member, Ken Cauthorn. The $500 award will be available beginning with the fall 2010 entering class." "This new award will be o ff e r e d t o o n e e n t e r i n g student at the beginning of each trimester. Selection for the award will be based on Texas Journal of Chiropractic
academic achievement with a minimum eligibility of a 3.25 cumulative grade point average at the time of entrance. An essay from the applicants on why they deserve the award is also required for consideration." "Hughes graduated from TCC in 1994 and opened a practice in El Paso, where she worked for seven years while also teaching high school science. She returned to Houston in 2001, and returned to her alma mater in 2003 as the director of admissions. She left admissions in 2009 to return to teaching high school physics. Cauthorn is the president of Hampton Tax Group. His business works primarily with t h e h e a l t h c a r e i n d u s t r y, especially with doctors of chiropractic, helping small businesses with tax and ﬁnancial planning."
TCC and Lee College Sign Transfer Agreement Texas Chiropractic College (TCC) has signed an articulation agreement with Lee College so that their
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students may more easily enroll in the Doctor of Chiropractic Program. Now Lee College students who earn 90 undergraduate credit hours and maintain a minimum grade point average of 2.5 overall, including a 2.5 in speciﬁc science prerequisite courses, will automatically qualify for TCC admission. "In addition to completing various prerequisite courses, applicants for the TCC program must demonstrate a commitment to the study of chiropractic care and maintain ethical and moral standards required for the profession," TCC reports.
An "Alternative" for Back Pain? Dr. Patrick Massey of the Chicago Daily Herald recently published a column and points out several interesting facts: •
"Nontraditional" medicine is the most common form of medical therapy used for back pain.
The most common "nontraditional" therapy used was chiropractic, and it achieved the best response among patients.
Over half of the patients using "nontraditional" medicine also made use of traditional medicine. 24
Traditional medicine is more expensive than "nontraditional" medicine.
However, the differences between the various methods were very small."
Patients want the best of ALL therapies regardless of their origins.
"What was interesting is that 53 percent of the respondents used traditional medicine and nontraditional medicine together suggesting a perception that both forms of medicine were beneﬁcial and could easily be integrated."
Reports Dr. Massey: "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." "A number of years ago, it was hypothesized that people who used nontraditional therapies for back pain did not believe in traditional medicine. C o n v e r s e l y, t h o s e w h o believed in traditional medicine did not use nontraditional treatments. A recent national survey demonstrates that it is not that simple." In a 2002 "study, the most common nontraditional therapy used was chiropractic manipulation followed by massage, herbal therapies yoga, tai chi and ﬁnally acupuncture. As far as perceived beneﬁts by patients, chiropractic methods were ﬁrst. Massage, yoga, tai chi and qi gong tied for second with acupuncture coming in third. 25
N o t e s D r. M a s s e y : " f o r persistent back pain, traditional medicine is often more expensive than the nontraditional approaches..." "Even with good medical evidence, traditional medicine has been slow to integrate many of the effective therapies found in nontraditional medicine. Patients, however, want the best of all therapies, regardless of their origins, and are integrating traditional and nontraditional approaches and beneﬁting from them." This leads one to ask the question: “when a healing art such as chiropractic is: •
so widely used as to be “the most common form of medical therapy used for back pain”;
when it achieves such great success;
when its education and licensure procedure is the same quantity or greater than "traditional medicine";
when it must integrate its care and management of patients with "traditional" or mainstream medicine;
Should it really be considered "alternative medicine?" Should it really be considered an "outsider" to "traditional" medicine? Should it not be viewed as a minority member of "mainstream medicine"?
UT Dallas Granted $1.7 Million for Tinnitus Research The National Institutes of Health (NIH) has allocated a researcher at University of Te x a s a t D a l l a s a n d a university afﬁliated biomedical ﬁrm $1.7 million to “examine whether or not nerve stimulation will give a long term cure for tinnitus." Tinnitus effects some 20 to 40 percent of returning military veterans and about 10 percent of all persons over the age of 65 years old. The U.S. Ve t e r a n s A d m i n i s t r a t i o n spends around $1 billion each year in disability payments associated to tinnitus. $448,000 of the grant will be spend over the next two years in continued testing as to whether vegus nerve stimulation (VNS) can reteach the brain to disregard the nerve signals that active ringing. In earlier tests Texas Journal of Chiropractic
researchers had discovered that VNS stimulation that when combined with the delivery of other tones it had seemed to reverse the reactions of tinnitus.
Medicare Cuts Medical Consultation Codes
“nearly 75% of its members responding to the AMA survey have seen revenues fall by more than 10% since January, and nearly 40% have had to reduce staff."
A portion of the grant will advance research by MicroTransponder, who will attempt to produce a less invasive way for sending the electric charge that activates the vagus nerve in the neck.
The AMA reports that "thousands of physicians say they have been forced to adopt a number of damaging cost-cutting measures as a result of Medicare discontinuing its use of consultation codes, a policy adopted by the Centers for Medicare & Medicaid Services that took effect on Jan. 1. “
The American College of Rheumatology estimates that “the elimination of the codes has negatively affected 80% of practicing rheumatologists who responded."
Currently tinnitus effects ﬁfty million persons in the United States. Unfortunately conventional treatments see a less than ﬁve percent favorable response. In past years there have been many case reports of chiropractic care helping persons recover from tinnitus. A published paper in 2009, International Tinnitus Journal, stated that spinal manipulations of the of the cervical spine had favorably treated patients inner ear symptoms. “Basically the debilitated cervical spine produces an agitation in the nervous system where it responds with hyperactivity. This causes blood vessels constriction to the organs which include the m i d d l e e a r. I t c a n a l s o produce neurogenic inﬂammation,” reported this article. The writers acknowledged that chiropractic may reverse the changes.
Texas Journal of Chiropractic
The AMA reported “Consultation codes are used most frequently by specialists after patients are referred to them by primary care physicians. Starting this year, Medicare eliminated the use of all consultation codes except telemedicine consults. It directed physicians instead to bill for the visits using only evaluation and management codes that apply." The policy has had a negative e ff e c t t h e A M A r e p o r t s . According to a survey "the vast majority of specialists have seen their revenue stream drop after the change -- most by more than 5% -and three out of every 10 already have reduced services to Medicare patients or are contemplating other cost-cutting steps that will impact care." The American Academy of Neurology estimates that
The results of the AMA poll was that: • " •
some 35% said that their revenue stream had been reduced less than 10%; 40% had between a 10 and 20% reduction in revenue;" 12% had more than a 20% reduction.
Older Patients' Share of Ofﬁce Visits Grows According to government statistics, older patients account for a majority of physician ofﬁce visits, which increasingly involve specialists who treat chronic conditions. Patients 45 and older made 57% of all physician ofﬁce visits in 2008, compared with 49% in 1998. Medical and surgical specialists accounted for 55% of ofﬁce visits among patients 26
65 and older and 48% of visits among patients ages 45 to 64. Findings from a study by the National Center for Health Statistics (NCHS) suggest that U.S. demographics virtually assure that the trends in physician-service use will continue, possibly at a more rapid pace. "In the future, the percentage of visits for those aged 65 and over will increase as the baby boomers, currently aged 45 to 64, move into the 65-and-over age group..." "Physician visits are becoming increasingly focused on management of chronic conditions such as hypertension, coronary atherosclerosis, and diabetes." "From 1998 to 2008, the 65and-older age group increased by 15%, and the 45-to-64 age group increased by 37%...As older patients have accounted for more ambulatory care, they also have accounted for a growing share of healthcare resources.” From 1998 to 2008, the share of services and medications received by patients 45 and older increased substantially:" •
Medication prescribed, 50% to 70%; Imaging ordered or provided, 52% to 66%; Physician time, 50% to 59%.
Among patients 65 and older, primary diagnoses of various chronic conditions increased by double and triple digits from 1998 to 2008, including: • • • • • • •
Essential hypertension, 62% Cardiac arrhythmias, 139% Diabetes, 45% Dyslipidemia, 150% Urinary symptoms, 139% Coronary atherosclerosis, 24% Prostate cancer, 58%
"In 1978, primary care physicians accounted for 61% of ofﬁce visits by patients 45 to 64 and for 62% of visits by patients 65 and older. In 2008, the proportion had dropped to 53% and 45%, respectively. During the same time period, primary care physicians' share of ofﬁce visits by younger patients increased from 71% to 76%."
Nursing Gets Lots of New Money from HHS The Department of Health and Human Services (HHS) is awarding $159.1 million in grants to shore up the nation's healthcare workforce, with $106 million of it going to support all levels of nursing education. The rest of the grant money will be spent on training in geriatrics and boosting minority representation in health professions.
"The bulk of the nursing grants -- a total of $59.3 million -- will go toward programs that will boost the number of advanced practice nurses, including nurse practitioners, clinical nurse specialists, nurse anesthetists, and nursing faculty. The rest of the money is earmarked to broaden technological capacities at nursing schools and to recruit more nurses -- including those from racial and ethnic minorities -- prepare them at the baccalaureate level, and "promote career mobility." In geriatrics, a total of $29.5 million will fund programs to train health professionals in geriatrics; another to train health professionals who plan to teach geriatric medicine, geriatric dentistry, or geriatric behavioral or mental health; and a third to help educators providing geriatric curriculum development, faculty training, and continuing education for geriatric providers. In the minority recruitment area, $23.6 million in grants will support "Centers of Excellence" programs aimed at improving recruitment and performance of under represented minorities. Awardees include schools of allopathic and osteopathic medicine, dentistry, pharmacy, and allied health (including designated "Historically Black Colleges and Universities").
Texas Journal of Chiropractic
Food Safety Modernization Act Edges Toward Vote US Senators released S. 510, a bipartisan agreement called the FDA [US Food and Drug Administration] Food Safety Modernization Act. This move guarantees full debate on the bill this September. The bill was passed unanimously by the Health, Education, Labor and Pensions (HELP) Committee last November but has been stalled in the Senate since July. Senators allege that the bill would empower the US Food and Drug Administration to order product recalls, increase the frequency of plant inspections, and require all facilities that manufacture, process, pack, or hold food to have preventive control plans in place to prevent adulteration of food products. According to the Centers of Disease Control and Prevention, 300 000 people in the United States are hospitalized every year due to food-borne illness and about 5000 die. Numerous natural products industry members and small restaurant owners are opposed to the bill, stating it is too overbearing. For an overview of the Food Safety Modernization Act, go Texas Journal of Chiropractic
to www.opencongress.org/bill/ 111-s510/show and click on the “Ofﬁcial Summary” arrow at the bottom.
Malpractice Costs Less than 2.5% of National Health Care Tab Recent studies report that "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."" Another 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 would reduce medical malpractice premiums by 10% would only reduce the nation's total medical costs by 0.120% to 0.134%."
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 represents payment for economic damages, $2.4 billion for noneconomic damages, and $0.17 billion for punitive damages. Administrative expenses: $4.13 billion, which includes $1.09 billion in fees to defense attorneys and $3.04 billion in overhead expenses. (Estimated fees to plaintiffs' attorneys were $2 billion, but that amount is included in indemnity payments.) 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 authors estimated that physicians lose 2.7 to 5 working days for each malpractice suit -- and the cost of "reputational and or emotional harm" to the defendant physician."
The article reports that "taken together, the papers suggest that promoting tort reform as a means to control health care costs is a straw man, and their conclusions run contrary
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