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DECEMBER 2009

YOUR ISCA STANDING GUARD Dr. Anthony Wolf, D.C., FICC As we draw this year to a close we not only take time to reflect on the achievements and improvements of the ISCA, but look forward to the opportunities and challenges that will arise with the coming year! Throughout this past year our committees have continued to develop and improve with new methods to serve our membership. The ISCA Website continues to be a “work in progress” to serve as a “go to” area for our members to keep up to date on various issues and events that affect each of us. Be sure to visit the website regularly to keep informed of various information that affects our practices and upcoming ISCA events. If you have any comments or suggestions to improve the website or would like to serve on the committee, please call the ISCA office. Our By-laws Committee met several times to update and interpret our by-laws to keep them current with any changes necessary as the ISCA continues to evolve. Our Speaker/Convention Committee has done a great job in improving our continuing education experience bringing in informative speakers to keep our members on the cutting edge in regards to current techniques and the ever changing insurance industry. We will continue to develop and enhance the CA training sessions. CPR training was also introduced at this past Fall Convention. We plan on offering this again provided there is enough interest by our membership. The Speaker/Convention Committee always welcomes any suggestions of future speakers from our membership. I urge all of our members to continue to support our association by attending the ISCA Continuing Education Seminars. This is a significant portion of our operating budget. It is a great time for fellowship and to be connected as a family working together for this great profession. I look forward to seeing you at the 2010 Spring Seminar. The ISCA Insurance Committee, under Committee Chair Dr. Peter Furno, is consistently answering membership questions and concerns in a timely and accurate fashion. The ISCA recently joined forces with the ACA Insurance Liaison Program. This program is designed to connect our state insurance problems/issues with those of other states. Currently, as the ISCA representative to this

program, I am in contact with other doctors around the nation and the ACA’s Insurance Relations staff to coordinate efforts on a state and national level. When appropriate, the ACA will conduct research and lend help in regards to many different issues with insurance companies. If you feel an insurance company is wrongfully denying claims, discriminating against chiropractic, or conducting unfair audits, we urge you to communicate with the ISCA to determine if this is occurring on a state or national level. 2010 LOOKING FORWARD: PROTECTING-PRESERVNG-ADVANCING CHIROPRACTIC The ISCA Legislative Committee is prepared to face the many challenges ahead with the coming Indiana Legislative Session. The ISCA continues to be THE VOICE and protective force of the chiropractic profession in Indiana. Every year nearly 1,300 bills are introduced to our legislators that may potentially affect our profession directly or indirectly. The ISCA Legislative Committee is kept on the cutting edge of all bills that may affect our profession by our Executive Director/Lobbyist Pat McGuffey. The Committee decides whether we should support, oppose, or monitor each bill. This year we will be pro-active in introducing our own Assignment of Benefits Bill which has had increasing support every year. This bill protects the right for direct reimbursement to out of network providers. We feel this bill will be critical in the future as Doctors continue to be “squeezed” with decreasing reimbursements as an in network provider. The ISCA will also be introducing legislation for Chiropractic Inclusion in Healthy Indiana Plan (HIP). Currently, the Governor has excluded spinal manipulation although all other services are covered under HIP. The ISCA will also be actively supporting an “open access” bill which will protect the doctor’s right to limit the number of patients they wish to accept in any network they provide for. Currently, Anthem BC/BS wants to be able to demand that a provider must accept as many patients as they want you to see from their network. This would not allow the provider to diversify their practice to accommodate patients from other networks that reimburse at a higher rate. The ISCA is working closely with legislators providing the latest research that validates and supports chiropractic’s inclusion in these programs. PHYSICAL THERAPISTS The past efforts of the ISCA have kept the physical therapists from direct access and the ability to perform spinal manipulation as a

INSIDE THIS ISSUE PRESIDENT'S MESSAGE.....................................................................................1 ISCA BOARD OF DIRECTORS & STAFF INFO...................................................2 EXECUTIVE DIRECTOR'S MESSAGE................................................................3 OIG BULLETIN LIMITING GIFTS.......................................................................4 THANKS TO OUR SPONSORS & EXHIBITORS..............................................5 F4CP LAUNCHES 5-STATE ADVERTISING CAMPAIGN................................5 FTC PUBLISHES FINAL GUIDES GOVERNING ENDORSEMENTS...................6 MEET THE EXECUTIVE COMMITTEE..............................................................7 HOW CHIROPRACTIC HELPS THE INSURANCE INDUSTRY...........................8 ISCA PHOTOS FROM 2009.............................................................................9

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GOVERNMENT STIMULUS MONEY FOR EMR..................................................10 CMS REQUIRED FRAUD AND ABUSE TRAINING............................................11 TREATING CHRONIC MECHANICAL SPINAL PAIN...............................11 MRSA: DEBUG YOUR CLINIC NOW................................................................12 ISCA MEMBER RUNS IN THE CHICAGO MARATHON......................................13 GET TO KNOW YOUR LEGISLATOR: SENATOR RON ALTING.......................13 MANAGED CARE CONTRACTS: READ BEFORE YOU SIGN................14 CONGRESSIONAL MAP OF INDIANA...................................................16 ISCA SPRING CONFERENCE SAVE THE DATE.......................................17 ISCA CLASSIFIEDS......................................................................................18-19

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INDIANA STATE CHIROPRACTIC ASSOCIATION BOARD OF DIRECTORS President Anthony Wolf, D.C. Indianapolis, IN 317.898.1100 Drtony6900@aol.com First Vice-President Robert Tennant D.C. Shirley, IN 765.737.1117 doct@hrtc.net

Lewis Myers, D.C. Valparaiso, IN 219.464.4444 lew.myers@gmail.com Marian Klaes-Lanham, D.C. Seymour, IN 812.523.6476 drmarian@KlaesClinic.com DISTRICT DIRECTORS

Second Vice-President James Cox II, D.C. Fort Wayne, IN 260.484.1964 Cox.chiropractic@verizon.net

District One Ron Daulton, Sr., D.C. Hammond, IN 219.932.8900 reddcdr@comcast.com

Secretary Michael Phelps, D.C. Martinsville, IN 765.342.2208 mchiro@reliable-net.net

District Two Gerard Hofferth, D.C. South Bend, IN 574.256.1008 drhof@aol.com

Treasurer Chris Bryan, D.C. South Bend, IN 574.259.3355 cwbdc@aol.com

District Three George Joachim, D.C. Fort Wayne, IN 260.492.8811 drgeorge@aaronchiro.com

Immediate Past President Duane Binder, D.C. Clinton, IN 765.832.7777 Dbinder326@aol.com

District Four Peter Furno, D.C. Zionsville, IN 317.338.6464 pfurno@sbcglobal.net

Past President Representative Gary Billingsley, D.C. Indianapolis, IN 317.784.9311 tabill2k@comcast.net

District Five Derek Dyer, D.C. Huntington, In 260.356.1616 drderekdyer@gmail.com

DIRECTORS AT LARGE

District Six Matt Howard, D.C. Muncie, IN 765.254.9481 info@howardchiro.com

David Davis, D.C. Winchester, In 765-584-3665 Drddd@aol.com

District Seven Diane Vuotto, D.C. Indianapolis, IN

317.898.6989 vuottojd@comcast.net

260.483.5588 jdrussell10@hotmail.com

District Eight Shaun Tymchak, D.C. Newburgh, IN 812.858.1008 drshaun@newburghchiro.com

District Four Garry Fuller, D.C. Brownsburg, IN 317.852.8885 gtdlf@netcapade.com

District Nine Nate Unterseher, D.C. Seymour, IN 812.524.2273 drn8@live.com

District Five David Frischman, D.C. Wabash, IN 260.563.8476 ccincpc@comcast.net

ALTERNATE DIRECTORS AT LARGE

District Six Vacant

James Galyen, D.C. Scottsburg, IN 812.752.6202 iubigpig@msn.com

District Seven Sheila Wilson, D.C. Indianapolis, IN 317.297.8800 indysportdoc@iquest.net

C.C. Paprocki, D.C. Greenwood, IN 317.535.7507 John Volbers, D.C. Indianapolis, IN 317.299.3330 ecchiro@cs.com ALTERNATE DISTRICT DIRECTORS District One Chris Hayes, D.C. Crown Point, IN 219.661.8680 hayesfamilydc@hotmail.com District Two Bill Garl, D.C. Bremen, IN 574.546.1111 w.garl@comcast.com

District Eight Michael Toney, D.C. Terre Haute, IN 812.232.1464 Flopper1968@hotmail.com District Nine John Krawchinson D.C. Seymour, IN 812.524.2273 ALTERNATES: The ISCA by-laws allow for the Directors at Large and the District Directors to have Alternate Directors. The Alternate At Large Directors may reside anywhere in the state. The Alternate District Directors must reside within their district. There are 9 districts and their boundaries are the same as per the national census. This is done to keep the Districts in line on a proportional basis. When the Directors are not present, the Alternate Directors have the full voting powers as the Directors and may take their place at any meetings. This system was initiated to involve more people in the association’s decision-making process and to serve as a training ground for future board members. The Alternate Directors at Large are nominated by the Directors at Large and then must be approved by the Board of Directors. The District Director Alternates are recommended by the District Directors and approved by the board.

District Three Jason Russell, D.C. Fort Wayne, IN

INDIANA STATE CHIROPRACTIC ASSOCIATION STAFF & INFO

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Patricia McGuffey Executive Director pmcguffey@LMVconsulting.com

Stephanie Higgins Director of Events shiggins@LMVconsulting.com

Patrick Russell Association Manager prussell@LMVconsulting.com

Stacy Quasebarth Director of Communications squasebarth@LMVconsulting.com

200 S. Meridian St., Suite 350 Indianapolis, IN 46225 info@indianastatechiros.org www.indianastatechiros.org 317.673.4245 phone 800.572.8002 toll-free 317.673.4210 fax

Tom Johnson, CPA Chief Finanical Officer tjohnson@LMVconsulting.com

Connie Vickery Governmental Affairs cvickery@LMVconsulting.com

Become a Fan on Facebook! facebook.com/indianastatechiros

Debra Scott, IOM Vice President of Operations dscott@LMVconsulting.com

John Livengood Governmental Affairs jlivengood@LMVconsulting.com

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DECEMBER 2009


PRESIDENT'S MESSAGE CONTINUED... part of their scope of practice. Indiana remains as one of the only two states that do not allow some from of physical therapy direct access. ISCA is poised and ready to continue this effort. There is an agreement once again this year that they will not advance any bills in this legislative session. However, the ISCA will continue to closely monitor any move the physical therapists may make. In the coming year let us continue to serve each other and to continue to :

If you have a talent you would like to share with your profession consider participating on a committee or perhaps a position on the board. Call Pat McGuffey or myself.

STRENGTHEN THE VOICE OF CHIROPRACTIC • • • •

There are many other advancements and developments the ISCA is working on at the committee level. I am humbled by the many talented doctors that are “stepping up” to serve the ISCA and its membership at the committee and Board of Directors level. As active members I am proud to serve this profession with you! Let’s make 2010 our best year EVER!

Continue your Active Membership Contribute to PAC Participate in our Grassroots efforts Call your Senators/Representatives on a State and National level when requested

May God richly bless you, your family and this Great Profession this New Year. Anthony C. Wolf, D.C.,FICC

EXECUTIVE DIRECTOR'S MESSAGE Patricia McGuffey, ESQ.

CHIROPRACTIC TREATMENT BEATS OUT ALL OTHER MODALITIES! Chiropractic physician treatment is both the most successful and cost effective treatment for lower back and neck pain! These are the commanding results of the October 2009 Mercer study. The Study concludes that Chiropractic treatment for lower back and neck pain is an excellent value for insurance coverage and reduces healthcare costs. The ISCA is distributing the Mercer study along with numerous other studies widely to legislators and policy makers. We will continue to utilize all tools to eliminate discrimination and fight for full parity for Chiropractors. The ISCA takes our responsibility seriously to protect the interests of the chiropractic physician in every venue. One venue is Legislative Interim study committees. We monitored a number of study commissions and committees that have met throughout the summer and fall. The Committees study issues and make a number of recommendations that are then introduced as bills into the legislative session that begins January 5, 2010. One key Commission, the Health Finance Commission, studied one of ISCA’s priority issues, “assignment of benefits” (AOB). As part of that process the Department of Insurance surveyed health care providers and insurers costs of implementing insurers’ direct reimbursement to out-of-network health care providers. The IDOI felt that the data was inconclusive and recommended that the State determine the impact of the new notice requirements that insurers are required to include in material sent to insured individuals. The new legislated mandate warns patients to send their insurance payment to their out-of-network providers. However, Senator Miller indicated that AOB legislation will be introduced in the 2010 Session. The ISCA will continue to fight for its passage. The ISCA will also support legislation that the Health Finance Commission recommended for the 2010 legislative session called open access legislation. The legislation would prohibit a health plan contract from including a provision that would require contracted Chiropractors and other health care providers to treat as many patients as they want to give you. Without this legislation, insurers will continue to require health care providers to take all patients they refer if they take one patient. The practice prevents health care providers from being able to treat patients from other insurance carriers and manage their own business model. The ISCA will also continue to push for legislation that allows all chiropractic services (including spinal manipulation) to be included in the Health Insurance Plan (HIP). We are utilizing the Mercer study results to attempt to demonstrate the cost effectiveness of including chiropractic care. The ISCA fights to protect Chiropractic Physicians rights in every forum. We have filed a complaint with the IDOI and implored them to investigate insurance reimbursement discrimination against chiropractors. We will keep you posted on this ongoing dialogue. You, our members, are the ISCA and our goal is to serve all your practice needs. Our office answers numerous questions for our members daily on Medicaid, Medicare, insurance issues, scope of practice, advertising and various other inquiries. We provide information through seminars, newsletters, web page, action alerts, as well as a person answering ISCA phones. Please let us know if we can be of assistance to you in your practice. We value our members and know that there would be no ISCA without you.

DECEMBER 2009

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EXECUTIVE DIRECTOR'S MESSAGE CONTINUED... I recently Attended COCSA (Congress of Chiropractic State Associations) conference. I met with other State Association Executives and we discussed our programs, laws, and other areas of interest to our Chiropractic members. I will continue to strive to learn more ways that the ISCA can serve you by analyzing programs and services implemented in our fellow States. In addition, please share your ideas and suggestions. Many of you contact me to discuss what is happening in the trenches. This information is vital to us. Thanks for your interest and assistance. As the legislative session will begin soon, the ISCA plans to develop key legislative contacts for all 150 legislators. It is important for Chiropractors to develop strong relationships with your local legislators so you may call on them to assist at crucial legislative intervals. Please let the ISCA office know if you have a good relationship with your local Statehouse representative or Senator and are willing to serve as a key contact. As I look back on 2009, I know that we shared a number of successes both at the legislature and with vibrant educational conferences and seminars, a well attended and fun golf outing, and numerous other activities. I know together we can make 2010 even more successful. It is my sincere desire that each of you have a Happy Holiday and prosperous New Year!

OIG BULLETIN LIMITING GIFTS By David Elliott Jose, Esq. The federal Office of the Inspector General issued a Special Advisory Bulletin a few years ago on the topic of gifts and other inducements to beneficiaries. This is an important topic to review periodically for a couple of reasons. The first, and obvious one, is to underscore the importance for you and your practice to operate in compliance with the law. The second reason is to recognize the strict scrutiny given by federal and state enforcement authorities when it comes to activities that may influence or induce patients to select health care providers. In some respects, marketing gifts and other favors that are viewed as common business practices in other lines of business are viewed with skepticism and suspension in the health care field. The Special Advisory Bulletin relates to gifts to Medicare and Medicaid patients to influence their choice of a provider. This has the potential for constituting illegal “remuneration of any kind� to influence that provider selection process. Common targets for authorities include the waiver of copayments and deductibles (or any part of those patient obligations) and the transfer of goods or services for free or for less than fair market value. Sometimes, this activity can occur in common give-a-ways, gifts or favors. In order to provide some guidance, the OIG issued the Special Advisory Bulletin to describe the following principles: 1. Medicare and Medicaid providers may offer beneficiaries inexpensive gifts (other than cash or cash equivalence), which were defined a few years ago as having a retail value of no more than $10 individually, and no more than $50 in the aggregate annually. 2. Providers may offer certain expensive items or services that fit within one of the statutory exemptions (i.e., (a) waiver of copay or deductible based upon financial need; (b) properly disclosed co-payment differentials in health plans; (c) incentives to promote the delivery of certain preventative care services; and (d) practices explicitly permitted under the federal Anti-kickback Statutes). 3. The OIG also indicated that it would continue to look at specific activities, generally relating to services with a broader positive impact, such as a benefits for general public health. This is an area that must be carefully evaluated before pursuing marketing or business development practices. One practice that some have pursued includes providing a meal in conjunction with an educational/marketing program. It is possible to provide inexpensive meals or gifts as part of such programs, but one needs to also consider the aggregate impact this can have over the course of a year. There are significant financial penalties associated with each wrongful act, and it is important to appreciate that reports to authorities could come from any number of sources. As a result, it is important to consult with experienced legal counsel that can evaluate the many details and questions in such practices to assure compliance and remain off the authorities’ radar screen. If you have any questions about this area or its application to specific situations, you may contact David E. Jose at (317) 238-6211 or djose@kdlegal.com. Each situation is different, but all situations can be best addressed by anticipating the scrutiny that enforcement authorities are imposing in this area.

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DECEMBER 2009


OBITUARY: DR. KENNETH H. SMELSER Dr. Kenneth H. Smelser, 73, Peru, died at 1 p.m. Sunday, Nov. 22, 2009, at his residence. His funeral service was held on Wednesday, November 25th at the McGrawsville United Methodist Church with Pastors Mark Hill and Kenny Cole officiating and he was laid to rest in Park Lawn Cemetery, Amboy. Arrangements have been entrusted to Eikenberry-Eddy Funeral Home, Peru. Memorials may be made through the funeral home to the Smelser family to assist with funeral expenses. Dr. Smelser had been a licensed chiropractor in Indiana since 1977 and an ISCA member since 1987.

THANKS TO OUR SPONSORS & EXHIBITORS! The Indiana State Chiropractic Association’s meetings and conferences are successful due in large part to the support of our sponsors & exhibitors. The following companies sponsored this year’s Fall Conference: Benefit Resourcing ● ChiroGel ● ChiroTouch ● Denis Behm Supply ● Erchonia Medical ● Foot Levelers ● Haffner X-Ray ● Healthy Chocolate ● It Works! Marketing ● Medicfusion EMR ● Radiation Services ● RPS Imaging ISCA Exhibitors contribute to the success of the conference and offer attendees a convenient way to meet potential vendors and learn about the latest technology. MARK YOUR CALENDARS NOW!

PARKER OPENS STATE OF THE ART STANDARD PROCESS STUDENT ACTIVITY CENTER A festive celebration marked the official grand opening of the Standard Process Student Activity Center located on Parker College of Chiropractic’s campus. Standard Process Inc., a nutritional food supplement manufacturer, bestowed a generous $1 million donation to Parker to help advance the college’s academic potential and to further the education of future doctors of chiropractic. Part of the donation was used to support renovations and the naming of a new state-of-the-art student activity center, which is stocked with the latest workout and weight training equipment that will be used by students, faculty, and staff. The two-story activity center also includes a gymnasium, locker rooms, and student lounge. The gymnasium, when converted to an auditorium, accommodates 1200 people for assemblies, graduations, and special programs. Parker College held a ribbon cutting ceremony during the official opening of the StandardProcess Student Activity Center and also provided lunch, entertainment, and door prizes during the celebration. “We are so grateful for the generosity of Standard Process and for providing such a wonderful place for our future doctors of chiropractic to implement a health and wellness lifestyle,” said Dr. Fabrizio Mancini, president of Parker College of Chiropractic. “It is such an inspiration to see a company that is dedicated to promoting a holistic approach to health care and is giving to others that have that common goal.” The Standard Process Student Activity Center will help to maintain the health and wellness philosophy that Parker promotes. It will assist in producing positive lifestyle choices and a healthy environment. Source: Parker College of Chiropractic, www.parkercc.edu

DECEMBER 2009

ISCA 2010 Spring Conference is scheduled for February 19-21 at the Holiday Inn Pyramids, Indianapolis, IN

F4CP LAUNCHES 50-STATE ADVERTISING CAMPAIGN The Foundation for Chiropractic Progress (F4CP), architect of the chiropractic profession’s longest running public awareness campaign, announces the launch of a national media sweep to place advertisements in at least one major newspaper in every State. The “State-2-State” campaign, which rolls out in early 2010, will give state associations and chiropractic colleges an opportunity to partner with the Foundation to increase the size and frequency of the advertisement for additional exposure. “We already have several state associations and colleges that are moving forward, and are gratified that the Foundation is fulfilling its mission to make media campaigns like this possible,” states Kent S. Greenawalt, chairman and director of the Foundation. As a participating partner in the “State-2-State” campaign, organizations will enjoy multiple benefits: • Access to specific Foundation ads www.foundation4cp.com/communications.htm, • Collaboration in the selection of the targeted newspaper or publication, and • Their logo and Web address included in the featured advertisement. Source: Foundation for Chiropractic Progress, www.foundation4cp.com

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FTC PUBLISHES FINAL GUIDES GOVERNING ENDORSEMENTS, TESTIMONIALS CHANGES AFFECT TESTIMONIAL ADVERTISEMENTS, BLOGGERS, CELEBRITY ENDORSEMENTS The Federal Trade Commission today announced that it has approved final revisions to the guidance it gives to advertisers on how to keep their endorsement and testimonial ads in line with the FTC Act. The notice incorporates several changes to the FTC’s Guides Concerning the Use of Endorsements and Testimonials in Advertising, which address endorsements by consumers, experts, organizations, and celebrities, as well as the disclosure of important connections between advertisers and endorsers. The Guides were last updated in 1980. Under the revised Guides, advertisements that feature a consumer and convey his or her experience with a product or service as typical when that is not the case will be required to clearly disclose the results that consumers can generally expect. In contrast to the 1980 version of the Guides – which allowed advertisers to describe unusual results in a testimonial as long as they included a disclaimer such as “results not typical” – the revised Guides no longer contain this safe harbor. The revised Guides also add new examples to illustrate the long standing principle that “material connections” (sometimes payments or free products) between advertisers and endorsers – connections that consumers would not expect – must be disclosed. These examples address what constitutes an endorsement when the message is conveyed by bloggers or other “wordof-mouth” marketers. The revised Guides specify that while decisions will be reached on a case-by-case basis, the post of a blogger who receives cash or in-kind payment to review a product is considered an endorsement. Thus, bloggers who make an endorsement must disclose the material connections they share with the seller of the product or service. Likewise, if a company refers in an advertisement to the findings of a research organization that conducted research sponsored by the company, the advertisement must disclose the connection between the advertiser and the research organization. And a paid endorsement – like any other advertisement – is deceptive if it makes false or misleading claims. Celebrity endorsers also are addressed in the revised Guides. While the 1980 Guides did not explicitly state that endorsers as well as advertisers could be liable under the FTC Act for statements they make in an endorsement, the revised Guides reflect Commission case law and clearly state that both advertisers and endorsers may be liable for false or unsubstantiated claims made in an endorsement – or for failure to disclose material connections between the advertiser and endorsers. The revised Guides also make it clear that celebrities have a duty to disclose their relationships with advertisers when making endorsements outside the context of traditional ads, such as on talk shows or in social media. The Guides are administrative interpretations of the law intended to help advertisers comply with the Federal Trade Commission Act; they are not binding law themselves. In any law enforcement action challenging the allegedly deceptive use of testimonials or endorsements, the Commission would have the burden of proving that the challenged conduct violates the FTC Act. The Commission vote approving issuance of the Federal Register notice detailing the changes was 4-0. The notice will be published in the Federal Register shortly, and is available now on the FTC’s Web site as a link to this press release. Copies also are available from the FTC’s Consumer Response Center, Room 130, 600 Pennsylvania Avenue, N.W., Washington, DC 20580. The Federal Trade Commission works for consumers to prevent fraudulent, deceptive, and unfair business practices and to provide information to help spot, stop, and avoid them. To file a complaint in English or Spanish, visit the FTC’s online Complaint Assistant or call 1-877-FTC-HELP (1-877-382-4357). The FTC enters complaints into Consumer Sentinel, a secure, online database available to more than 1,700 civil and criminal law enforcement agencies in the U.S. and abroad. The FTC’s Web site provides free information on a variety of consumer topics.

CONNECT WITH US! ISCA ADDS A TOLL-FREE LINE & JOINS SOCIAL MEDIA PLATFORMS BECOME AN ISCA FAN ON FACEBOOK! www.facebook.com/indianastatechiros

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DECEMBER 2009


MEET THE EXECUTIVE COMMITTEE Dr. Anthony Wolf, President School: Logan College of Chiropractic In Practice: 24 years Dr. Wolf graduated Magna Cum Laude from Logan College of Chiropractic in 1985. He has been in private practice on the East side of Indianapolis for the past 24 years. He is married 21 years to his wife, Michelle. They have two children Caitlin (19), studying Pre-Chiropractic at DePauw University and Eric (16) a junior at St. Theodore Guerin High School, also on the path to a career in chiropractic. Dr. Wolf realized his calling to be a chiropractor while still in high school. After shadowing a local chiropractor he was convinced it was the career for him. Dr. Wolf believes being involved with chiropractic profession and looking forward to going to work every day is a great experience. “It is truly a blessing to have my wife, Michelle as a significant part of my career and practice successes. I am honored and excited to have my children choose careers in chiropractic.” After 24 years of practice Dr. Wolf has found that Thomas Edison's quote sums it up best, "The doctor of the future will give no medicine but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease." Chiropractic must lead this unified effort through leadership and involvement in the Indiana State Chiropractic Association. Dr. Duane Binder, Immediate Past President School: Palmer College of Chiropractic In Practice: 31 years Dr. Duane Binder has been in private practice in the small town of Clinton, in west central Indiana since 1980. Dr. Binder graduated from Palmer College of Chiropractic in 1978 and briefly practiced in Michigan before moving to Indiana. Dr. Binder has been active in the ISCA for many years and has served on the executive committee at every level, including President, for the past 10 years. He works along side his wonderful supportive wife, Debbie, and has 3 grown children. His son Curt graduates from Palmer Florida in June, 2010, his son Jeff, starts Logan College January 2010 and his daughter finishes

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Pharmacy College at Purdue in May 2010. He is proud of each of them. Dr. Binder had this to say about chiropractic, “One of the best rewards in life is when a patient says thanks Doc, for helping me. If it wasn't for you, I don't know what I would have done." Then the patient gives you a big hug. Dr. Robert Tennant, FICC First Vice President School: National College of Chiropractic In Practice: 38 years Dr. Robert Tennant, Shirley, Indiana, earned Chiropractor of the Year honors both in 2005 and 2008. Dr. Tennant is a graduate of National College of Chiropractic and has been a member of ISCA for over 30 years. He also serves as the Indiana delegate to the American Chiropractic Association. Dr. Tennant is a Past President of the ISCA and has served as a past member of the Indiana Board of Chiropractic Examiners in addition to acting as a consultant to both the Farm Bureau Insurance Company NIC Committee and Blue Cross Blue Shield. Dr. James Cox II, 2nd Vice President School: National College In Practice: 13 years After graduating from National College of Chiropractic in 1986, Dr. James Cox II joined his father, Dr. James Cox, as a third generation chiropractor in Fort Wayne, Indiana. He has been married to his wife Karen, a pharmacist, for 12 years and they have two children, Evan 7, Morgan 4. Dr. Cox II serves as the Medicare rep for the State of Indiana and has been active with the ISCA Board for the last three years. When asked how he got started in his profession Dr. Cox had this to say, “Chiropractic is in my blood and God has shown me this path as mine to follow. I truly value our profession for its ability to reach people, take time to listen, and comprehensively help our patients create a healthy lifestyle.”

ISCA REPORT

Dr. Christopher Bryan, Treasurer School: Palmer College of Chiropractic In Practice: 28 years Dr. Bryan was raised in the Angola and he received his BS from Manchester College in Biology and Bio-Chemistry. He attended Palmer College of Chiropractic in Davenport, Iowa and graduated Summa-Cum Laude in 1981. Dr. Bryan began his specialty practice in Mishawaka in the fall of 1981. He has attended over 1100 hours of post-graduate training in over 26 years of practice to keep abreast of the current aspects of his profession. He has been a Member of the American Chiropractic Association (ACA), Indiana State Chiropractic Association (ISCA) (serving in all positions except for president) since the beginning of his practice. He was awarded the President Award, by the Indiana State Chiropractic Association in 1987 and 2007. He is a member of the prestigious Chiropractic Golden Circle. Dr. Bryan is also licensed in the States of Michigan and Texas. Dr. Bryan resides in Niles, Michigan with his wife Vickie. He has dogs, cats, donkeys, deer and wild turkey on his land. Dr. Bryan and Vickie have two daughters, Jennifer with grandson Trey, Sarah with son-in-law Andy and granddaughters Katie and Isabella. Dr. Michael Phelps, Secretary School: Palmer West In Practice: 16 years Dr. Michael Phelps said he got started in chiropractic like many others, “I got started in chiropractic, by going to a D.C. for something that the medical profession wasn't fixing.” After graduating from Indiana University, Dr. Phelps went on to Palmer West for chiropractic. Dr. Phelps has been practicing since 1993 in Martinsville and his wife is the director of the Intensive Care Unit for the Bloomington Hospital. Together they have 4 children, the youngest a senior in high school, and 2 grandchildren. Dr. Phelps has been a member of the ISCA since 1991 and has served in many capacities, including Directorat-Large.

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HOW CHIROPRACTIC HELPS THE INSURANCE INDUSTRY REPORT SUGGESTS COVERING CHIROPRACTIC CARE OF NECK AND LOW BACK PAIN INCREASES VALUE-FOR-DOLLAR OF HEALTH BENEFIT PLANS. By Peter W. Crownfield, Executive Editor

Insurance companies and others hesitant to expand coverage of chiropractic care should review a copy of a report commissioned by the Foundation for Chiropractic Progress and prepared by Mercer Health and Benefits, a San Francisco-based human resources and financial advisor. The report, "Do Chiropractic Physician Services for Treatment of Low Back and Neck Pain Improve the Value of Health Benefit Plans?" concludes that chiropractic care "is likely to achieve equal or better health outcomes at a cost that compares very favorably to most therapies that are routinely covered in U.S. health benefit plans" and that covering chiropractic services for neck and low back pain "will likely increase value-for-dollar by improving clinical outcomes and either reducing total spending (neck pain) or increasing total spending (low back pain) by a smaller percentage than clinical outcomes improve." Study Parameters Niteesh Choudhry, MD, PhD, assistant professor at Harvard Medical School, and Arnold Milstein, MD, MPH, chief physician at Mercer Health and Benefits, evaluated the peer-reviewed literature and constructed an economic model to estimate the likely impact of expanding chiropractic coverage for neck and low back pain within U.S. health plans, including the relative costeffectiveness of coverage of chiropractic physician services compared to coverage only for medical physician services (medical doctors, osteopathic doctors, physical therapists and others). Dividing differences in total costs of care per episode of care between chiropractic and other care modalities by differences in their effectiveness provided the authors with estimates of effectiveness measured in dollars per quality-adjusted life years (QALY) units. According to the report, estimates based on dollars per QALY units "are a common currency for assessing the value of health care interventions and thus facilitate the comparison of chiropractic care for spinal disorders with other treatments for these conditions as well as unrelated disorders." To calculate unit prices payable by U.S. insurers for the coverage of low back and neck pain care, the authors pulled billing data from Mercer HealthOnline, which houses data for more than 80 large employer-sponsored health plans covering nearly 3 million members. Of note, prescription drug expenditures were not included in the analysis; inclusion of said expenditures presumably would have increased non-chiropractic costs of care significantly. Take-Home Points • Chiropractic care is widely used, with almost half of all patients with persistent back pain seeking this form of treatment. • "Chiropractic care is more effective than other modalities for treating low back and neck pain." • Chiropractic care for the treatment of low back and neck pain "is highly cost-effective, represents a good value in comparison to medical physician care and to widely accepted cost-effectiveness thresholds." • "Insurance coverage for chiropractic physician care ... is likely to drive improved cost-effectiveness of U.S. care." • These findings "support the value of health insurance coverage of chiropractic care for low back and neck pain at average fees currently payable by U.S. commercial insurers." To download a complete copy of the Choudhry and Milstein report, visit www.f4cp.com/MercerReport.htm. To review other recent study findings suggesting the cost-effectiveness and clinical value of chiropractic care, read "The Research You've Been Waiting for? (Aug. 26 issue) and "Cost-Effective Care: The Evidence Mounts" (Sept. 9 issue). SOURCE: Dynamic Chiropractic

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ISCA REPORT

DECEMBER 2009


ISCA PHOTOS FROM 2009

DECEMBER 2009

ISCA REPORT

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GOVERNMENT STIMULUS MONEY FOR EMR - HEALTHCARE IT STIMULUS FUNDS: FREQUENTLY ASKED QUESTIONS Q. How much funding is available for healthcare IT through the American Recovery and Reinvestment Act (ARRA) of 2009? A. Precise figures vary due to changing projections and the inconsistent inclusion of investment and cost savings to the government, but there should be close to $17 billion (net) for electronic medical records (EMR) adoption through Centers for Medicare & Medicaid Services (CMS) and approximately $2 billion for the Office of the National Coordinator (of which $300 million is specified for regional health information exchange [HIE] efforts). There is substantial additional funding elsewhere in the bill that can and likely will also support Healthcare IT, but the specific designations and uses of that funding are less clear. Q. Who qualifies for the funds? A. Electronic medical records (EMR) funds are available for non-hospital–based providers and for hospitals. Recipients must care for Medicare or Medicaid beneficiaries, and payments depend on the patient mix. Special provisions apply for critical access hospitals, for providers practicing in health and human services–designated provider shortage areas, and for certain other categories of recipients. Q. How will the funds be distributed? A. EMR funds are available through both Medicare and Medicaid programs, structured as reimbursements, but providers and hospitals cannot receive both. Q. How do I know if I can receive reimbursement for my EMR? A. Recipients must make meaningful use of certified EMR products to receive payment. Both terms are pending clarification as described in the next question and answer. Q. What constitutes meaningful use and certified EMR? A. Meaningful use • Includes information exchange. • Reports on clinical quality measures. • Is, as yet, undefined. The Secretary of Health and Human Services will define meaningful use. • Certified EMR • Provides clinical decision support. • Supports physician order entry. • Captures/queries information relevant to health-care quality. • Exchanges electronic health information with other sources and integrates such information from them. • Is, as yet, undefined, both as a process and as a definition. • The Office of the National Coordinator will define certified EMR by December 31, 2009. Q. How much am I eligible for?*

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ISCA REPORT

DECEMBER 2009


CMS REQUIRED FRAUD AND ABUSE TRAINING

By: Dr. Robert Tennant, D.C., FICC - ISCA First Vice President

Many providers are receiving notices that they must complete a Fraud, Waste and Abuse (FWA) training program from Medicare Advantage Plans. In 2007, CMS regulations mandated that Medicare Advantage (MA) programs require MA providers to take a FWA training program once a year, beginning in 2009. However, in response to concerns from the provider community, CMS has recently proposed to revise this requirement. In the Oct. 22 Federal Register Proposed Rule, CMS stated that individuals who were enrolled as Medicare providers should not be required to complete the FWA training because it was redundant to the Medicare requirements for enrollment. This proposal has not become a final regulation, but will most likely become final next year. At this point, MA providers are required to take the FWA training. Many individual MA plans are offering their own FWA training courses. An example of an available training course can be accessed here (http://www.bcbstx.com/ provider/medicare/mandatory_provider_training.htm).

TREATING CHRONIC MECHANICAL SPINAL PAIN Spinal manipulation may provide broader and more significant long-term benefit for chronic spinal pain patients than acupuncture and medication. Muller R, Giles LGF. Long-Term Follow-Up of a Randomized Clinical Trial Assessing the Efficacy of Medication, Acupuncture, and Spinal Manipulation for Chronic Mechanical Spinal Pain Syndromes. J Manipulative Physiol Ther 2005;28(1):3-11. BACKGROUND Chronic mechanical back pain and neck pain, which are often caused by an injury or disease, present a diagnostic and treatment challenge and pose a significant financial strain on the health care system. Some evidence shows that a multidisciplinary team approach to treating spinal pain results in high patient satisfaction. The evidence about the superiority of a particular treatment for non-specific chronic spinal pain is inconclusive. THE OBJECTIVE of this study was to assess the long-term effect of medication, needle acupuncture and spinal manipulation on treating patients with chronic (> 13 weeks) spinal pain. THIS STUDY conducted a one-year follow-up of a randomized clinical trial investigating the effectiveness of medication (Celebrex, Vioxx and/or acetaminophen), acupuncture or high-velocity low-amplitude spinal manipulation on treating chronic spinal pain. Sixty-nine patients were randomized into three treatment groups, receiving one type of treatment for nine weeks. The one-year follow-up was conducted through Oswestry Back Pain Index, Neck Disability Index, Short-Form-36 and Visual Analog Scales. The study analyzed the results of treatment of 40 patients who had received only one randomly allocated type of treatment. RESULTS Comparison of the initial and long-term follow-up questionnaires produced the following results: • Only the group receiving spinal manipulation showed long-term treatment benefit, with five of the original seven improvements remaining statistically significant after one year. • Only one of seven improvements remained statistically significant in each of the acupuncture and the medication treatment groups at follow-up. CONCLUSION For treating chronic spinal pain, spinal manipulation, if not contradicted, may provide broader and more significant long-term benefits than acupuncture or pain-relief medication. CAVEATS Larger studies evaluating long-term efficacy of treatments for chronic spinal pain are needed. LEARN MORE ABOUT chiropractic at www.acatoday.org. For more information on chiropractic research, visit www.ccgpp.org. The research described in this column comes from credible, peer-reviewed journals. It is intended to serve as a resource for practitioners and patients to assist them in consideration of various health care options and does not replace clinical judgment.

DECEMBER 2009

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MRSA: DEBUG YOUR CLINIC NOW

By John Maher, DC, DCBCN, BCIM / Dynamic Chiropractic In the U.S., methicillin-resistant Staphylococcus aureus, commonly known as MRSA, currently accounts for more deaths each year than AIDS, and incidence is increasing at alarming rates.1 Studies at Parker College of Chiropractic concluded that all teaching clinics and private chiropractic offices should adopt infection-control practices, including routine table disinfecting and hand sanitizing. They noted that vinyl tables need to be cleaned regularly to remove both pathogens and allergens. All cloth tables need to be replaced. Fundamentals of MRSA Infection MRSA is a type of staph infection resistant to antibiotics. Staph infections occur most frequently in health care facilities. While S. aureus is commonly found in the nasal cavity, most are skin infections. These may appear as pustules or boils which often are red, swollen, painful or have pus or other drainage. These skin infections commonly occur at sites of visible skin trauma such as cuts and abrasions, as well as areas of the body covered by hair, such as the back of neck, groin, buttock, armpit and the bearded area of men. MRSA is usually transmitted by direct skin-to-skin contact, or contact with shared items or surfaces that have come into contact with someone else's infection. Five factors make it easier for MRSA to be transmitted: crowding, frequent skinto-skin contact, cuts (or abrasions), contaminated items and surfaces, and lack of cleanliness. The need for vigilant personal hygiene by chiropractors is very important. Unfortunately, most antibiotic soaps have the potential of creating more antibiotic-resistant bacteria. Alcohol's effect does not last long and dries out the skin with frequent use. For those health professionals who desire a natural product for frequent daily hand washing and nail cleaning, there is a special type of honey from New Zealand called manuka honey. It is available in multiple forms for both personal protection and medical treatment via dermal application. Natural Anti-Microbials Unlike antibiotics, manuka honey destroys bacteria by drawing water out of the microorganisms by osmosis. Bacteria have the ability to mutate and become resistant to elements that can destroy them. However, no bacteria can survive without water. That should prevent future manuka-resistant strains from developing. Furthermore, all honeys produce an anti-microbial peroxide reaction upon application. Manuka honey contains high levels of the natural anti-microbial chemical methylglyoxal. Gels, foams, creams, sprays and bandages for personal protection and/or for wound healing are all currently available. For those doing deep-tissue work that utilizes oils, both manuka oil and tea tree oil (melaleuca) at less than 5 percent dilution have shown utility against MRSA.

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Although manuka honey may be considered for hand washing and treatment of cuts and abrasions, we must also consider our tables and therapeutic devices that come into skin contact with our patients. While there are many sanitizing products that are chemical-based, there is a growing body of products that are not only effective, but also non-sticky, nontoxic and even allnatural and "green." Products that have a long-lasting effect are also desirable, as that will make actual daily compliance much easier. Just as desirable are products that will not adversely affect the materials upon which they are applied. A most natural approach is to use products based on environmentally friendly, nontoxic ingredients like silver ions and citric acid. Of all the modalities we must consider in our hygienic efforts, the chiropractic table presents perhaps the greatest, and certainly the most common and obvious challenge. Although face paper should be used, it is woefully inadequate in itself. Application of an EPA-approved, hard-surface anti-microbial spray should be used on the table itself between patients to kill germs on surfaces including the hand holds and face-cradle. Considering the rising potential of worldwide pandemics (SARS, avian flu, norovirus), H1N1 and antibiotic-resistant superbugs like MRSA, it is all the more incumbent on all chiropractors to review their clinic and personal hygiene in light of these increasing threats. Supporting a Healthy Immune System Of course, we also emphasize the import of a healthy immune system through neuroaxial balance, proper rest, recreation, hydration and nutrition. In regard to the latter, the minerals zinc and selenium, and vitamins A, C and D are perhaps the best appreciated. One might also consider nutraceuticals like mushroom and thymus extracts or colostrum. The American Society for Microbiology meeting in Atlanta in June 2005 included a presentation on a natural garlic extract, allicin, for treating MRSA. Healthy intestinal flora and fauna is also part of a robust immune system. According to the May 8, 2006 online edition of Medical News Today: "Current interest in probiotics is motivated by the increasing antibiotic resistance of pathogenic bacteria and the rise of consumers' demand for natural substitutes of drugs." Spigelman has a novel idea concerning probiotics and MRSA prevention: "Any student who has grown bacteria in a lab will know that they (bacteria) generally do not grow on top of one another. So when we wash our hands, we could actually be killing off harmless commensals to the extent that we leave space for other bacteria, such as MRSA strains, to settle. Perhaps we should be thinking about using probiotics and even dipping our hands after thorough washing into a solution which contains harmless bacteria, which could then colonize our skin and prevent pathogenic bacteria from settling on it." Unfortunately, I am not aware of any such probiotic hand

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DECEMBER 2009


MRSA: DEBUG YOUR CLINIC NOW CONTINUED... treatment on the market as of yet. As a closing thought, for those doctors who provide wellness care, consider the following quote from the American Academy of Anti-Aging Medicine: "Chronic infection is a vastly underestimated cause of disease and disability. The public needs to be mindful that low-grade infections are estimated to

potentially reduce the healthy human lifespan by up to 20 years, robbing them of a lifetime of bountiful energy, productivity, and happiness. Bacteria, fungi, viruses, and parasites may well be the single most important yet undiscovered cause of premature aging and the chronic degenerative disorders of aging that now plague Americans."

GET TO KNOW YOUR LEGISLATOR

ISCA MEMBER RUNS IN THE CHICAGO MARATHON FOR CHIROPRACTIC CHARITY

Senator Ron J. Alting (R- Lafayette) District 22 In an effort to help Indiana chiropractors remain and stay involved in the political process, the ISCA Report will periodically profile a prominent legislator in our pages. The subject of our first profile is Commerce, Public Policy, & Interstate Cooperation Committee Chairman Ron Alting of Lafayette, Indiana.

Chiropractic history was made on Sunday, October 11th on the streets of Chicago when all runners on Team NPCO for Chiropractic successfully crossed the finish line at the 2009 Bank of America Chicago Marathon in front of over one million cheering spectators. Waking up early and bearing the chilly 33 degree weather, runners from various parts of the country ran 26.2 miles on behalf of Non-Profit Chiropractic Organization (NPCO). The 82 runners raised over $20,000 all for NPCO. Fundraising was not a requirement for Team NPCO runners, but many runners created their own personal fundraising web pages. All monies raised went directly to NPCO, an official 501(c)3 charity dedicated to providing chiropractic healthcare, in the form of non-profit clinics, to those less fortunate around the world, specifically those in under-developed countries, where often times people lack proper health care due to discrimination, neglect, and/or an under-staffed health care system. Dr. Bruce Phillips of North Vernon, Indiana and an ISCA member, received over $500 in donations for NPCO. Dr. Phillips had this to say about his run, “the Chicago Marathon was just an awesome experience. I was very delighted to participate and support Team NPCO in their first appearance at the Chicago Marathon! The fans were great and I received many positive comments from fellow runners in support of chiropractic! I was a little sore on Monday, but it was worth it.” After mainly biking for the past eight years and having just finished the 160 mile RAIN Ride across Indiana, Dr. Phillips decided to take on marathon running. “The mission of being able to help bring chiropractic to more people around the world has inspired me to lace up my running shoes again. I love chiropractic and know the potential it has to unlock health in so many people. I hope this event continues to improve chiropractic awareness.” If you would like to donate to NPCO on Dr. Bruce Phillips’ behalf it’s still not too late. Visit his personal fundraising site to contribute http://www.firstgiving.com/drphillips. If you are interested in participating in the 2010 Chicago Marathon and would like to join the NPCO team please visit http://www.npco. org/chicago_marathon_application.htm.

DECEMBER 2009

A graduate of Purdue University, Senator Alting is also a Captain in the Indiana Guard Reserve. He is a member of the Community Advisory Board for the Indiana University School of Medicine, Lafayette campus and on the board of directors for the Liberal Arts Alumni Association at Purdue University. He also serves on the board of directors for Meals on Wheels, Bright National Bank, Lafayette Symphony Orchestra and the Tippecanoe Arts Federation. A true champion of Chiropractic, Ron Alting is a three time ISCA Legislator of the Year Award winner. Senator Alting has stood up for the ISCA against physical therapists time and time again, successfully blocking their attempts to insert their ability to perform spinal manipulation and gain direct access into state statute. Sen. Alting has spoken passionately on the Senate floor of the extensive and specialized education Chiropractors must obtain to perform spinal manipulation and has continuously stressed the issue of patient safety. In addition to speaking out against PTs encroaching on Chiropractic, Senator Alting has also taken on the Healthy Indiana Plan’s exclusion of Chiropractic Services. He fought hard to have cost effective chiropractic services inserted back into the HIP plan in 2009 and will be introducing similar language in the 2010 session. Chiropractic and the ISCA could not have a better friend than Senator Ron Alting. He believes in Chiropractic treatment on a very personal level as he has been a long time patient of Chiropractic. He also continues to be an influence in the legislature for Assignment Of Benefits legislation and has spoken out in the legislature on this issue. Join us in saluting Senator Ron Alting as the true Voice for Chiropractic treatment in the Indiana General Assembly.

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MANAGED CARE CONTRACTS: READ BEFORE YOU SIGN

By Mario Fucinari DC, CCSP, MCS-P - Certified Insurance Consultant Unfortunately, health insurance coverage for a patient is not a right in the United States. From a patient’s perspective, they desire coverage and they desire you, their doctor, to be in their Preferred Provider Organization (PPO) Network. As their treating doctor, or as a potential doctor in the network, you want to be there for the patient. Before signing any PPO or managed care contract, you have to make sure that your decision is a sound business decision more than an emotional decision. I often will be sent an unsolicited proposal from a PPO network to be in their network. On other occasions, I may call and ask the insurance company to send me a contract, if one of my patients has a PPO that I am not in their network. Every doctor should keep in mind that you must read the contract first and decide if involvement in the PPO network is right for you. Interestingly, I find that in some networks, I am actually reimbursed better if I am not in their network. In others, I find that the contract is so restrictive that it is as if I am being punished to be associated with the PPO. It is advised that you carefully read any PPO contract before signing it. In many cases, you may wish to consult with an attorney for any legal ramifications in the contract. Below are a few contract provisions that may give you cause for concern. 1. Chiropractic services limited only to the neuromusculoskeletal system. These may limit your role as a primary provider, which is allowed in the sate of Illinois. Treatment is disallowed for conditions such as asthma, constipation or otitis media. 2. Limitation of the number of visits a patient may be seen throughout the year or for a given condition, regardless of the need for care or progress in their condition. 3. Reimbursement rates that require a PPO discount that is greatly below charges that are considered customary and reasonable for your locality. 4. Provisions that do not pay for examinations or re-examinations. 5. Requirement to use only certain forms provided by the managed care organization, and that all others that you may utilize become null and void. 6. Demand by the managed care organization to allow inspection of any financial or administrative records of the doctor’s practice 7. Provisions to demand certain hours of operation of the office or of your office location. 8. Provisions that demand electronic billing, even if you do not use any type of electronic billing. 9. Restriction as to the use of x-ray procedures. 10. Restriction that prohibits you from using a legal service or collection agency for collection of delinquent patient accounts. 11. Restrictions that prohibit you to bill the patient in any manner for services rendered. 12. Agreement to provide medical records copies at no charge. Illinois law allows fees to be charged for reproduction of records in most cases. 13. A contract that restrains you in any way after the termination of the contract. 14. A contract in which allows the company to release or sell your information to other PPO networks. Often, if you join one network, another network will automatically enroll you without your approval of their contract. 15. Contracts that pay no benefit whatsoever to the chiropractor or to the patient. The patient pays the fee to the chiropractor minus the discount. A managed care contract is an agreement between you and the insurance company. The restrictions and provisions listed above should give you cause to carefully consider any contract before you sign. This body of work is not to be misconstrued as legal advice, but only to demonstrate the need for you to read the contract before you sign it and to engage appropriate legal counsel. For an Audience of One, Dr Kris Sargent Chiropractic Physician RESTOR Healing Centre 416 East Roosevelt Rd Wheaton, IL 60187 630.682.5090 office 630.269.5171 cell

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ISCA REPORT

DECEMBER 2009


HIP UPDATE: CHIROPRACTORS MUST ENROLL IN THE HIP PROGRAM TODAY Spinal manipulation is not included in the Chiropractic services that are reimbursed under the Healthy Indiana Plan! Consequently, only 34 Indiana DCs have signed up to participate as providers. The State of Indiana sees the low enrollment as an indication that Chiropractors do not care if they are included in the HIP plan. The State uses this low number as an argument with Legislators and others against including all chiropractic services. Even though spinal manipulation is a non-covered service, other services covered under HIP that are within a chiropractor’s scope of practice include examination, x-rays, and physical therapy. The ISCA URGES you to sign up for the HIP Program TODAY! We are working hard to have spinal manipulation added to the chiropractic services in the Healthy Indiana Plan but we need your help. We need every DC in Indiana to enroll in HIP to show the FSSA our commitment to providing the best care to HIP patients. Please follow the steps below to enroll TODAY! Q. How do providers enroll in HIP? A. Providers must enroll as an Indiana Medicaid (Indiana Health Coverage Programs, IHCP) provider and must be affiliated with one or more of the HIP insurers. • To enroll with Indiana Medicaid, call 1-877-707-5750 or go to www.IndianaMedicaid.com • For MDwise with Americhoice provider network information call Sherri Miles at 317-829-5532 or Dan Westlake at 317630-2838. • For Anthem Blue Cross Blue Shield provider network information call 1-800-455-6805. Provider FAQs: http://www.in.gov/fssa/hip/files/providerfaqs1106.pdf

INDIANA STATE CHIROPRACTIC ASSOCIATION Q&A Q: What should you do when you are getting denials from Insurance Companies for extremities manipulation claiming this is a non-covered service? A: First off, read your contract very carefully. Extremities manipulation may be a non covered service strictly to that particular insurance company. Many Insurance companies are now beginning to remove extra spinal from their covered services to fall more in line with Medicare. You can still bill it as a 98943 but be aware that it will be the patient’s responsibility to pay for the service. If you are doing more than adjusting the extremity (such as trigger point work or joint mobilization) you might be able to use the 98140 code with proper documentation and in a timely fashion (under 15 min). Patrick Russell Indiana State Chiropractic Association 200 S. Meridian St., Suite 350 Indianapolis, IN 46225 prussell@LMVconsulting.com 317-673-4245

DECEMBER 2009

ISCA MEMBERSHIP UPDATE PLATINUM MEMBERS: Duane Binder Anthony Wolf Robert J. Krause Robert W. Foster Robert W. Tennant Calvin E. Finch David S. Dyer Kenneth Ackles Christopher Nunier Charles Solano James M. Cox, II GOLD MEMBERS: Michael Gallagher Steven C. Mangas Gary R. Billingsley Robert C. Prather Michael Toney

Robert P. Maddox John S. Wagner Benoit O. Choiniere Marian F. KlaesLanham Chris J. Klaes Diane Vuotto SILVER MEMBERS: Stephen Price Michael Mungovan Mark A. Schneider Charles Cochran Thomas Stevens Peggy Solano John W. Moore Daniel J. Benko John R.

Krawchison Gerald A. Langley Eric L. Mitz NEWEST ISCA MEMBERS: Brandon Coleman Colette Hittner Shaunnon Flickinger

ATTENTION ISCA MEMEBERS HELP THE ISCA GO GREEN! Did you know that The US uses approx. 68 million trees each year to produce 17 billion catalogues and 65 billion pieces of direct mail? In an effort to do our part in cutting down on waste, the ISCA is trying to do all it can to go green, which includes, moving as close to being completely paperless as possible. Please cut out this card and return to the ISCA if you would be willing to accept your Newsletter in an electronic version only. Or email us at info@indianastatechiros.org. Yes! I want to help ISCA Go Green by opting out of the paper versions of this publication and only receiving the e-version via e-mail.

First Name: ___________________________________ Last Name: ___________________________________ Email Address:________________________________ _____________________________________________

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CONGRESSIONAL MAP OF INDIANA DIRECTORS AT LARGE David Davis, D.C. Winchester, In 765-584-3665 Drddd@aol.com Lewis Myers, D.C. Valparaiso, IN 219.464.4444 lew.myers@gmail.com Marian Klaes-Lanham, D.C. Seymour, IN 812.523.6476 drmarian@KlaesClinic.com DISTRICT DIRECTORS District One Ron Daulton, Sr., D.C. Hammond, IN 219.932.8900 reddcdr@comcast.com District Two Gerard Hofferth, D.C. South Bend, IN 574.256.1008 drhof@aol.com District Three George Joachim, D.C. Fort Wayne, IN 260.492.8811 drgeorge@aaronchiro.com District Four Peter Furno, D.C. Zionsville, IN 317.338.6464 pfurno@sbcglobal.net District Five Derek Dyer, D.C. Huntington, In 260.356.1616 drderekdyer@gmail.com District Six Matt Howard, D.C. Muncie, IN 765.254.9481 info@howardchiro.com District Seven Diane Vuotto, D.C. Indianapolis, IN 317.898.6989 vuottojd@comcast.net District Eight Shaun Tymchak, D.C. Newburgh, IN 812.858.1008 drshaun@newburghchiro.com

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District Nine Nate Unterseher, D.C. Seymour, IN 812.524.2273 drn8@live.com

District Eight Michael Toney, D.C. Terre Haute, IN 812.232.1464 Flopper1968@hotmail.com

ALTERNATE DIRECTORS AT LARGE

District Nine John Krawchinson D.C. Seymour, IN 812.524.2273

James Galyen, D.C. Scottsburg, IN 812.752.6202 iubigpig@msn.com C.C. Paprocki, D.C. Greenwood, IN 317.535.7507 John Volbers, D.C. Indianapolis, IN 317.299.3330 ecchiro@cs.com

ALTERNATES: The ISCA by-laws allow for the Directors at Large and the District Directors to have Alternate Directors. The Alternate At Large Directors may reside anywhere in the state. The Alternate District Directors must reside within their district. There are 9 districts and their boundaries are the same as per the national census. This is done to keep the Districts in line on a proportional basis. When the Directors are not present, the Alternate Directors have the full voting powers as the Directors and may take their place at any meetings. This system was initiated to involve more people in the association’s decision-making process and to serve as a training ground for future board members. The Alternate Directors at Large are nominated by the Directors at Large and then must be approved by the Board of Directors. The District Director Alternates are recommended by the District Directors and approved by the board.

ALTERNATE DISTRICT DIRECTORS District One Chris Hayes, D.C. Crown Point, IN 219.661.8680 hayesfamilydc@hotmail.com District Two Bill Garl, D.C. Bremen, IN 574.546.1111 w.garl@comcast.com District Three Jason Russell, D.C. Fort Wayne, IN 260.483.5588 jdrussell10@hotmail.com District Four Garry Fuller, D.C. Brownsburg, IN 317.852.8885 gtdlf@netcapade.com District Five David Frischman, D.C. Wabash, IN 260.563.8476 ccincpc@comcast.net District Six Vacant District Seven Sheila Wilson, D.C. Indianapolis, IN 317.297.8800 indysportdoc@iquest.net

ISCA REPORT

DECEMBER 2009


2010 SPRING CONFERENCE

FEBRUARY 19-21, 2010 Holiday Inn North at the Pyramids 3850 N. Depauw Blvd. Indianapolis, IN 46268

Do Your CA’s Have the Training and Systems to Build Your Practice? How well do your CA’s:  Keep patients on their recommended care schedule?  Collect pre-payments for care?  Ask for referrals on a daily basis?  Ensure that new patients don’t slip through the cracks?  Educate patients about the value of chiropractic care?  Coordinate marketing events to increase retention?  Maximize third-party collections?  Create a “wow” experience for everyone in your practice? The A.C.E. Program develops your CA’s into your Greatest Practice Asset for just $97 per month or less!** Get the CA training, coaching and systems you need via tele-seminars—no travel expenses. Enroll today.

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Kim Klapp, CA


INDIANA STATE CHIROPRACTIC ASSOCIATION CLASSIFIEDS PRACTICES FOR SALE Southside Indianapolis. Established 14 years. Located in professional building with Dentist, MDs and MRI facility. High growth community near St Francis Hospital. Gorgeous, open floor plan with rehab area, part time PT and fulltime LMT. 1000 visits monthly. 17 hr work week. Contact drmchiro@aol.com Posted 10/22/09 (M) Perfect opportunity for a new practitioner or someone looking for a satellite office. Established practice located in Peru Indiana (215 W. Main). 1 Exam room, 2 tables, and waiting room furniture included. Willing to negotiate. Contact Dr. Smelser at 765-4727610. Posted 10/17/09 (M) Practice which pays for itself and a doctor's paycheck! Collections about ÂźM per year. Small town practice. Doctors semi-retired. With down payment and contract, owner carries paper for associate doctor ready to own and grow. Contact tabascoi812@ hotmail.com Posted 09/17/09 (M) Nice office on NW side of Indianapolis for sale. Good mix of PI and Insurance. Office has new equipment including, Kodak Digital CR x-ray processor with 37" LCD TV for viewing x-rays, X-ray machine, Back Project's ATM-2, 1 Hydro-massage table, 4 Intersegmental traction tables. Drop adjusting table. Necksys and Synergy low tech rehab, 2 exam rooms, open adjusting/ rehab area. Office has been established 16 months and sees around 400 patient visits per month on a 3 1/2 day week. Office markets well and is in a very visible location. This office is NICE!! Call 317-4647530 or email drspine26@yahoo.com Posted 05/27/09 (M) Excellent Opportunity for a Chiropractor in a newer 2,000 sq ft , state of the art clinic located in beautiful Fishers, Indiana. This turn key office is ready to go for a nominal amount. The current DC/Owner is looking to downsize. If you have excellent credit the current owner is willing to transfer office and equipment lease over to you. Equipment includes Cervical/Lumbar Decompression, Digital X-ray, Cold Laser Therapy, Hill Flexion Distraction Tables, Open Bay Physiotherapy. and more! Call (317) 607-0464 or email: ChiropracticWellness2009@gmail.com

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if interested in learning more. Visit www. fishersfind.com to learn more about the fantastic demographics and location. Posted 05/27/09 (NM) ASSOCIATES AVAILABLE Seeking part-time or full-time associate position. Very good rapport with patients and comfortable with fast-paced office. Mainly diversified technique, but comfortable with others. Adam Davis, DC (812) 767-0394 or dradamdavis@yahoo. com Posted 9/29/09 (M) Seeking Part-time Associate Position. I am available on Tuesdays and Thursdays. I work in my own office on the other days. Excellent adjusting and people skills. Comfortable with high volume. Diversified technique. References available. Email me at ckwhitemandc@sbcglobal.net or contact me at my office. Dr. Chris Whiteman (765) 864-1877. Posted 5/18/09 (M) ASSOCIATES WANTED Associate position available at vibrant, busy 30-year practice. Located in beautiful, recession-proof Bloomington, home of Indiana University. Newly remodeled clinic with exceptional visibility. A chiropractor will see more patients, earn more income, and work less hours in this position compared to starting a solo practice. Send CV resume to normhouze@comcast.net or 2501 E. Third St. Bloomington, IN 47401. Posted 12/10/09 (M) Chiropractor wanted for a beautiful clinic in Fishers. Must be highly energetic, confident, a good communicator and willing to put in the time and effort to market and build a successful practice. Pay will be based on production. Come be part of a great team of four chiropractors, two massage therapists and a great staff. Please respond to drhatfielddc@yahoo.com. Posted 12/03/09 (M) Licensed or soon to be licensed Associate Doctor needed for busy Northwest Indiana chiropractic office. Great location, in a growing practice, located less than an hour from Chicago. Please send resume to chirodan@comcast.net or call 219-7763781. Posted 10/28/09 (M)

ISCA REPORT

Excellent position open for the right doctor in our expanding wellness center. Must be wellness focused with integrity and strong personal ethics non negotiable. Nine year established practice. Email resume and vision statement to jcjchuffman@ yahoo.com - East central Indiana. Posted 10/1/09 (M) Associates needed to run busy Satellite clinics across the U.S. Self-motivated Clinic Directors needed for busy practices. No previous experience needed, but must be driven and eager to learn all aspects of running your own Chiropractic clinic. Income starts at $60,000/year, but bonuses create unlimited income potential. Paid training, vacation time and health insurance are just a few of the added incentives. If interested, please email your resume/CV to Rebecca at Recruiter@careersinchiro.com Posted 8/25/09 (NM) Indiana Associate/Partner wanted for either of 2 new practices planned to open late summer in Indy area. Must be a leader, goal oriented, confident, task oriented, self starter, good communicator, willing to put in the time and effort to market and build a successful practice. Visit www. spinallogicchiropractic.com and call Dr. Mike 317-340-4368 Posted 07/01/09 (NM) Indiana licensed Associate/Partner wanted, must be a leader, goal oriented, confident, task oriented, self starter, good communicator, willing to put in the time and effort to market and build a successful practice, who is willing to work as a associate then earn your way to partner with a large upscale chiropractic clinic in suburb of Indy. See - www.spinallogicchiropractic. com and then call Mike 317-340-4368. Posted 07/01/09 (NM) Southern Indiana - Excellent opportunity at an established chiropractic office of 20 years in a small town in southern Indiana. Work independently but benefit from successful 3 affiliated clinic's shared expertise. Email resume to tenaxinc@fuse. net. Posted 6/26/09 (M) VACATION DOCTORS Available for short term or extended absences. Great people skills and

DECEMBER 2009


INDIANA STATE CHIROPRACTIC ASSOCIATION CLASSIFIEDS comfortable with fast-paced office. Please contact Adam Davis, DC (812)767-0394 or dradamdavis@yahoo.com Posted 9/29/09 (M) Office Coverage: Traveling Chiropractors, America's first Chiropractic employment agency, has been Providing quality, caring Temporary and Associate Doctors nationally for over 25 years. Call 1-800-624-8876; or visit our web site @travelingchiropractors. com Posted 8/12/09 (NM) Vacation - Fill-in, Etc. I have sold my practice in Iowa and am moving to Indiana. Logan grad and 40+ years experience with multiple techniques specializing in extremities. Call Dr. Larry Phipps at 641751-7755. Posted 8/7/09 (M) Vacation, Maternity Leave, Seminar Fillin, Etc. Palmer graduate, 20+ years of experience, licensed in Indiana, NCMIC insured. Proficient in multiple techniques; diversified, activator, soft tissue, drop, flexion/distraction, basic. Able to travel statewide. Excellent adjusting & people skills. Call Dr. Guest - 317-462-0022 or email drvgpnow@yahoo.com. Posted 6/8/09 (M) Fill-in/Vacation relief Doctor! Licensed in Indiana & Kentucky, Multiple techniques, $400.00 a day. Contact Bill Overstreet, D.C. (765) 480-6283 or bojostreet@hotmail.com Posted 5/27/09 (NM) Vacation Doctor - Do you want a day off? Available Tuesdays and/or Thursdays. I work in my own office on the other days. Excellent adjusting and people skills. Comfortable with high volume. Diversified technique. $400 a day base fee. References available. Email me at ckwhitemandc@sbcglobal. net or contact me at my office. Dr. Chris Whiteman (765)864-1877. Posted 4/28/09 (M) EQUIPMENT FOR SALE -X-RAY SUITE for sale: Chirotech 300/125 Anatomical Generator, rare earth screens, Bolan type filtration system, total floor footprint 4 X 6 feet, ~600 shots on new Varian tube, add digital tomorrow. Automatic computer/digital calculations on LCD Illuminated control board. ***Qualifies for huge section 44 tax reduction*** Electrical components for connection equipment

DECEMBER 2009

included. All darkroom accessories also included EXCEPT processor which is also available. Pictures on request. NEED ROOM FOR REHAB !! MUST SELL!! $7,800.00 or best offer! Call Dr. Gary Shaw at (317) 507-1376. ALSO AVAILABLE Custom grey oak 36 X 48 viewbox Indestructible Kodak 100 processor w/ extra heat element and motherboard Removable wall leading & 3 sliding lead door/window shields. Associate foot scanner (unopened) from Foot Levelers. Posted 11/30/09 (M) Omni elevation table in perfect condition for $4500. The table has been recently re-upholstered (blue) and has all drops. This table will last forever, one of the best made tables on the market. Great time of year to get the elevation tax credit. Email drdc@ compassindy.com for more information or pics. Posted 11/11/09 (M) Lead Barrier - 10x72 joined to 26x72 with 8x10 window, plywood based on both sides for $100. Call Dr. Hal Miller 574-295-7250. Posted 10/28/09 (M) Like NEW Triton DTS decompression system complete with lumbar and cervical decompression and patient treatment cards. Purchased in 2008 for 10K, only used with three patients, excellent results. Will sell for 8K. Call Dr. Huffman @ 765 593-9355. Posted 10/1/09 (M) Office Equipment for sale, everything must go. Zenith Hi-Lo Table $2500, 2 SOT flat adjusting tables-$75 each, Exam Table $50, Amrex Low Volt Therapy Unit-$300, 3 Chiropractic Pictures-$15 each, Reception Area Chairs-$15 each, Bilateral Scales-$50 If interested call (219) 798-6410 and ask for Matt. Posted 7/27/09 (NM) Chattanooga Intellect Legend Combo EStim Pre-mod, Russian Stim, IFC, high Volt, Ultrasound Machine is like new. 3 years old, but hardly used. Selling b/c I do not use it at all anymore. $3000 Brand new. I will sell for $1500 to get rid of it. Contact Mark Jones at 317-867-4323 or drjones@joneshealth. com Posted 7/8/09 (M) -X-Ray Unit and Processor - Fisher 300/125 xray unit with 14 x 17 cassette holder and Alphatek Cold Water Processor . 7x17, 14x17 and 8x10 cassettes included $6000 OBO. Contact Dr. Bob Graham 616-5307474 or spinalcare08@sbcglobal.net

ISCA REPORT

Posted 05/04/09 (NM) Mobile Lead Barrier 30" X 72" with 8" X 10" window $650.00. Contact w.garl@mchsi. com or 574-546-3435. Posted 05/01/09 (M) Complete Bennett X-Ray Room Equipment & Accessories (processor needs motor)14x17 high frequency autotech, asking $6700.00; 4-Tier X-Ray File Shelves, $175.00; Petecto Scales, $75.00; X-Ray Copier, $175.00; 2 3-Panel Screens, $125.00, 2 Standard Therapy Tables (Walnut Finish), $275.00. Call Dr. Jim Ebler at 812-397-2981. Pictures can be emailed to interested parties. Posted 4/22/09 (NM) Hands Free Ultra Sound Machine, and a Rehab Exercise Machine for Back/Hip. All in great condition. Call SpinalAid at 317-2724100. Posted 4/15/09 (M) POST A CLASSIFIED AD ISCA members may place classified ads for free and will run for two consecutive issues unless otherwise requested. ISCA Report: Quarterly Member Printed Newsletter Deadlines are for ads to be included in the printed version of the ISCA Report Classified ads will also be posted online until the next issue’s deadline. March Issue Ad Submission Deadline Feb 25 June Issue Ad Submission Deadline May 25 DECEMBER Issue Ad Submission Deadline August 25 December Issue Ad Submission Deadline November 25 To place a classified ad visit us online at www.indianastatechiros.org or call 317.673.4245.

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ISCA Report

200 S. Meridian St. Suite 350 Indianapolis, IN 46225 317.673.4245 www.IndianaStateChiros.org

PRSRT STD U.S. POSTAGE PAID INDIANAPOLIS, IN PERMIT NO. 779


ISCA Winter Newsletter 2009