The Wisconsin Chiropractor, Fall 2023

Risks and Benefits of Selling to a Corporate Buyer

Dr. Ray Foxworth, DC, FICC | Founder and CEO of ChiroHealthUSA

Passing your practice to a corporation could mean renewed growth and opportunities. It could also be a step backward. Consider these pros and cons before selling to a corporate buyer.

The Benefits

Greater Expansion and Compensation Opportunities

Joining a corporate “family” can greatly increase your resources and reach. Their existing network of professional connections and customers may be accessed to your benefit, boosting exposure and revenue. You may also find that a corporation is able to offer improved benefits and incentives to employees.

Your Patients Could Receive Better Service

The potential for a corporate-owned clinic to have access to superior equipment and methodology translates directly to a better patient experience. New or improved technologies could unlock a more diverse range of services allowing you treat new patients while helping existing ones more effectively.

Improved Work/Life Balance

Some corporate deals allow practice owners to keep working in the clinic at reduced capacity. This lets them stay connected to a business they worked to build, while letting them step away more often to expend energy in other professional and/ or personal areas.

The Risks

Corporate Due Diligence (and Lack of Your Own)

Every chiropractor knows the feeling of intense regulatory scrutiny. Those are arguably less severe than the eyes of corporate buyers who’ll be looking into every aspect of your business for the slightest flaw.

Any weaknesses in your past and present compliance structure, company policy, or documentation can and will be used to reduce what you gain from the sale or even sink it entirely. It’s essential to review these deal-breaking areas and make them as strong as possible before considering a corporation. You can request a free gap analysis from ChiroArmor.

Chiropractors must also rigorously research corporate buyers. One essential step is speaking to other chiropractors the corporation has previously acquired to discuss how their agreements went. It’s a big risk to sign any deal if the corporate buyer refuses to provide that contact information.

Holdbacks

Any practice sale could be subject to holdbacks – portions of the sale price retained as a form of insurance for the corporation until certain post-sale conditions are met. Holdbacks can prevent nasty surprises for corporate buyers, while adding significant pressure and risk for sellers.

Terms can vary and may include the practice performing at a certain level for a set period after the sale, key employees staying with the business, or proving to be as well-regulated and compliant as you appeared pre-sale.

Satisfying holdback provisions will see this financial retention released. Underperformance means a pronounced risk – if not a guarantee – of losing it. The better organized your clinic, the lower you can reasonably expect holdbacks to be. This is by no means a rule. Weigh the danger of how much you stand to lose; meeting holdback conditions isn’t always within your control.

Inability to Disengage

It’s now no longer your business. Imagining and living

continued on page 7

Risks & Benefits - Cont. from page 5

this reality are different, and some ex-owners may find their diminished influence on the practice’s future harder to bear than anticipated. This feeling can be lessened by joining a corporation with a similar company culture. Aligning with one that doesn’t share your values is more than a risk – it's a recipe for regret.

Disengaging from ownership can be tough. Doing so from the agreement itself can be a long and arduous process (if it’s even possible) without legal forethought. Sellers should include a get-out clause in the Letter of Intent that allows them some form of payment should they step away from the partnership under pre-determined and mutually agreed-upon terms.

Whether your exit strategy includes selling to an associate or even corporation, it is important to know the risks and benefits. Additionally, it is never too early to think about your exit strategy. Your practice is likely a huge part of your retirement planning. For more information on selling your practice now or in the future, you can watch the webinar recording presented by Dr. Tom Necela in March of this year, by clicking here!

Dr. Ray Foxworth, DC, FICC, is founder and CEO of ChiroHealthUSA. For over 35 years, he worked "in the trenches" facing challenges with billing, coding, documentation, and compliance, in his practice. He is a former Medical Compliance Specialist and currently serves as chairman of The Chiropractic Summit, an at-large board member of the Chiropractic Future Strategic Plan Committee, a board member of the Cleveland College Foundation, and an executive board member of the Foundation for Chiropractic Progress. He is a former Staff Chiropractor at the G.V. Sonny Montgomery VA Medical Center and past chairman of the Mississippi Department of Health.

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Chiropractic Medicare Coverage Modernization Act

H.R. 1610 and S. 799, Chiropractic Medicare Coverage Modernization Act have been introduced in their respective chambers, and co-sponsors are needed for both bills. These bills expand patient access to Medicarecovered benefits within a chiropractor's scope of practice.

The Chiropractic Medicare Coverage Modernization Act of 2023 (H.R. 1610), legislation that would ensure that Medicare beneficiaries have full access to all the services a chiropractor can provide under their state’s chiropractic scope of practice, was introduced in the U.S. House of Representatives on March 14, 2023.

H.R. 1610 is bipartisan legislation that would allow the nation’s more than 63 million Medicare beneficiaries to receive the full range of chiropractic care, not just manual manipulation of the spine to correct a subluxation, as has been the case since 1972.

The Chiropractic Medicare Coverage Modernization Act of 2023 (S.799), is legislation that would ensure that Medicare beneficiaries have full access to all the services a chiropractor can provide under their state’s chiropractic scope of practice, was introduced in the Senate on March 14, 2023.

S.799 is the Companion Bill to H.R. 1610 and is bipartisan legislation that would allow the nation’s more than 63 million Medicare beneficiaries to receive the full range of chiropractic care, not just manual manipulation of the spine to correct a subluxation, as has been the case since 1972.

What is H.R. 1610?

What is S. 799?

How You Can Help? 2 Minutes to Take Action.

We are asking all Wisconsin DCs and their staff to ask their Representatives and Senators to sign on to these bills. We have made this easy for you by partnering with the ChiroCongress Voter Voice tool which makes it easier than ever for you to email your Senators and Representatives.

How You Can Help.

Click the appropriate links below to email a prepared message to your Representative and Senator. You will need to click one for your Representative, and a second click for your Senator(s).

DC Forms

Contact your Senators on S.799

Contact your members of Congress on H.R. 1610

Staff & Patient Forms

Contact your Senators on S.799

Contact your members of Congress on H.R. 1610

Have You Taken Action Yet?

Click these links to email your Representative and Senator today.

Going Above & Beyond

Shout-out to the WCA members who have been meeting with their Senators and Representatives to advocate for H.R. 1610 and S. 799 to expand patient access to Medicare-covered benefits within a chiropractor's scope of practice.

Pictured L-R: WCA President Dr. Chris Resch, Dr. Shayne Bauer, Congressman Grothman, Dr. John Corsi and Dr. Ben Mikla.

Pictured L-R: Gene Gunderson, Dr. Ben Mikla, state legislative Director for Senator Johnson Tom Petri, Dr. Gene Yellen Shiring, and WCA President Dr. Chris Resch.

Dr. Alex Kocken, Dr. Chris Resch and Dr. Dan Higgins meet with Congressman Gallagher (second from left) to discuss the Chiropractic Medicare Coverage Modernization Act.

B Vitamins and Cardiovascular Health

Cardiovascular disease is the leading cause of death for men and women alike. In 2021, 1 of every 5 deaths was accredited to heart disease. Cardiovascular disease, which refers to any disease affecting the heart or blood vessels, can lead to heart attacks, stroke, heart failure, and peripheral artery disease.

Strategies to manage cardiovascular disease include maintaining a healthy weight, stress management, staying active, limiting tobacco use, and consuming a low sodium, heart-healthy diet. All of these strategies support healthy blood pressure and cholesterol levels.

While many of these strategies are well-known by the general population, there are some additional factors that may not always be considered. Vitamin deficiencies are often present in those with heart conditions, and B vitamins may play an under-examined role regarding heart health.1

Homocysteine

Homocysteine, an amino acid involved in one carbon metabolism and methylation reactions, has been associated with greater risk of cardiovascular disease when levels are elevated.2 Excess homocysteine may contribute to damage of artery linings, potentially leading to blood clots and blood vessel blockages. Daily supplementation of vitamin B9 (folate/folic acid) has been shown to be effective in decreasing plasma total homocysteine (tHcy).3 Observational studies also support that supplementation of folic acid, vitamin B6 (pyridoxine), and vitamin B12 (cobalamin) may support cardiovascular health by lowering homocysteine.3

Lipoprotein Cholesterol

High levels of low-density lipoprotein cholesterol (LDL-C) contribute to the risk of conditions like atherosclerosis as a result of LDL accumulation in blood vessel walls.4 Contrarily, high-density lipoprotein cholesterol (HDL-C) allows for reverse cholesterol transport, removing cholesterol from plaque build-ups for active reprocessing or elimination.5 Vitamin B3 (niacin) is a powerful agent for both raising low levels of HDL-C and lowering levels of LDL-C as well as triglycerides and lipoprotein (a). Low HDL-C and high LDL-C are independently associated with increased risk of cardiovascular events, and an adjunctive therapy utilizing niacin to manage lipoprotein levels may be an effective strategy for improving cardiovascular function.5

B vitamins can be obtained through both supplementation and diet. While the direct impact of B vitamin supplementation on cardiovascular outcomes is controversial, its potential role as an adjunctive therapy is a promising one—ideally inspiring future study and consideration.

References

1. Bistola, V., Filippatos, G. (2020). Hellenic J Cardiol, 61(5):338.

2. Strain, J.J., Dowey, L., Ward, M., Pentieva, K., McNulty, H. (2004). Proc Nutr Soc, 63(4):597.

3. Zhang, C., Wang, Z.Y., Qin, Y.Y., Yu, F.F., Zhou, Y.H. (2014). PLoS One, 9(9):e107060.

4. Ma, H. (2004). Nature and Science, 2(4):17.

5. Boden, W.E., Sidhu, M.S., Toth, P.P. (2014). J Cardiovasc Pharmacol Ther, 19(2):141.

The Mind-Body Connection The Mind-Body Connection

Manage the Depression and Anxiety Associated with Chronic Pain, Holistically and Concurrently

Abstract

Physical pain and depression are both costly, often chronic, conditions that significantly increase healthcare resource utilization, negatively impact the economy and decrease quality of life. Too often, however, these conditions are managed separately, or one condition is not treated at all. As a result, patients may not experience relief from their physical pain or depression symptoms, which can then exacerbate both conditions. In this paper, we describe the association between physical pain and mental health and how treating the two concurrently through chiropractic care and cognitive behavioral therapy and other evidence-based mental health treatments can deliver more optimal outcomes. We also urge healthcare providers to embrace holistic management of the patient so all conditions are treated.

Chronic pain and depression are two significant economic burdens in the U.S. Back pain and lower extremity pain account for more than $2 billion in annual healthcare spending. More than a quarter (26.4%) of American workers experience low back pain over any three-month period, which contributes to absenteeism and lower productivity. Meanwhile, a recent report from Mental Health America (MHA) shows that Americans with moderate to severe symptoms of depression and anxiety increased throughout 2020 and is higher than before COVID-19. However, even before the pandemic, 19% of adults reported experiencing a mental health condition, according to MHA, up 1.5 million people from the previous year.

The economic burden of major depressive disorders in the United States increased by 21.5% over the 10 years studied, with 45% attributed to higher direct medical costs. For every dollar of direct costs, an estimated $6.60 was spent on comorbidities, workplace costs and suicide-related costs. Finding the right pharmacotherapy for depression is often challenging due to intolerable side effects or lack of efficacy. It is estimated that each patient with depression who is prescribed three or more different medications costs $21,259 for commercial health plans and $20,964 for Medicare.

Most recently, a study of U.S. patients published in 2023 showed significant associations between back pain and major depression while a longitudinal analysis found that back pain preceded major depression at follow-up and vice versa, suggesting that one condition is contributing to the other. While little research has been conducted on the economic impact of patients with both back pain and depression, abundant research has shown how the two conditions are often comorbid and likely influence a patient’s perception of their mental and/or physical health.

'Optimizing Patient Care' at Fall Convention

Foundation for Chiropractic Progress President, Dr. Sherry McAllister, Speaking at WCA’s Fall Convention

Sherry McAllister, DC, M.S. (Ed) CCSP, serves as the President for the Foundation for Chiropractic Progress (F4CP), a national notfor-profit organization showcasing the benefits of chiropractic care through award-winning campaigns.

Dr. McAllister will be presenting, “Optimizing Patient Care Using the Latest Research-Based Outcomes,” at WCA’s Fall Convention on Saturday, September 23rd at 9:00 am. This CE course will provide you with the latest research surrounding mental health and addiction, chronic pain and how to make the best clinical decisions for your patients.

About Dr. Sherry McAllister

Dr. McAllister earned her Master’s in Science from the University of California East Bay and is a graduate of Palmer College of Chiropractic West, where she served as an Associate Professor.

Dr. McAllister served as a Qualified Medical Examiner, Expert Chiropractic Witness for the State of California and has been in private practice in San Jose since 1996.

She has been featured in several publications including: Forbes, Boss Magazine, Becker's Spine Review, Momtastic, LiveStrong, Martha Stewart Living, Managed Healthcare Executive and News Break.

She has been awarded; Top Women in Healthcare: PR News Access Intelligence, Person of the Year Dynamic Chiropractic and Chiropractor of the Year by the Women DC organization.

F4CP, celebrating its 20th anniversary, has been honored with; PR World Awards Gold Winner in Healthcare Achievement, Digital Healthcare Award for the Adjusted Reality Podcast, Viddy Award for outstanding Videography in a commercial, prestigious Telly Award for the Tokyo Olympic Advertisement and the Global Gold Marcom award for the first-ever ChiroThon Campaign.

Dr. McAllister is looking forward to seeing everyone at WCA’s Fall Conference, be sure to attend her presentation, “Optimizing Patient Care Using the Latest Research-Based Outcomes”!

Don’t miss Dr. McAllister at the Fall Convention Opening Breakfast & Celebration as well as her session "Optimizing Patient Care Using the Latest Research-Based Outcomes" on Saturday morning.

F4CP Launches New Commercial

The Foundation for Chiropractic Progress (F4CP) has produced a brandnew :30 second commercial documenting professional soccer player Olivia Athens' journey with chiropractic care.

The commercial, which launched during the FIFA Women's World Cup, has recently aired on ESPN, Fox Sports and other major networks to direct users to find a chiropractor near them.

Olivia Athens was not only the star of the commercial, but was also featured on F4CP’s Adjusted Reality Podcast, Trusted by the Adjusted.

Olivia is a professional women’s soccer player for OL Reign in the National Women’s League (NWSL). She played college soccer at UCLA where she won two Pac-12 championships. Olivia’s father, Nick Athens, is a chiropractor who has been practicing chiropractic for 41 years in Northern California. Chiropractic has had a big impact on Olivia’s health growing up and continues to be a part of her routine as a professional athlete.

In this episode, Olivia shares her TOP performance tips, plus she shares what it was like growing up with a chiropractor as a dad.

WCA members are Group Members of F4CP.

As an F4CP Group Member, you can download this commercial and use it for your practice reception room, on social media or in your patient newsletter.

To view the commercial, visit f4cp.org, click the MEDIA CENTER tab and navigate to the ‘Videos and Webinars.’

As an F4CP Member, you can use this episode in your clinic to share with your patients! To listen to this episode, visit adjustedreality. buzzsprout.com.

WHY ATTEND?

DCs: Earn up to 28 CE credits over four days! Work towards your Chiropractic Nutritional Counseling Certification with modules 2 and 3 available.

DCs, CT, CRTs: earn continuing education hours for license renewal.

Clinic Staff: Expand your knowledge and skills and earn up to 19 hours of CE. Become certified as a Chiropractic Technician!

Catch the Wave at the WCA Fall Convention 2023!

Join Us September 21-24 in Wisconsin Dells!

We are thrilled to be back at the Kalahari Resort & Convention Center for the 2023 WCA Fall Convention. The Kalahari is a favorite for our attendees and their families. There are so many activities including waterparks, arcade games, theme park, mini golf, bowling, ropes courses, laser tag...you name it, Kalahari has it!

Here is your chance to catch the wave by expanding your skills and earning CE hours for license renewal.

Tracking Your Convention CE Hours

• Course hours and approval codes are noted on the agenda.

• Be sure to sign in and out of each course you attend.

• Attend any session you wish. If your name is not listed, please add your name to the sign in sheet.

• WCA will notify you (within 10 business days) when your CE has been awarded. Instructions to download your attendance certificate will be included.

Haven't Registered Yet? There's still time!

We will accept on-site registrations this year. Don't get hit with a late fee. Registrations received after September 15 will incur a $25 late fee.

Catch the Wave Special Events

NETWORK with Convention Exhibitors

Convention attendees are invited to join us in the Exhibit Hall for lunch on Friday. This will be a great opportunity to network and mingle with WCA Exhibitors to learn about their products and services which are designed to improve your skills, enhance your business practices and build success.

BREAKFAST

Featuring Dr. Sherry McAllister

Start your day right with coffee, breakfast and special guest speaker, Dr. Sherry McAllister (Foundation for Chiropractic Progress). Reignite your passion for chiropractic, find new inspiration to become the best you can be, build your brand, and build a sense of community and common purpose.

CELEBRATE Colleagues in the Profession

The WCA has four distinguished awards for outstanding service and dedication to the chiropractic profession. Award recipients will recognized at this special luncheon. All convention attendees are invited to attend (pre-registration required).

ENTER TO WIN Corporate Partner Giveaways

Giveaways are displayed at WCA Corporate Partner exhibitor booths. To be eligible to win, simply complete the contact information card at their booth. Winners will be announced at the corporate partner booths during the Saturday afternoon break from 3:00 - 3:40 PM.

Catch the Wave Register Today!

Choose a Convention Pass that works for Your Schedule!

We will accept on-site registrations this year; however, standard convention fees apply until Friday, September 15. After this date, a $25 late fee will apply to all registrations. REGISTER NOW!

Pre-registration is required for these events.

Typical treatment time: 4-12 quick treatments over 2-4 weeks

Pain management:

- Arthritis

- Epicondylitis

- Back and neck pain

- Neuropathy

Sports injuries:

- Ankle sprains

- Knee/shoulder/elbow injuries

Skin conditions:

- Wounds

- Eczema

- Psoriasis

GigaLaser™ large-area, unattended

PowerLaser™ Pro1500 compact, battery-operated, medium-size areas

PowerLaser™ Pro500 compact, battery-operated, small/specific points

Don't Google and Guess

John Murray, Executive Director & CEO | jmurray@wichiro.org | 608-292-1803

Oneof the toughest things for me as a parent is finding ways to offer help to my teenagers without seeming like I am always telling them what to do. As they say - its all in the presentation.

A few years ago, the WCA engaged a marketing consultant to help us better determine the needs of our younger members. The result were interesting to say the least. There is no question that the younger generation of chiropractors are unique. They want greater work-life balance, they communicate differently and they approach their profession and practice differently. As a state association, we work hard to recognize the unique likes and dislikes of all of our members and tailor our services and communications appropriately.

The feedback we received from younger members coupled with the lessons of the pandemic informed a number of changes to the way we communicate with all of our members, particularly our younger doctors.

1. Better organization of WCA website resources

The WCA has a lot of great resources available to members at www.wichiro.org. We found that while members were utilizing those resources, they needed to be better organized and easier to find. This also spurred us to start the process of upgrading our website which is coming soon.

Our bi-weekly “Need to Know” series has been well received but we needed to organize all past releases on the website in a manner that is easier to search.

Under the Member Benefits tab, there is a page called Communications Archive. On this page, you will find all past editions of both the bi-weekly Need to Know series and The Wisconsin Chiropractor magazine. Check it out here and let me know what you think.

it in a way that meets the standard of care in Wisconsin and state rules and regulations is another thing. As we say at the WCA, don’t Google and guess.

Contact the WCA Help Desk and we can verify that you have the correct information and are applying properly in your clinic.

2. Connect with experienced chiropractors.

This one can be little more tricky in that some young chiropractors who work in a clinic with other chiropractors might find awkward or not feasible to ask for help. The WCA can connect you with an experienced chiropractor who is not competing with you in your market and can be a clinical and business resource.

Just being able to call, email or text an experienced colleague through the WCA Help Desk to bounce things off of has huge value. Let the WCA help you make that connection and get the resources you need to make the right decision in your clinic.

Don't Google & Guess

We also recently started a communication series called “Don’t Google and Guess.” During our focus groups with younger members, we found that they consistently relied on information from classmates, colleagues and searching topics using Google on both clinical and business issues.

We certainly encourage collaboration with classmates and colleagues. It is also appropriate to utilize resources from the internet provided they are credible and properly sourced. But do you really want to risk the health of your patient, risk your license or a malpractice lawsuit because you relied on something you found on the internet without confirming its veracity with a WCA subject matter expert?

Furthermore, generic information about a clinical or business issue can be a good starting point but actually implementing

3. The world is run by people who show up.

We are all busy. I totally understand that making time to attend in-person events can be a challenge. But we make time for what it important.

We don’t expect young doctors to have time to attend every WCA district meeting or attend both the spring and fall conventions. But professional connectivity and esprit de corps happens when you engage with other chiropractors inperson and most times over food and beverage. I know that sounds like an antiquated concept in the digital world but you work in a hands on profession, face to face with your patients.

Consider making time to interact with your fellow chiropractors young and old - face to face. It will be worth your while.

continued on page 26

Communications Archive

Why take unnecessary risks with your license, the threat of a malpractice lawsuit, or the frustration of not getting paid?

With your WCA membership, you have exclusive access to the WCA Help Desk, consistently ranked as one of the top member benefits. Below, you'll find a sample of a common Frequently Asked Questions at the Help Desk.

MEDICARE: Why isn’t the Medicare payment of 80% taken from my full charge?

A: Medicare will only pay 80% of the allowed amount, which is the agreed-upon fee schedule. When a provider enrolls with Medicare, whether participating or nonparticipating, they agree to the Medicare allowed amount that corresponds with their participation level. From that fee, they will pay 80% of services that they determine to be payable.

Read WCA Medicare FAQs

WCA Subject Matter Experts Are Here to Help!

Our Help Desk consultants are subject matter experts and are here to empower you. Whether you choose to connect with our expert consultants by phone or explore our online resources, we're dedicated to helping you overcome any challenges you may encounter!

We hope you will consider joining the WCA today!

Unlock Access to WCA Help Desk

4. Utilize the experience and expertise of instructors who teach continuing education. Speakers tell us they want chiropractors who take their classes to reach out to them afterwards with questions. You paid for the class, take advantage of those speakers who will be an ongoing resource.

5. Health care provider burn out is real - take time to take care of yourself.

Survey after survey shows that health care providers around the globe are experiencing burnout at a high level. Chiropractors young and old are not immune to burnout. You not only have to manage the clinical aspects of treating your patients but you also have to manage the business side of running a practice in ways that many other providers don’t. Don’t ignore signs of burnout and get the help you need to maintain your work-life-health balance.

The long term health of the chiropractic profession depends on all chiropractors and their staff being healthy and successful, particularly our young doctors. Just making it through the first 3 years in practice can be an enormous challenge. Young DCs do not have to go to alone on everything. To use corny phrase in our profession, we have your back.

Resources to Check Out

Here are some great resources from our valued corporate partner NCMIC.

9 Ways to Take Care of Your Mental Health

Your CA Can Make or Break Your Practice

~ John Murray WCA Executive Director and CEO

P.S. - I believe in putting my money where my mouth is - my personal cell phone is 608 609 1130. My email is jmurray@ wichiro.org. Call, text or email me any time on any topic.

The WCA Help Desk can be reached at wcahelp@wichiro.org or by calling WCA Help Desk Director Tammy McKeown at 608 292 1804.

Tammy McKeown, C.T. | Membership Services Director | wcahelp@wichiro.org | 608-292-1804

Complimentary Member Webinar

It's that time of year again, avoid denied claims!

The WCA Help Desk presents the ICD-10 updates for 2023. The changes that will be covered during this webinar, will go into effect October 1st 2023. Dr. Evan Gwilliam will cover all that you need to know about changes that will affect Chiropractic/Chiropractic claims. This webinar is perfect for Doctors, Staff and Billers.

Wednesday September 27 | 12:00 - 1:00 pm | Online

Via Zoom | Not for CE credit

Presented by: Evan Gwilliam, DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP

Dr. Gwilliam, Clinical Director for PayDC Chiropractic Software, graduated from Palmer College of Chiropractic as Valedictorian and is a Certified Professional Coding and ICD-10 Instructor, Medical Compliance Specialist, and Certified Professional Medical Auditor. Because he is also a clinician with a Bachelor’s degree in accounting and a Master’s of Business Administration he is a soughtafter seminar speaker. He provides expert witness testimony, medical record audits, consulting, and online courses for health care providers and has authored and contributed to reference books and articles for multiple publications.

Sponsored by: Infinedi Electronic Data Interchange

Billing and Documenting for Therapeutic Exercises versus Therapeutic Activities

By Evan M. Gwilliam, DC MBA QCC CPC CCPC CPMA CPCO AAPC Fellow | Clinical Director, PayDC EHR Software

Chiropractors treat, among other things, issues with the musculoskeletal system. Active therapeutic procedures are accepted as effective ways to treat many common conditions and therefore can be billed and generate revenue for a clinic. Two common CPT codes that might be used in a chiropractic setting include:

97110

Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility

97530

Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes

Though Medicare does not reimburse chiropractors for either of these codes, understanding their policies in relation to these services is wise since many private payers follow Medicare standards. Medicare states that, “Therapeutic procedures are procedures that attempt to reduce impairments and restore function through the application of clinical skills and/or services.” So, first and foremost, in order for either of these services to be justified, there must be some sort of functional loss and the service must provide functional gains, requiring the skills of someone who knows what they are doing.

There are several other things that these codes have in common:

• Codes in the Physical Medicine and Rehabilitation section of the CPT code book are not limited to any particular specialty group. That is, they are not just for physical therapists.

• These codes require one-on-one contact, usually with a licensed provider, but some state scope of practice and some payers allow for delegation to unlicensed individuals. Check with your insurance plans and state board to be sure before allowing unlicensed individuals to perform these services.

• These codes are time-based, in 15-minute increments.

o Per the Medicare 8-minute rule, which is the accepted standard for most carriers, a minimum of 8 minutes must be completed to bill for the first unit. Less than 8 minutes is not billable.

o To bill for two units of either of these codes (or both of them at the same encounter), the total time must be at least 23 minutes (8 + 15).

o In the CPT code book there is a different method for calculating time-based codes; verify with the payer if in doubt.

• Some payers require modifier GP to be added to this code on the claim form. This tells the payer that there is a therapy plan in place for the code. If your records are reviewed, and you used the GP modifier, make sure you clearly have a plan around the service and it was not just arbitrarily added to an encounter with no clear purpose.

• Therapeutic procedures are often billed as part of an ongoing series of encounters. It is essential to periodically document progress. It might be wise to link a documented goal to each procedure and comment on the progress of that goal as it relates to the service billed, every 2-3 visits, and in greater depth at a re-exam or discharge exam.

• The specific exercise or activity needs to be documented. Think of the record as a script for a play. If it contains enough information to re-enact the encounter, then it is sufficient. Otherwise, it may be lacking.

• Each service must include documented functional progress continued on page 31

at reassessment and discharge. If no progress, the reason for lack of progress needs to be documented and/or an alternative treatment strategy.

Although Medicare does not pay chiropractors for 97110, we can learn from their policies. LCD L35036 tells us that:

“Therapeutic exercise is designed to develop strength and endurance, range of motion, and flexibility and may include: active, active-assisted or passive (e.g., treadmill, isokinetic exercise, lumbar stabilization, stretching, strengthening) exercises. The exercise may be medically reasonable and necessary for a loss or restriction of joint motion, strength, functional capacity or mobility that has resulted from a specific disease or injury. It is considered medically reasonable and necessary if an exercise is taught to a patient and performed by a skilled therapist for the purpose of restoring functional strength, range of motion, endurance training, and flexibility. Documentation must show objective loss of joint motion, strength or mobility (e.g., degrees of motion, strength grades, levels of assistance). This therapeutic procedure is measured in 15-minute units with therapy sessions frequently consisting of several units.

Many therapeutic exercises may require the unique skills of a therapist to evaluate the patient’s abilities, design the program, and instruct the patient or caregiver in safe completion of the special technique. However, after the teaching has been successfully completed, repetition of the exercise, and monitoring for the completion of the task, in the absence of additional skilled care, is non-covered.”

The takeaway is that if the documentation shows that the patient has a loss of strength, range of motion, endurance, or flexibility, then 97110 can be justified. However, the treatment goals for exercise should clearly document anticipated improvement in those same parameters.

If we look at CMS policies (see LCD L35036) regarding 97530 we learn that:

“This procedure involves using functional activities (e.g., bending, lifting, carrying, reaching, catching and overhead activities) to improve functional performance.

The activities are usually directed at a loss or restriction of mobility, strength, balance or coordination. They require the professional skills of a qualified professional and are designed to address a specific functional need of the patient. These dynamic activities must be part of an active treatment plan and directed at a specific outcome.”

For 97530, the record needs to document some sort of loss of the ability to perform activities and explain how the procedure restores that loss. The activity description would often include a verb ending in “ing”. The patient’s condition should be such that he/she is unable to perform therapeutic activities except under the direct supervision of a physician or physical therapist. Related diagnoses might include:

Loss of strength (M62.81)

Loss of balance (R27.0)

Loss of coordination (R27.8)

97110 focuses on one parameter, such as strength. 97530 takes things to the next level and focuses on some activity that may be dependent on multiple parameters in addition to strength. For example, shoulder strengthening exercises might be billed as 97110, but tossing a ball against a trampoline and catching it, which focuses on multiple parameters, would be 97530.

In a clinical setting, a patient may begin care with stretches to improve ROM (billed as 97110). After four weeks of stretches, and the goals are reached, perhaps care starts to focus on strengthening exercises due to findings of weakness in the initial exam. This would also be billed as 97110. Once the strength goals are reached (maybe after another four weeks), the new procedure could focus more on the dynamic activity of lifting boxes, which would then be billed as 97530.

When deciding which code is more appropriate, make sure the documentation includes objective findings that line up with the official code description, and goals that focus on the parameters that are outlined by the code and the payer and CPT guidelines above.

About Dr. Gwilliam

Dr. Evan Gwilliam is a certified coder, auditor, and compliance officer. He trains clinicians on how to create rock solid records with PayDC, which is a dynamic cloud based EHR software. If you would like to learn more, email him at evang@paydc.com.

YOUR PARTNER IN CHIROPRACTIC IMAGING

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WCA Continuing Education Opportunities

Stay In The Know!

If you are planning to attend a WCA CT Certification Course, here’s the process for becoming Licensed. The Department of Safety and Professional Services has a new on-line licensing platform called LicensE.

In order to receive your CT license, you must follow these steps:

If you ALREADY have a LicensE account, DO NOT setup a second account. Skip the instructions and go to “Last and Final Step” (last page) to document your Application number (Par Number).

If you DO NOT have a LicensE account, follow these steps:

• Apply for your CT license through LicensE (https://license.wi.gov)

• Document your Application number (Par Number)

• Bring your Application number to your CT class.

Watch Webinars at Your Convenience! A WCA Member Benefit.

The following previously-held webinars are available for WCA members to view on-demand. Note: recordings do not count for CE.

CT Licensing Instructions

WCA 2023 Fall & Winter CE Schedule

Can't make it to the Fall Convention? Don't worry, we've got you covered. Earn continuing education credits towards license renewal or certification with these courses lined up for fall and winter! Registration now open!

Online Registration

Chiropractic Radiology Technician

September 30-Oct 1; Oct 21-22; November 4-5

48 CE CRT

Location: Madison

Instructor: Dr. Wendy Varish

Fundamentals of Exercise Rehabilitation

Saturday & Sunday, October 7-8 | 8 AM - 8 PM

24 CE DC/CT

Location: Yeomans-Edinger Chiropractic Clinic, Ripon

Instructor: Dr. Steven Yeomans

DOT Medical Examiner

Saturday, October 14 | 8 AM

8 CE DC

Online via Zoom

Instructor: Dr. Christopher Murray

Dry Needling Level 2

Friday-Sunday, October 20-22

25 CE DC

Location: Oconomowoc

Instructor: Dr. Gary Estadt

Photonic Therapies for Joint and Spinal Neuromusculoskeletal Conditions

Thursday, October 26 | 12-1 PM

1 CE DC

Online via Zoom

Instructor: Dr. Nelson Marquina

Sponsored by:

Overview of Autism Disorder

Saturday, October 28 | 8 AM - 5 PM

8 CE DC/CT/CRT

Location: Milwaukee Marriott West, Waukesha

Instructor: Dr. Janet Lintala

Sponsored by:

Functional Neurology Series Module 12: Advanced Applications for Your Challenging Patient

Saturday, November 4 | 8 AM - 5 PM

8 CE DC

Location: Madison Marriott West, Middleton

Instructor: Dr. Mike Powell

Sponsored by:

continued on page 38

Continuing Education - Cont. from page 37

Common Extremity Complaints: Diagnosis and Treatment Strategies

Thursday, November 9 | 12-4 PM

4 CE DC

Location: BayCare Clinic Lakeside Campus, Manitowoc

Instructor: Dr. Jason DeVries, Dr. Carl DiRaimondo, Dr. Jon Henry, Dr. Brian Kurcz, and Dr. Craig Olson

Sponsored by:

Evolution of Chiropractic & Evidence-Based Rehab for the Busy Practice

Saturday, November 11 | 8 AM - 2 PM

6 CE DC/CT/CRT

Location: Pewaukee

Instructor: Dr. Wendy Varish

Sponsored by:

CT Light Therapy & Cold Laser

Saturday, November 11 | 2:30-5:30 PM

3 CE CT

Location: Pewaukee

Instructor: Dr. Wendy Varish

Equipment provided by Turowski's

HIPAA and OSHA Compliance

Wednesday, November 15 | 12-2 PM

2 CE DC/CT/CRT

Online via Zoom

Instructor: Mike Rizzo, HIPPA & Bradley King, OSHA

Sponsored by:

Case Management for Chiropractors: Lumbar & Cervical Herniated Discs

& Headaches

Thursday, November 16 | 8 AM - 5 PM

8 CE DC Location: Green Bay

Instructor: Dr. Steven Yeomans

Women's Health & Wellness Forum

Saturday, November 18 | 7:30 AM - 5 PM

8 CE DC

Location: Oshkosh

Sponsored by:

CT Certification and Modality Training

Friday & Saturday, December 1-2

23 CE CT

Location: Neenah

Instructor: Dr. Brenda Holland

Equipment provided by Turowski's

Nutritional Counseling Certification Module 4

Saturday & Sunday, December 2-3

12 CE DC/12 Nutrition

Location: Oconomowoc (Summit)

Instructor: Dr. Robert Silverman

Sponsored by:

Immunity: Your Seventh Sense

Wednesday, December 6 | 12-2 PM

2 CE DC/CT/CRT

Online via Zoom

Instructor: Dr. Christopher Bump

Sponsored by:

New DCs & Students

Students and DCs (in their first three years of practice)

COMPLIMENTARY CE SEMINARS and CONVENTIONS

included in their membership benefits.

CE SPOTLIGHT Overview of Autism Disorder

8 CE DC/CT/CRT

Saturday, October 28

About this CE Course

8 AM - 5 PM (with break for lunch)

Milwaukee Marriott West W231N1600 Corporate Ct, Waukesha

An overview of autism spectrum disorder (ASD) including autism rates, signs, symptoms, causes, gender differences, conventional medical approaches, prognosis and aspects of autistic culture The presentation will include an overview of the underlying health challenges, dysfunctions, and comorbid conditions of ASD, useful lab tests for this patient population, and step-by-step customizable support protocols used at my center, as well as helpful templates and resources Autism cases from my practice will be included No adjusting techniques will be discussed or demonstrated

Learning Objectives:

Attendees will participate in a review of the definition of, basic facts, statistics, genetics, language, symbols and myths about autism spectrum disorder

Attendees will participate in a review of the comorbid health challenges on the autism spectrum, helpful lab tests, and support protocols for the autism patient.

Attendees will become familiar with a new patient questionnaire and a suggestions/treatment plan template for ASD, and simple changes to make the office more suitable for autistic patients.

Attendees will participate in a review of risk reduction tips for working with the autistic population.

Meet Dr. Janet Lintala

I began my 25-year “residency” in autism with the birth of one of my sons Over the years, I have attended many autism training conferences, and completed two Mentorships at RIMLAND Center under Dr Elizabeth Mumper, M.D., the former Medical Director of The Autism Research Institute. I was blessed to be a speaker for Intersect4Kids for several years – The I4K “Dream Team” included Dr Elizabeth Mumper, MD, Maureen McDonnell, RN, who was the Medical Director of The Imus Cancer Ranch for Kids, and Dr Monika Buerger, DC who trains for International Chiropractic Pediatric Association, and is the founder of Intersect4Kids I am now an Associate Instructor for her developingMINDS Program I have a B S in Genetics from Ohio State, and graduated as Doctor of Chiropractic Salutatorian, summa cum laude, from The National University of Health Sciences I was a member of the Media and Medicine: How to Tell Stories that Make Difference, inaugural Class of 2020 at Harvard Medical School

Sponsored by:

TIME TO DO

SOMETHING FOR YOU.

Physical adjustments. Diagnosing issues. Listening to concerns.

While you spend your days helping others, we’re here to watch out for you. From the best malpractice insurance in the profession to financial services to help you grow your practice, we’re here to help you do more—not just for others, but for yourself.

How can we take care of you?

ncmic.com/dc

Functional Neurology Series - Module 12: Advanced Applications for Your Challenging Patient

This course is for the doctor who wishes to be a unique resource to not only patients, but other healthcare providers. This class will be presented in a Grand Rounds style, patient cases from Dr. Powell’s clinic will be used to develop concepts and methods that will allow doctors to serve at an even more expert level.

We will focus on the most useful strategies for helping patients that continue to suffer despite care from many other doctors and therapists. Some of these patients will lack a definitive diagnosis, despite severe symptoms. Dr. Powell will share effective methods for approaching and navigating challenging cases with brain-based chiropractic care.

Objectives - Doctors completing this module will be able to:

• Confidently take on any complex patient presentation using thoughtful, evidence informed procedures

• Differentiate between likely damage or disease vs dysfunction in patients with neurological issues

• Use a multi-modal and multi-disciplinary approach to patient care

• Thoughtfully limit variables in treatment planning

• Establish objective measures to gauge the effectiveness of care

Saturday, November 4 | 8:00 am - 5:00 pm

Madison Marriott West, 1313 John Q Hammons Drive, Middleton

8 CE DC

Speaker: Dr. Mike Powell

Sponsored by NCMIC

Dr. Mike Powell, DC, DACNB has been teaching other doctors how to have a greater impact on their patients by applying functional neurology for over 20 years. He is on the faculty of the Carrick Institute, past president of the Iowa Board of Chiropractic, current district director for the Iowa Chiropractic Society. Dr. Powell lectures to educators, brain injury specialists, rehab providers and support groups. He is also trained in Bredesen protocols for prevention and treatment of Alzheimer’s Disease. Dr. Powell has developed a series of both in-person and online courses on functional neurology for healthcare providers. He is proud to be a second generation chiropractor, practicing with his wife, Kourtne, in Cedar Rapids, Iowa.

Don’t miss Dr. Powell’s "Functional Neurology 11: Brain-Based care for Pain" on Saturday at the WCA Fall Convention sponsored by NCMIC.

What About Polyphenols for Gut Health?

by David R. Seaman, DC, MS

When it comes to improving gut health, virtually everyone thinks about probiotic supplements, drinks, and foods.

Simultaneously, virtually no one ever thinks or asks about polyphenols for gut health. This is not unreasonable as polyphenols have never promoted as a healthy modulator of the microbiota, so most people are unaware of this well-documented relationship(1,2). In contrast, fermented foods have been around for the entirety of all of our lives, so we don’t think about how they became foods or developed a healthy reputation. The same thing holds true for the abundance of probiotic supplements.

With the above in mind, we need to also appreciate that at some point in history, people had to make the choice to eat foods that were fermenting and then learned about their safety, health benefits, and shelf life or eating window. When this happened, I do not know; however, we do know that fermented foods were consumed by early African, Egyptian, and Chinese cultures, so they have been around for thousands of years (3,4) .

It is important to recognize that the people of our early cultures would have consumed fermented foods in addition to other healthy whole foods. They also would have been physically active more than today by virtue of having less technology and automation. In contrast, today people believe that eating yogurt or taking a probiotic supplement can make up for eating an unhealthy diet, which is not possible to any appreciable degree, especially if someone is obese and hyperglycemic, which is known to be correlated with dysbiosis. In contrast, we must also appreciate that people can live a healthy life for 80 or more years and rarely eat fermented foods, so observationally, we clearly do not need fermented foods or probiotics to maintain a health gut and body. So it is reasonable to question the habit of taking probiotics – is it worth it and are they necessary?

Research clearly demonstrates that probiotics do have positive effect on gut health, so I would not dissuade one from taking them; however, their effectiveness should be put in perspective. Some people who take probiotics have great outcomes, while others experience no beneficial symptomatic changes – it depends on one’s prevailing inflammatory state. This means that the first step to improving gut health is to achieve an appropriate body weight and normalize glucose levels. While engaged in this process, it would be wise to take both supplemental probiotics and polyphenols.

It turns that the polyphenols in vegetation have a profound modulatory effect on our gut microbiota (5). In fact, evidence suggests that carotenoids from vegetation are readily absorbed, while polyphenols are absorbed less efficiently and so travel to the colon where they modulate bacteria to help maintain a state of homeostasis and symbiosis with human cells (6)

Ginger is one of the best sources of anti-inflammatory polyphenols because it is very cheap as the raw herb or as a supplement. Turmeric is more expensive than ginger and is known to be poorly absorbed, which is why it is great for gut health. To be clear, all polyphenols have a beneficial effect on the gut, so your supplemental and dietary options are vast.

References

1. Kemperman RA et al. Novel approaches for analysing gut microbes and dietary polyphenols: challenges and opportunities. Microbiology. 2010;156:3224-31.

2. Moco S et al. Metabolomics view on gut microbiome modulation by polyphenol-rich foods. J Proteome Res. 2012;11:4781-90.

3. Odunta SA. African fermented foods: from art to science. MIRCEN Journal. 1988;4:259-73.

4. Anukam KC, Reid G. African traditional fermented foods and probiotics. J Med Food. 2009;6:1177-84.

5. Rastmanesh R. High polyphenol, low probiotic diet for weight loss because of intestinal microbiota interaction. Chemico-Biological Interaçtions. 2011;189:1-8.

6. Seaman DR. The DeFlame Diet: DeFlame you Diet, Body, and Mind. Wilmington (NC): Shadow Panther Press, 2016.

About David R. Seaman, DC, MS

Dr. Seaman was a Professor of Clinical Sciences in Chiropractic Medicine at NUHS in Pinellas Park, Fl from 2011 to 2016. He is a consultant for Anabolic Laboratories, for whom he has designed several nutritional supplements. He has authored many articles on the topic of diet, inflammation, and pain. His most recent book written for laypeople is entitled The DeFlame Diet. He posts regular DeFlame nutrition updates on Twitter @DeflameDoc and DeFlame Nutrition on Facebook.

Sexual Health Through the Functional Medicine Lens

There is a quote from a recent television show that said, “Everything is about Sex, except Sex, which is about power.” Replace “Power” with “vitality”, and it’s not far from wrong. Sexual health is the culmination of a person’s vitality summed up in a single action for their maximal reproductive capacity. As such, issues with libido and performance become a much more complicated issue than the myopic approach usually taken with boiler-plate hormone therapy and vasodilators to artificially increase performance.

Sexual health from a functional medicine standpoint should begin with comprehensive testing, examining vascular and hormone status, levels of thyroid function and neurotransmitter balance, and review of their diet and exercise habits.

NITRIC OXIDE SUPPORT , particularly from an l-citrulline based formula, gives vascular support without the risks of excess arginine in a non-age dependent fashion. Focusing at least short term on vasodilation, particularly in the male patient, can give some immediate symptomatic improvement which can help with overall patient compliance to a more comprehensive protocol which will likely take a few additional weeks to become symptomatically apparent.

HORMONE EVALUATION for both men and women needs to examine the entire androgen pathway and the balance between those two hormones. Subsequent regulation of aromatase with a di-indolylmethane (DIM) based formula may be warranted in most cases. Estrogen Dominance plays a role in both men and women when examining this hormone balance, with either progesterone or testosterone playing the symptomatic balance to estrogen in each case.

THYROID EVALUATION and its impact upon overall metabolic rate is an often overlooked component. Clinicians should look beyond the conventional TSH value as a thumbnail for this function. I would strongly suggest the integrative physician consider Free T3 at a level of 3.5 or greater as a much more indicative sign, and evaluate possible interference from TPO or Thyroglobulin antibodies as exacerbating factors in these cases. Astute clinicians will note that if either of these are positive, evaluation for Immunoglobulin based food sensitivities or chronic EpsteinBarr infection would be warranted.

NEUROTRANSMITTER TESTING , despite controversy, remains a vital tool in any system requiring the interaction between mood, cognition, and biologic functioning. Serotonin balance, while remaining the primary target for most pharmacologic interventions, needs to be evaluated in balance with the catecholamines. While dopamine for pleasure would be the first choice, I’ve found that a greater

emphasis on the nor-epinephrine/epinephrine balance plays a more critical role in excitation/release cycles related to sympathetic and parasympathetic balance in the autonomic nervous system.

However, both hormones and neurotransmitters can be blocked, modified, or exacerbated by Endocrine Disruptors and other environmental chemicals that modify receptor binding. Heavy metals such as lead and aluminum have long been recognized as risk factors, but in recent years expanding diagnostic abilities have uncovered a central role of mycotoxins and Per- and polyfluoroalkyl substances (PFAS) as highly bioactive factors in this function. Increases in glutathione and antioxidant levels are the tip of the detoxification protocols, with binding factors such as humic and fulvic acid playing increasingly more widespread usage in environmental medicine.

DIET & EXERCISE: Lastly, the foundations of any functional medicine approach to health, regardless of symptom, remain diet and exercise. Weight and metabolic issues will always play a fundamental issue where sexual health is concerned. In my practice, I have found particular use in high fat and protein diets (ketogenic diets) paired with an eating window restricted to 6-8 hours (intermittent fasting) to address these patients. While patients are initially reluctant, their compliance usually becomes more consistent after seeing weight loss and improvements in fatigue and ‘brain fog’. Exercise programs focusing on muscle gains promote aforementioned functions by increased baseline metabolic rates and myokine feedback to both endocrine and central nervous system functions.

Edison once said (to paraphrase) that the ‘doctor of the future will concern himself with diet and exercise’. While he was correct, it is only with the utilization of proper diagnostics that a clinician can best target both which programs and what interventions will be best suited to address the particular constellations of issues a given patient has that drives forward their set of symptoms. Overall vitality and sexual health can then only be achieved by measuring those factors and setting forth a customized plan that allows those patients to address their unique factors and reach optimum vitality.

Don’t miss Dr. Carsrud’s presentation on Friday morning at the WCA Fall Convention entitled “Men’s and Women’s Sexual Health: The Vital Factor,” sponsored by NuMedica.

Dr. N.D. Victor Carsrud | MD, PhD, DC, MBBS, MS, MS, DABCI, DCBCN

Find Your Foundation for Success

Spotlighting Dr. Martin Jacobson, DC -- A Chiropractor Making a Difference

"Be yourself when starting out in practice."

After more than three decades as a Wisconsin chiropractor, Dr. Martin (“Marty”) Jacobson keeps the recipe for success simple. He adds that it’s helpful for new DCs to find their practice style and comfort level when “getting out there” after graduation. “As soon as you can, find the best fit for you,” says Dr. Jacobson. Do sales and promotion come naturally? Are you comfortable with the spotlight, and do you have a strong desire to promote your practice? Being genuine on your professional path is a way to build long-term success in chiropractic. Staying committed to a clinical mindset and focusing on day-to-day patient care has allowed Dr. Jacobson to be successful while remaining genuine to who he is as a DC.

Making a Difference

A 1991 graduate of Palmer College of Chiropractic in Davenport, Dr. Jacobson started practicing in his hometown of Stoughton, WI before relocating to northeast Wisconsin, where he began practicing in Luxemburg near Green Bay. Dr. Jacobson practiced in Luxemburg from 1993-2005, until he began working in his current position at Aurora Health Care Health in Green Bay (while beginning with Aurora in 2005, he also continued to work in Luxemburg until 2009). Since 2009 he has been part of the healthcare team at Aurora where he collaborates with and receives referrals from doctors in family practice, women’s health, and pediatrics. He focuses on providing day-to-day care for pain management and patients with musculoskeletal disorders. Seeing patients both feel and function better lets Dr. Jacobson know he’s making a difference in people’s lives.

Chiropractors like Dr. Jacobson are making a difference. He was recently featured in a Healthwatch Segment by CBS News in Green Bay for helping a school bus driver, only in her mid-thirties, continue to work after experiencing a significant condition resulting in severe pain. The pain was impairing her ability to work and spend time with her family. In the news story, she credited Dr. Jacobson and the functional chiropractic care he provided with being essential to her improved quality of life.

Dr. Jacobson values the difference the WCA makes for the profession and DCs in Wisconsin. He has been a WCA member since graduating from Palmer and attributes much of how doctors are able to practice today to collective advocacy efforts, such as for insurance equality. The WCA advocates daily to preserve and enhance chiropractic’s standing with third-party payers, other healthcare professionals, and the public. Dr. Jacobson acknowledges this and encourages Wisconsin

continued on page 49

Dr. Jacobson - Cont. from page 47

DCs to be WCA members. He also appreciates access to WCA resources like the Help Desk which provide guidance in day-to-day practice.

His years of experience in practice also help Dr. Jacobson provide valuable input as a member of the WCA Board of Directors; he currently represents WCA’s Northeast District 3 alongside WCA President Dr. Chris Resch. Dr. Jacobson’s unique perspective practicing within a healthcare system makes him a resource on the Board. He frequently sees patients on Medicaid and BadgerCare and is a strong advocate for DCs being able to practice to scope under Medical Assistance plans.

In addition to his role on the Board, Dr. Jacobson also serves as a member of the WCA Education Committee and encourages DCs to attend the upcoming Fall Convention being held September 21-24 at the Kalahari Resort in Wisconsin Dells. According to Dr. Jacobson, “Offering a substantial amount of CE hours, this year’s event boasts a quality lineup of speakers, vendors on hand to demonstrate equipment and educate on the latest nutrition products, and the opportunity to connect with other members of our profession.”

A Connection to Athletics

Dr. Jacobson also serves as the team DC for Green Bay Gamblers hockey and recently assisted with the annual physicals for players before the beginning of the season. His mother was an assistant to the Athletic Director at the University of Wisconsin-Madison, and he grew up around the UW Athletic Department. This combined with a Norwegian-American background and hockey tradition in his native Stoughton led to his lifelong passion for the sport. Dr. Jacobson even played on the club hockey team at Palmer. Outside of chiropractic, he maintains a saltwater aquarium, a scientific hobby that requires a difficult balance of managing proper water chemistry, lighting, and temperature. He and his wife recently purchased a small boat to venture out on the Fox River (although they’ve yet to go too far). The couple have been married for 26 years and have two golden retrievers at home.

The WCA is fortunate to have leaders like Dr. Marty Jacobson who give back to the chiropractic profession. We are grateful to Dr. Jacobson for providing over three decades of genuine care to Wisconsin patients!

As a WCA leader advocating firsthand for DCs on issues such as Medicaid expansion, Dr. Jacobson is impacting the big picture for chiropractic, something he humbly approaches with an attitude of service to the profession.

Dr. Martin Jacobson pictured with his golden retrievers, Rizer and Ziggy.

Medicaid Payment Parity State Budget ProvisionWhat You Need to Know.

{Read time - less than two minutes}

A provision was approved in the 2023-2025 state budget that requires the State Medicaid program to reimburse chiropractors at the same rate as physicians for shared CPT codes.

The provision budgets an additional $1.6 million per year to pay for the higher reimbursements to chiropractors and is scheduled to go into effect January 1, 2024.

During the 2021-2023 state budget, the WCA was able to get a provision approved that increased reimbursement for chiropractic manipulation within Medicaid. The budgeted amount was approximately $4 million per year.

Both budget provisions increase compensation for chiropractic services to Medicaid patients by alma $6 million dollars per year. That is the WCA at work for YOU!

The WCA is working with the State Medicaid office to ensure that the payment parity provision is implemented in a manner that is consistent with legislative intent.

State Representative Clint Moses - the first chiropractor elected to the Wisconsin Legislature - was instrumental in getting this provision included in the state budget.

Also instrumental were State Senator Rachel Cabral Guevara and Speaker Robin Vos.

Two other Medicaid provisions affecting chiropractors were offered but were not included in the state budget - full scope reimbursement and spinal manipulation increase. These items will be pursued as separate policy initiatives.

The WCA Policy Steering Committee - Chaired by WCA President Chris Resch began working on these budget provisions years ago. We have to recognize and thank the hard work of the members of the PSC - Wilder, Willhite, Edwards and the grassroots advocacy of Wisconsin chiropractors who took the time to contact their legislators on these provisions during the budget process.

Watch for more communications in the future as the payment parity provision moves closer to the January 1, 2024 effective date.

WCA Membership Update

WELCOME n e w WCA mem be rs !

DC Members:

Cody Sromek

Kelly Von-Schilling Worth

Margo Nolte

Gina Percuoco

Scott Newcomer

Kylee Stevenson

Erik Steine

Carli VanGoethem

Rex Knauf

Madeline C Meyer

Jessica Waterworth

Brandon Ohlrich

Amber Lyn Bittner

Logan Feldt

James Appel

Jordan Stittleburg (Peel)

Alexander Kirchner

Tanner Tryggestad

Kyle Canales

Seth Anderson

Kelly Andrews

Logan Clarahan

Emily Doudlah

WCA On Campus

This August, WCA was on campus to visit with students at Palmer College of Chiropractic to chat with students, have a bite to eat, and discuss the profession.

Bryan Knipfer

Mackenzie McDonald

Hannah Secker

Sean Halpin Betsy West

Student Members:

Kaylee Harris - Palmer

Sarryn Luther - NWHSU

Klairice Schwartz - NUHS

Kenneth Lintner – LIFE West

Mary Stackpool - Palmer

Tristan Emmett - Palmer

Katelyn Mendini - Palmer

Mackenzie ShawbackPalmer

Alexandria RitzemaPalmer

Alec Gillett - Palmer

Kai Kerl - Palmer

Bryce Fischer - Palmer

Madalyn Walter - Palmer

Payton AndersonPalmer

Amy Whiteman - Palmer

Member Benefits from

Savings on Everyday Essentials

We also offer discounts on everything from travel to technology. Using this program on everyday purchases can save you thousands each year!

No-Cost Business Promotion

Our program has over 2.7 million registered users! Your members can access a no-cost business listing on the Abenity Perks platform.

Nutritional Counseling Certification Module 1 at the WCA Education Center in Madison with Dr. Robert Silverman and NutriDyn.

WCA members at the Dockspiders game in Fond Du Lac with State Senator Dan Feyen.

Hawks Quindel is a Wisconsin law firm with offices located throughout the state, including in Milwaukee, Madison, Kenosha, and Appleton. Many individuals that seek chiropractic care for significant medical issues also have a claim for one or more of these benefits. Hawks Quindel is an excellent place to refer such patients for exceptional representation and advocacy. To refer a client to Hawks Quindel please have them contact our intake line at 608-257-0040 option #2.

What is Workers compensation?

When an employee suffers an injury on the job, this insurance should help them recover from their injury by paying for medical treatment and compensating for time off work. Sometimes, however, insurance companies deny workers compensation claims and workers must resort to the courts to get their benefits. Judges, former clients, and even the attorneys who represent the workers compensation insurance companies refer injured workers to our firm. Why? Quite simply, we achieve outstanding results for employees across Wisconsin.

What makes Hawks Quindel’s Wisconsin Personal Injury different from our competitors?

Madison personal injury attorneys Danielle Schroder and Marisol González Castillo do this work because they care. Their job is to work on your behalf to optimize your results. Hawks Quindel’s personal injury attorneys serve their clients in the following ways:

1. No-charge initial consultations: You will have the opportunity to speak directly with an attorney to discuss your situation free of charge.

2. Contingent fee representation: For most cases, our attorneys are able to offer representation without initial upfront fees.

3. Personalized, professional legal attention: We are not a ‘big box’ legal shop like other PI firms in Wisconsin! Our personal injury attorneys communicate with clients to understand their objectives and work to meet the clients’ goals. Every case is unique; they will treat yours with the special attention it deserves.

4. Results through settlement or trial: Our attorneys are results-orientated. Hawks Quindel’s personal injury attorneys are not afraid to take your case to trial if that what it requires to get you a fair and just result.

Understanding Short & Long-Term Disability Insurance Claims

Most employees are eligible for short term disability insurance benefits; if your disability lasts more than a few weeks, you may also be eligible for long term disability insurance benefits. You may be able to receive short term disability benefits and long term disability benefits even if you are receiving workers compensation and/or Social Security disability benefits. Hawks Qundel’s disability insurance attorneys can help you apply for disability benefits. Our attorneys can also help your navigate the process following a disability denial and convince a court to award disability benefits to you.

Social Security Disability Claims

Whether due to an injury-causing accident or the onset and progression of a serious illness, it may become necessary to apply for Social Security Disability benefits to obtain modest income in this difficult time. Hawks Quindel can help you navigate the social security disability application and appeals process to see your claim through to approval.

The Department of Neurosurgery Presents Spine Day 2023 “

8:30 – 9:00 AM Registration and Breakfast

9:00 – 9:05 AM Opening Remarks (Not for CE) Shekar N. Kurpad, MD, PhD Jeffrey King, DC, MS

9:05 – 9:35 AM

Female Athlete Triad Revised and its impact on Bone Health

Heather Curtiss, MD, Assistant Professor Physical Medicine & Rehabilitation, M edical College of Wisconsin

9:35 – 10:05 AM A Pain in the Pelvis

Camila Bomtempo, MD, Assistant Professor General – OB/GYN – Medical College of Wisconsin

10:05 – 10:35 AM Pelvic Floor Muscle Considerations During Rehabilitation of Females with Back pain

Beth Barkowitz, MPT Outpatient Neuro Rehab – Froedtert Hospital

10:35 – 11:20 AM Caring for the Female Spine Patient. Considerations for the Peri-Partum Period

11:20 AM –12:20 PM

Invited lecturer: Farah Hameed, MD

Lumbopelvic Pain: Diagnosis and Treatment Recommendations for Women

Keynote Speaker: Heidi Prather, DO

ACCME Accreditation Statement:

The Medical College of Wisconsin is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

AMA Credit Designation Statement:

The Medical College of Wisconsin designates this Live Activity for a maximum of 3.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Hours of Participation for Allied Health Care Professionals

The Medical College of Wisconsin designates this activity for up to 3.25 hours of participation for continuing education for allied health professionals.

For Chiropractors:

This program is not yet approved for CE credit. Conference organizers will be requesting 3.25 credits from the Chiropractic Examining Board of the State of Wisconsin.

For Physical Therapists:

This program is not yet approved for CE credit. Conference organizers will be requesting 3.25 credits from the Wisconsin Physical Therapy Association.

In accordance with the ACCME policy on relevant financial disclosure, all Speaker/Planners and P resenters will be asked to reveal any relevant financial information.

hub-365 com

EMPLOYEE SAVINGS ON EVERYDAY ESSENTIALS.

Hub-365 supports your business and employees with discounts and services on office essentials, travel, and technology at no cost!

WCA CLASSIFIEDS

WINDING DOWN?

You have spent your entire career developing and growing your practice. Now is the time to look ahead. If you do not have an exit plan, LSM may be your solution. Consider joining this large, patient-centered practice and see how smooth your move to retirement can be. Please contact Sarah Pavlik at 608-316-6972 or spavlik@lsmchiro.org for more information.

collaboration with our existing high-performing professional network. You will be a part of a high-energy, fast paced, and successful culture. Your clinic will have corporate support including a billing team of over 30 people, marketing team of over 120 people, HR, maintenance, IT, practice development, and more!

Looking forward to hearing from you regarding our opportunities! Contact: Claudia.wright@medullallc.com or call: 708-595-5227

STUCK OR PLATEAUED?

Running a chiropractic practice is not easy. Now, with Covid, it may be almost impossible. Consider joining with LSM to revitalize your career. With 18 clinics, support staff and the latest technology, LSM can help you flourish. All benefits including healthcare, dues, malpractice and 401K plan. Work as the Chiropractor you were meant to be. Please contact Sarah Pavlik at 608-316-69722 or spavlik@lsmchiro.org for more information.

BUYING OR SELLING A CHIROPRACTIC PRACTICE?

Current Wisconsin Practices for Sale:

• Oshkosh - Desirable family referral practice! Part-time, low volume. High visibility in center on main frontage road. Div/Tho/Gon., trigger point, soft tissue. Established 6 yrs. Asking only $22,500 including equipment & furnishings, and seller assistance for smooth transition.

• Hudson, WI Area - Integrated practice. 2022 gross $605,000. Fully equipped, all cash practice! Skilled staff and efficient systems in place. Financing available.

HIRING MOTIVATED, TALENTED AND DRIVEN DOCTOR OF CHIROPRACTIC

Join our community of over 150+ mission-driven and motivated chiropractors at Chiro One Wellness Centers in Wisconsin! With over 120+ clinics and growing, we have immediate needs!

• $70,000 Starting base salary!

• 12-weeks paid resident-in-training program

• 4-day work weeks

• PTO, short/long term disability options, parental leave, 401k options, and paid malpractice.

• Medical, dental, and vision options for the whole family.

• Clinic directors earning on average over $200,000 in salary.

Provide exceptional outcome-based chiropractic care through

• Elkhorn/Lake Geneva - Long established practice, located in attractive, neatly maintained building on corner with high visibility. Doctor Retiring. Asking only $89,000 including sell assistance to assure smooth transition. Financing available.

• Fond du Lac, WI Area - Very attractive and meticulously maintained 4 Bdrm 3 BA home/practice combination. Solid, highly profitable practice. Gross $306,688 with low overhead. 135 pv/week. Fully furnished and equipped office. 60% self pay. Excellent practice and opportunity, priced to sell! Financing available.

Contact Loren Martin: Practice Opportunities, Inc. P: 952.322.1177| Email: martin@practiceop.com | Website: www.practiceop.com. WCA Member/Licensed Broker

BUYING OR SELLING A PRACTICE?

Current Wisconsin Practices for Sale

East Central City Along Lake Michigan. Family referral practice established 27 yrs. Div./Cox also therapies. Gross $247,437. Net $217,000. Poised for additional growth.

SE Wisc. Prosperous city south of Lake Geneva by Illinois border. Beautiful lakes area. Gross $259,775. Well equipped. Must sell. Offering creative seller financing.

Sheboygan. Low volume practice by choice. Established 40 yrs. Includes attractive fre e-standing building with 2 apts up. Asking only $235,000 total, no blue sky.

Elkhorn. 34 yr established practice with excellent reputation. Gross $191,875. Low overhead. Priced to sell at only $89,000.

Waupun. Southeast of Fond du Lac. Very attractive & meticulously maintained 4 Bdrm 3 Bath home/ office combination in desirable, prosperous city. 2022 gross $306,688. Low overhead.

Hudson. Functional medicine. High volume, all cash practice! Very efficient. Fully equipped.

We offer full service brokerage service as well as appraisals.

Phone: 952.322.1177

www.practiceop.com

Email: martin@practiceop.com

EQUIPMENT FOR SALE - RIVER FALLS, WI

Newer Zerona Z6, Non-invasive, cold laser for fat loss. This is the only treatment FDA market cleared for overall body circumference reduction. Very lightly used. Bought to partner with staff member but their plans have changed. FREE DELIVERY anywhere in WI. Safe & effective with very easy set-up.

Asking $28,000. If Interested, Email: jazsky@aol.com

EQUIPMENT FOR SALE - GREENFIELD, WI

Zenith II Chiropractic 210 Table - Used

Blue leather, pelvic drop, power front section, and ankle rest.

Asking $3,500

Contact Zastrow Chiropractic if interested: Call: 414-430-2696 OR Email: zchiro@wi.twcbc.com

TWO PRACTICE LOCATIONS FOR SALE - CENTRAL & WESTERN WI

Doctor is retiring due to medical reasons and is listing two different clinic locations for sale. Excellent opportunity in both locations as they are currently operated on a part-time basis. Gonstead, Diversified, Thompson drop techniques primarily. Equipment included. Will entertain all options, but clinic price is negotiable.

• Adams, WI Location: Well-established 20-year practice. The clinic is located within a free-standing building currently with 3 renters. Therefore, low overhead and room to grow the practice. 2022 gross $253,157 at 62 pv/ week. Click here to see photos of the clinic.

• Sparta, WI Location: Recently acquired with great growth potential in an underserved market. In close proximity to both commercial and residential property. 2023 gross through August, $113,267 at 23 pv/week. Click here to see photos of the clinic.

Please Call Dr. Jon Wall at: 608-487-1959 for information.

EQUIPMENT FOR SALE - ONALASKA, WI

Several pieces of equipment for sale including:

• Zenith HiLo table with Pelvic drop. Good condition w/ extra motor. Asking $500.

• Kyroflex intersegmental roller traction table. Asking $150.

• Ultrasound. Asking $125.

• Jamar hydraulic hand dynamometer and finger pinch gauge Contact for details.

• Assorted office furniture, file cabinets, and desks (2).

Please Contact Dr. Mark if interested. Ph: 608-769-2412.

Email: mark.drdc@gmail.com

ASSOCIATED WANTED - WAUPACA, WI

We are actively looking for an additional teammate to join us at Koch Chiropractic & Wellness in Waupaca, WI. We are a multi-faceted dynamic practice that offers several different treatment modalities to help achieve positive outcomes for all of our patients.

To learn more about this great opportunity, view the video of Dr. Gina Koch here.

DOC FOR A DAY - COVERAGE DOCTORS NEEDED

Are you semi-retired, between positions, looking for extra income, or enjoy the thought of working when you choose?

Doc For A Day is a locum tenans company that assists clinics with doctor coverage when their doctors are gone or cannot work. We are looking for coverage doctors to help us fill this growing need.

Must have up to date chiropractic license and malpractice insurance. Otherwise, a few years of experience and a background check are all that's needed to get started.

For more info contact Maggie @ 847-367-9641 or Email: info@docforaday.com

POSITION WANTED – GREENVILLE, WI

Synergy Chiropractic and Wellness Center is looking to add another DC to the team. You would be an independent contractor paying rent to utilize the office space. You will also have access to the front desk receptionist and software with billing, scheduling, and submitting insurance claims.

The chiropractor will be responsible for setting their own schedule, marketing for new patients, purchasing their own tools, etc. The office space includes a Thuli manual drop table, but you most definitely have the option of purchasing your own. Contact Dr. Jessica if interested: Email: drwill@ synergychiropractor.com or Call: 920-268-7352 to discuss more details.

POSITION WANTED – WESTFIELD, WI

Opportunity for ambitious, up-beat, full-time Doctor to join our clinic in central Wisconsin. Well established family-based wellness practice with opportunity for future partnership potential. Looking for caring, self-motivated, energetic, and ethical doctor. EMR and electronic billing in state-of-art modern staffed facility. Digital x-rays and multiple physiotherapies. Activator certification, diversified, and drop piece adjusting skills preferred. Nutrition certification recommended.

Salary based on collections with opportunity to earn a very competitive income. Benefits include retirement, insurance, group practice, and continuing education.

Please submit your resume to: westfieldchiros@hotmail.com

continued on page 67

ASSOCIATE WANTED – SOUTH CENTRAL WISCONSIN

With four locations in south central Wisconsin, Bakke Chiropractic Clinic, has immediate openings for an associate doctor. Bakke Clinic is a multi-disciplinary practice of over 65 years with a strong reputation for patient-centered quality care, an excellent relationship with insurance companies, other healthcare entities, and maintains a professional billing office on site.

This is an exciting and unique opportunity for lifelong personal, professional, and financial reward. We are seeking qualified doctors who are interested in establishing a long-term relationship and are motivated to build a strong patient-centered practice.

Please contact us to offer your letter of interest and your resume. Applications will be reviewed, and an interview will be scheduled with those individuals who meet our criteria.

Email Hannah Jolin: bakkeclinicdc@gmail.com or Call: (608) 837-7600.

CHIROPRACTOR AVAILABLE FOR RELIEF COVERAGEMENOMONEE FALLS, WI

Licensed and fully insured with NCMIC. 25 years of experience treating patients in Wisconsin. I am available on Tuesdays, Thursdays, and Fridays. I have worked at multiple offices and I'm familiar with many chiropractic techniques. I live in Menomonee Falls, Wisconsin.

Dr. Jeff Hamill can be reach at: 262-328-4678 or Email: hamillchiropractic@yahoo.com

ASSOCIATE WANTED - JANESVILLE, WI

Van Roo Family Chiropractic is seeking an Associate Doctor to join our family practice which has been serving the Janesville community for 20 years. We are at an ideal stage to begin the search for a long-term Associate Doctor with potential ownership of the clinic in the future. The new Doctor must have a good work ethic and values, like to have fun yet be professional, and would also like to be in our area long-term. We will provide training and salary of $50-100K plus incentives.

Call Dr. Ryan at 608.751.3124 or Email: ryanlaurawyatt@hotmail. com if interested.

EQUIPMENT FOR SALE - WISCONSIN RAPIDS, WI

1) MT manual flexion-distraction table for sale. Purchased new in 2015. It has the following features: Electric variable height. Elevating head piece with cervical, lumbar, pelvic drop, and abdominal breakaway. Flexion assist handle. Pecan brown covering w/ matching stool, pelvic blocks, and cushion. The table is in great condition. $2200.

2) PowerPlate Pro5 certified medical device with posture rack. Purchased new in 2015. Runs great. Cosmetically it is in good shape with a few scratches on the base. $3500.

If interested, email: drpat@stoiberchiropractic.com OR Call: 715424-8000.

R-E-L-A-X WE GOT YOU COVERED!

Need vacation, maternity, illness, or other coverage? DOC FOR A DAY covers your clinic and provides you income when you cannot. All Docs are licensed, insured, experienced and have had background checks. Free office intro. Flat rates and no sneaky extras.

Call or Text Maggie: 847-367-9641 or Email: info@docforaday. com

CLINIC WANTED FOR PURCHASE - GREATER MILWAUKEE AREA

Chiropractic Company is currently looking to purchase a clinic in the Greater Milwaukee area.

If you have interest in selling, a merger or are contemplating retirement and need an exit strategy:

Please contact Kent McLeod at 414-213-4808 or drmcleod@ chiropracticco.com or visit chiropracticbuyers.com for additional information.

ASSOCIATE WANTED - GREATER MILWAUKEE AREA

Chiropractic Company is a rapidly expanding group of clinics in the greater Milwaukee area and we are currently looking for associate doctors.

We are unique in the profession in that doctors have the opportunity to advance from associate, to clinic director, to shareholder in the corporation all based on their personal performance.

In addition to a salary and bonus structure we also offer health insurance, short term and long term disability insurance, and a matching 401k plan. Continuing education, chiropractic coaching, 50% off a gym membership, license, CPR training, and malpractice insurance are also covered benefits of working with the Chiropractic Company.

For more information go to: www.chiropracticcompany.com OR Email: drmcleod@chiropracticco.com

The Wisconsin Chiropractor

The Official Publication of the Wisconsin Chiropractic Association