The Wisconsin Chiropractor_Spring 2024

YOUR SPECIALTY CARE PARTNER

BayCare Clinic provides a range of highquality, personalized health care services to patients throughout northeastern Wisconsin.

We pride ourselves on a collaborative approach to patient care. We remain excited and proud to grow our partnership with Wisconsin Chiropractic Association.

BayCare Clinic is proud to partner with the Wisconsin Chiropractic Association and more than 100 chiropractors in northeastern Wisconsin to provide top-level musculoskeletal care to their shared patients.

BRUCE

Education

Corporate

LEAH

Everyone’s Feet Tell A Story: Are You Listening?

Dr. Kevin M. Wong, BS, DC

The average patient who seeks care from us has little knowledge of how their body actually works. They are accustomed to taking a pill, getting a shot, getting surgery, or being referred immediately out for physiotherapy. Patients often come to our offices out of frustration and desperation and their musculoskeletal knowledge is very lacking. A majority of musculoskeletal pain that patients present with clinically has a significant link to the feet and the arches. The feet have a strong relationship to overall body health.

The feet are the foundation of our human “house.” Everything that affects the feet will be reflected upwards to the joints above. Picture in your mind, a house with a cracked foundation and a cracked chimney. The instability of that house comes from the ground up, just like our bodies. The feet support the weight of the entire body so however they do this, well or not, will then dictate biomechanical health or stress to the ankles, knees, hips, pelvis, spine, shoulders, and jaw/skull. In essence, the more unstable our feet are (cracks in our human foundation), the more likely we see cracks (instabilities, stress, pain, injury) to the structures above.

We will focus on flat, over-pronated feet because they cover 9/10 patients that walk through your clinic door. Excessively supinated feet and healthy arch support people make up the remaining 1%, and they are less commonly seen in practice.

Patients think that we have only ONE arch under the inside of each foot.

In fact, we have 3 functional arches that form the plantar vault or underside of each foot. When the 3 arches are well supported, we are none the wiser. Weight-bearing posture is healthy, supported, and more stress-free. What patients don’t realize is that by age 7, the arches are fully formed. This is the age where foot arch issues begin, and we can start seeing them flatten (overpronate).

Much of the reasons for this excessive pronating are based on genetics, sports, shoes, gravity, injuries, and some other factors. Some patients show this very early and others later in life. But it is something very important to observe as it literally gives you a roadmap for stress and subluxation patterns in the patient’s body.

From toes to nose, there are biomechanical and rotational stress patterns that can cause pain and repetitive stress to many parts of the patient’s body.

5 Easy Ways to Spot Excessive Foot Pronation:

1 2 3 4 5

Foot flare during gait: As the arches of the foot keep flattening, the feet flare. You can often spot one foot being more pronated than the other due to the foot flare. Often, it’s worse on one side vs. the other.

Internal Knee Rotation: This is due to the excessive internal rotation of the tibia/femur and their subsequent increased pull on the patella in a medial direction.

Bowing Achilles Tendons: As the arches fall, the foot flattens, and the Achilles’ tendons bow medially. This is one of the easiest and most obvious things to observe.

Flat Feet: The medial arches (which are the last ones to fall) are visibly dropped or flattened.

Lateral heel wear (uneven): Since the patient is overpronating in the foot flat portion of the gait cycle, they over supinate on heel strike. This causes too much lateral heel wear. You will notice in runners and heavy walkers/hikers that they tell you about having to replace their shoes every 4-6 months.

See Dr. Wong at the WCA Spring Convention on Saturday, April 13

"Mastering the Extremities and Spine the Wong Way"

This is just a teaser for what we are going to talk about during my 8-hour program at the WCA Spring Convention. I will be teaching extremity and spinal adjusting where we will start at the feet/ankles and end up at the shoulders/ribs and Thoracic spine. I look forward to educating and entertaining you, and I look forward to seeing you there! *Sponsored by Foot Levelers

Join Us at the WCA Spring Convention!

April 11-14, 2024 |

The Osthoff Resort in Elkhart Lake

Please join us for the 2024 Spring Convention at The Osthoff Resort, a stunning AAA Four Diamond Resort located on the shores of Elkhart Lake! If you are a Chiropractor, Clinic Staff and/or Healthcare Professional looking to bring pain relief, wellness care, immunity support and rehabilitative exercises naturally without drugs or invasive surgery, the Spring Convention is the perfect opportunity!

Education for ALL Staff

Treat yourself to professional development designed just for you! Make the weekend a staff retreat and bring the whole clinic, take advantage of Osthoff amenities with your spouse, or bring a friend to enjoy the spa during your downtime.

Our Speakers Get It

Our engaging speakers teach locally, regionally, nationally and internationally. They are also in active practice with years of real-world clinical experience.

Regardless of where you are in your career, our top-notch instructors will help you build skills and grow as a DC, CT, CRT, Front Desk or Billing Staff.

CE Hours for Clinic Staff

Executive Director’s Message

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

Welcome to the party, pal.

After years of doing battle with the insurance lobby at the Wisconsin State Capitol, I had to laugh (to myself) during meetings last year with the coalition of health care providers supporting Assembly Bill 507 relating to pre authorizations. Chiropractors have had the pleasure (sarcasm alert) of dealing with the hoops, hurtles and outright abuse of insurance companies for years. Now that other health care providers are being more stringently managed by insurance and utilization management companies, there is increased interest in addressing the issue through legislation at the State Capitol. The American Medical Association has even made eliminating preauthorizations one of their top legislative priorities. This is all good news to which I say in my best John McClane voice - “welcome to the party, pal.”

The Wisconsin Physical Therapy Association (now known as APTA-WI Chapter) pushed a pre authorization bill late in the 2021-2022 legislative session that applied only to physical therapy services. This session, they asked the author of the bill, Rep. Nancy VanderMeer (R-Tomah), to draft the bill more broadly and include chiropractors, occupational therapists and speech therapists. This was a smart move as it did not engender any more opposition, but did add the political power of more patient and provider advocates. Joining the APTA-WI Chapter in supporting the bill was the Wisconsin Speech-Language Pathology and Audiology Association, the Wisconsin Occupational Therapy Assn, the Chiropractic Society of Wisconsin, the Rural Wisconsin Health Cooperative, Advocate Aurora Health, Bellin Gundersen Health system and the Wisconsin Chiropractic Association. This coalition of health care groups worked well together in advocating for AB 507 during the committee hearing in Assembly Health and in meetings with the insurance industry. Opposing the bill was the usual cast of insurance companies and utilization management groups.

But with the 2023-2024 session of the Wisconsin Legislature wrapping up later this month, it appears that Assembly Bill 507 has stalled and is likely dead for the session.

Am I surprised? No. I was frankly surprised that the bill got a unanimous vote in the Assembly Committee on Health. That had more to do with the Chair being Rep. Clint Moses (first chiropractor elected to the Wisconsin Legislature and appointed Health Chair), strong support from members of the committee and the credible testimony from patient advocates and provider groups. From a policy standpoint, supporters of AB 507 carried the day during the hearing and the arguments against it from the insurance lobby were a bit tired.

So why did the bill move out of committee on a unanimous vote but fail to be scheduled for a vote on the Assembly floor? One answer is that it was late in the legislative session and not every bill gets to the floor in time. I propose the real answer is the same reason why the WCA has had to fight tooth and nail over the past 50 years to expand and protect access to chiropractic care in Wisconsin.

The bill ran into the political version of the "jersey barrier" otherwise known as the immense political power of the insurance lobby in Madison.

continued on page 10

Assembly Bill 507 Lobbying

Insurance companies have a large corporate, employee and political presence in Wisconsin. As WCA Executive Director, I am intimately familiar with the insurance “jersey barrier.” Sometimes we can avoid it (i.e. worker’s compensation issues, Medicaid payment parity) and sometimes we smack right into it (i.e. AB 507).

So what is the future of AB 507 and similar pro patient, pro chiropractic legislation?

That depends on a number of factors, namely who has partisan control of the Legislature in 2025. If Republicans control the State Assembly, and both Rep. VanderMeer (the author of AB 507) and Rep. Moses (Chair of Assembly Health) are both reelected, AB 507 has a good chance of being reintroduced (it will have a different bill number in the 2025-2026 session).

The biggest factor is whether supporters of the bill can overcome the political power of the insurance lobby in the Wisconsin Legislature.

One indicator will be if and how health care groups leverage the issue during the 2024 election cycle. It is common practice for health care associations, including the WCA, to include issues like support for AB 507 in their candidate questionnaires when determining candidate endorsements. With new legislative maps and more competitive seats that put the partisan majority in play this fall, candidates may (that is a big may) be more attentive to the policy concerns of constituents and provider groups during their election efforts.

Of course, the insurance industry will be playing the same game this election with way more chips in their stack. We overcome their advantage by leveraging the voices of our doctors and their patients.

When that candidate for the legislature knocks on your door and asks for your vote, ask them how they voted on legislation reducing insurance barriers to chiropractic care. Ask them how they would vote on AB 507 should it ever get to the floor of the Wisconsin Legislature. I know the WCA will asking these questions as we determine who we endorse.

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WCA Membership Update

n e w WCA mem be rs !

DC Members:

Michael Berglund

LouRae Bottorff

Guy DaWalt

Michael Fetter

Patrick Flynn

Lucas Gindl

Amy Hamlin

Malorie Konkol

Mac Kozaczuk

Punita Kukreja

Cody Larsen

Dalton Lewallen

Sarah Lynch

Devyn Martinez

Melanie Nuthals

Jeffrey Oles

Bridget Owens

Sheena Pio

Ralf Schurmann

Benjamin Tenpas

Melissa Walenton

Corey Weinfurtner

Jay White

Dean Wilhitte

Student Members:

Austin Werdin

New WCA Resource Hub

WCA members consistently rank the WCA Help Desk as one of the most valuable member benefits. In addition to the Help Desk, we have a plethora of resources at your fingertips. The WCA Resource Hub is a one-stop shop for ready-to-use chiropractic resources including our regularly updated “FAQs & Guides” page.

Login to your WCA account today to access this time-saving information!

Watch Webinars at Your Convenience!

The following previously-held webinars are available for WCA members to view on-demand. (Recordings do not count for CE.)

Here are a few webinars recently added to our Webinars On Demand library:

Importance of Micronutrients with Exercise

What Chiropractors Need to Know About Worker’s Compensation

Webinars On Demand

Will HEDIS Prevent Payment & Increase Barriers for Low Back X-rays?

Dr. James McRae

Dr. Douglas Cox

Dr. John Haase

WHEN YOU NEED IMAGING TO GUIDE A PATIENT’S CARE, YOU WANT A PARTNER YOU CAN TRUST.

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● Same- and next-day appointments with evening and weekend hours

● Subspecialized and DACBR radiologists who interpret patient exams and are available for consult

● Customized protocols:

● Weight-bearing imaging

● Flexion/extension imaging of the spine for a detailed diagnosis

● MRI options:

● 3T

● High-field open

● High-field wide-bore

SUPPORTS DISC AND CONNECTIVE TISSUE HEALTH

• A SPECIAL BLEND OF INGREDIENTS DESIGNED TO NATURALLY REDUCE INFLAMMATION

• PROMOTES THE PRODUCTION OF COLLAGEN

• SUPPORTS THE REBUILDING OF CARTILAGE

BayCare Clinic is a physician-owned specialty care clinic headquartered in Green Bay, Wisconsin.

We pride ourselves on our commitment to excellence and our collaborative approach to care for patients throughout the region.

To best serve WCA members, BayCare Clinic offers an Online Referral Portal which allows providers to seamlessly send referral or consultation requests to the BayCare Clinic specialists of your choice.

The site is secure, allowing you to add medical information about a specific patient and send images with confidence.

BayCare Clinic is committed to this dual care process and will maintain strong communication with each WCA member until your patient returns to your care.

How To Use BayCare Clinic’s R E F E R R A L P O R T A L

We’ve simplified our referral portal by removing the requirement to log in with a username and password.

To send your referral, simply:

1. Select the medical service you are referring.

3.

Go to www.baycareclinic.com/referral-portal.

2. Fill in all required information on the page.

Upload and attach relevant files or select a different way to send them.

4. Click Submit.

Print/save if needed.

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We’ve got it from here!

CClass IV Laser Therapy

Dr. Kyle Pankonin, DC, DACO, DACCP, CFMP, CCEP

lass IV laser therapy is a near perfect marriage for the average chiropractic practice. This high-powered laser can enhance the treatment and outcome of almost any pain condition that presents at a chiropractic practice. Recent research revealed it’s an effective treatment for improving pain, functionality, range of motion and quality of life in people with musculoskeletal disorders.1 Successfully adding this remarkable therapy to your practice will benefit your patients and your bottom line.

We incorporated class IV laser therapy into our practice in 2016. I was looking for a safe, game-changing therapy to help my patients’ painful conditions that was also a cash-based service to increase my business. To recommend this therapy with clinical confidence, I needed to see the outcomes myself. The first year I kept statistics on every patient who received laser as part of their treatment plan. I tracked pain ratings at the beginning and end of care and had patients do functional outcome assessments at the start and end of treatment. Patients were asked to rate their overall percent improvement from the start to end of treatment.

Success was defined as the patient reporting 50% or greater improvement by the end of treatment. Our first year showed 88% of our patients reported 50% or greater relief. This built clinical confidence to recommend laser to more patients. Fast forward to 2024, we use four class IV lasers non-stop every day. We still track each patient. Over the past eight years our success rate has ranged from 85-89% for all conditions. I can confidently look patients in the eye and tell them the odds of significant help when laser is added to their treatment plan. Keep in mind many of these cases were treated with laser alone.

My recommendation for most acute musculoskeletal conditions is six sessions. It is paired with chiropractic adjustments, traction, or home exercises. I offer patients silver or gold plans; silver being chiropractic adjustments, traction and home exercises and gold being these treatments plus six laser sessions. Many patients choose gold because we can confidently tell them laser will speed the healing process

and reduce pain faster. For most chronic conditions we recommend 12 sessions. Again, this is paired with chiropractic adjustments, Graston Technique, shockwave therapy and home exercises. Treatment packages are offered within the silver or gold plan framework, with gold always including laser therapy. Most patients choose laser even with it being a cashbased service.

We have developed protocols for specific niche conditions including chronic neck or back pain from disc issues or stenosis; chronic knee pain, often due to osteoarthritis; and peripheral neuropathy. Laser is featured as the centerpiece of these 24-visit treatment protocols. Chronic neck and back pain due to disc or stenosis treatment includes laser, spinal decompression, custom orthotics, home exercises and disc support supplements. Chronic knee pain treatment includes laser, knee traction, custom orthotics, home exercises and joint support supplements. Peripheral neuropathy treatment includes laser, electroanalgesia, vibration therapy, custom orthotics and nerve support supplements. Last year we had a 94.6% success rate for our chronic neck and back protocol, 82% success rate for our chronic knee protocol and 77% success rate for peripheral neuropathy. For these challenging conditions, these are great success rates.

Many doctors hesitate to take this next step due to financial considerations. Yes, class IV laser is a significant investment, but, when implemented correctly, most doctors can expect a full return on investment within one year. The enhanced clinical results and revenue can be significant when done right. If I had to give up all other therapies and keep just one it would be class IV laser. Paired with good chiropractic care, it is a true game changer.

References:

1 Arroyo-Fernandez, R.; Aceituno-Gomez, J.; Serrano-Munoz, D.; Avendano-Coy, J. High-Intensity Laser Therapy for Musculoskeletal Disorders: A Systematic Review and MetaAnalysis of Randomized Clinical Trials. Journal of Clinical Medicine 2023, 12, 1479. https://www.mdpi.com/20770383/12/4/1479

See Dr. Pankonin at the WCA Spring Convention on Saturday, April 13

"Class IV Laser Therapy: Research, Conditions and Outcomes"

Discuss research related to class IV laser therapy, how to perform a world class examination and determine the primary pain generator, effective treatment protocols and outcomes from Dr. Pankonin’s years of practice. *Sponsored by Cutting Edge Lasers

Medical Marvel Massage Chairs

We designed the Medical Marvel Massage Chair specifically to address the needs of the Chiropractors. It was designed in concert with what Chiropractors needed and wanted

Chiropractors who have implemented the Medical Marvel Massage Chair into their practice by having their patients sit in the chair prior to an adjustment are reaping tremendous rewards and benefits!

When you, as a Chiropractor, adjust patients with their muscles and joints already warmed up, it is much easier and quicker to adjust them. As a result, you see more patients and you are not working as hard when you adjust them . You are also making considerably more money. We have Chiropractors who have recovered their entire investment, ROI, in as little as six weeks.

But most importantly your patient will have far better results.

Medical Marvel Massage Chairs has been in business for 20 years. We manufacture and distribute the finest massage chairs in the industry that can handle people up to 375 lbs. and 6 ft 6”. We also have the only massage chair that becomes an automated traction machine that qualifies for insurance reimbursement.

We also have the only wireless office massage chair that gives a great massage.

Ultimate Ultra Product Video (youtube.com) Welcome To Medical Marvel Massage Chairs info@medicalmarvelmassagechairs.com

WCA Continuing Education

Education Committee Update

The WCA Education Committee is thrilled to welcome Dr. Heather Miley, DC, MS, DACBR, who joined the committee in February 2024.

Dr. Miley holds a Diplomate from the American Chiropractic Board of Radiology (DACBR) and her professional radiology experience includes clinical radiology for chiropractic institutions, private radiology consultation services for chiropractic physicians and a medical imaging center in Chicago, and instruction at NUHS covering multiple topics, earning status as Associate Professor. She has served on the board for the American Chiropractic Board of Radiology (ACBR) for over ten years, currently as examination coordinator. Dr. Miley has performed several professional radiology and poster presentations at various conferences, such as the Association of Chiropractic Colleges – Research Agenda Conference (ACC-RAC), the Council on Diagnostic Imaging (CDI), homecoming, grand rounds, and the American Chiropractic College of Radiology (ACCR) annual workshop.

Dr. Miley joins Dr. Julie Qualle, Chair; Dr. Martin Jacobson; Dr. Danielle Ryan; Dr. Jeffrey Sergent; Dr. Jacob Stoffel; Dr. Scott Vander Wielen; Dr. Steve Yeomans

WCA Spring Continuing Education

Online: Compliance Law Changes Overview

Wednesday, April 24 | 12-1 pm

1 CE DC/CT/CRT

Location: Online Via Zoom

Instructor: Dr. Ty Talcott

Sponsored by:

Fundamentals of Exercise Rehabilitation

April 27-28 | Saturday 8 am - 8 pm; Sunday 8 am - 8 pm

24 CE DC/CT

Location: Ripon

Instructor: Dr. Steven G. Yeomans

Pickleball: Chiropractic Rehabilitation for Common Injuries and Performance

Saturday, May 4 | 8:00 am - 5:00 pm (1 hour lunch break)

8 CE DC

Location: Cedarburg

Instructor: Dr. Jeff Sergent

CT Certification and Modality Training

May 4-5 | Saturday 8 am - 8 pm; Sunday 8 am - 7 pm

23 CE CT

Location: Oconomowoc

Instructor: Dr. Brenda Holland

Compliance Law Changes: HIPAA, OIG, CURES & No Surprises Act

Two dates/locations to meet your needs!

Wednesday, May 8 | 1-6 pm | Eau Claire

Thursday, May 9 | 1-6 pm | Green Bay

5 CE DC/CT/CRT

Instructor: Dr. Ty Talcott

Sponsored by:

Online - HRV Biofeedback for Chiropractors

May 21 | 12-1 pm

1 CE DC

Instructor: Dr. Mike Hopper

WCA CE CALENDAR

Spring 2024 Chiropractic Nutritional Counseling Certification

Module 1 – April 11-12, Spring Convention

Module 2 – April 13-14, Spring Convention

Module 3 – April 27-28, DeForest

Module 4 – May 18-19, DeForest

12 CE DC/12 Nutrition per module

Instructor: Dr. Scott Bergman

Sponsored by:

Physical Manifestations of Stress & Light/ Laser Therapy: Photobiomodulation 101

Saturday, June 1 | 8 am - 5 pm

8 CE DC/CT/CRT

Location: Eau Claire

Instructor: Dr. Wendy Varish

Sponsored by:

Comprehensive Whole Body IASTM Course

June 1-2 | Saturday 8 am-5 pm; Sunday 8 am-12 pm

12 CE DC

Location: Oconomowoc

Instructor: Dr. Michael McQueen

Online - OSHA/HIPAA Overview

Tuesday, June 4

2 CE DC/CT/CRT

Instructors: Travis Watson & Mike Rizzo

Sponsored by:

CT Certification and Modality Training with Light Therapy

July 19-21, 2024

Location: TBD

Instructor: Dr. Wendy Varish

TMedical College of Wisconsin Creates First Chiropractic Fellowship Program at an Academic Medical Center

he department of Neurosurgery at the Medical College of Wisconsin (MCW) has added the nation’s first Doctor of Chiropractic Fellowship involving an academic medical center, with the first fellow beginning July 1.

Led by Dr. Jeffrey King, Associate Professor and Director of Chiropractic at MCW, the fellowship provides recent DC graduates with an educational pathway that integrates evidenced-based didactics with the cultivation of clinical and professional skills acquisition through clinical care experiences, interprofessional education and scholarship.

“As the country’s population ages, there’s a growing demand for chiropractic treatment at hospital settings nationwide,” said Dr. King. “Most chiropractic training, however, focuses on working in small, private practice settings – not necessarily exposing someone to the team-based, multidisciplinary care of a medical center or the research aspect of academic medicine.”

How the Fellowship Program Will Work

MCW’s Doctor of Chiropractic Fellowship will train fellows within the patient-centered, transdisciplinary Froedtert & the Medical College of Wisconsin SpineCare clinic. This unique training will prepare fellows to incorporate additional evidence-based tactics into their practice as well as increase participation in research that may affect the entire specialty.

Fellows will participate in the care of patients with simple to complex spine challenges, with the goal of helping them safely return to their routine activities and workplaces, while preventing long-term disability from back and neck pain.

Fellows will learn an evidence-driven, team-based approach for early intervention and comprehensive spine care, which places the patient at the center of the process. They also will engage in a variety of patient care experiences, beginning under the supervision of attending chiropractors, with increasing autonomy as they progress through the program.

Fellows will work and train with team members from physical medicine and rehabilitation, family medicine, radiology, neurosurgery, orthopaedic surgery, pain psychology, and physical/occupational therapy; and they will observe a variety of spine care procedures –from ambulatory settings to the operating room – to prepare for practicing on a spine-focused team.

Along with their clinical experiences, fellows will engage in multiple scholarly activities to enhance their competency in evidencebased practice, critical thinking, and critical appraisal. Activities may include ground rounds, didactic lectures, clinical workshops, peer-reviewed research efforts, academic presentations at conferences, and more.

Such specialized training and comprehensive experience have the potential to make graduates even more competitive candidates for prestigious jobs at academic medical centers and VA hospitals in Wisconsin and around the country.

Later this month, the Medical College of Wisconsin will be announcing the first fellow with the program which will run through the 2024-2025 academic year. Applications for the next academic year will open in January 2025.

As the country’s population ages, there’s a growing demand for chiropractic treatment at hospital settings nationwide."

~Dr. Jeffrey King, MCW Associate Professor and Director of Chiropractic (pictured right)

A P A R T N E R I

“Collaboration in patient care is at the forefront of our valued partnership with the Wisconsin Chiropractic Association. We thank you for trusting us to care for your patients.”

– Dr

Ashwani Bhatia,

BayCare Clinic CEO and CMO

BayCare Clinic is proud to partner with the Wisconsin Chiropractic Association to provide a range of highquality, personalized health care services to communities in and around northeastern Wisconsin.

With more than 150 physicians across 20 specialties, BayCare Clinic can provide care for just about anyone. Our physicians are either board certified or active candidates for certification through boards recognized by the American Board of Medical Specialties. Additionally, many of our specialists are fellowship trained in subsets of their fields.

At BayCare Clinic, we value the independence that comes with being physician owned. That sense of independence helps us offer our patients the best choices for their health care journeys

Oftentimes, those health care choices begin with a patient’s chiropractor, a great first line of defense for some when it comes to various health care issues such as back or neck pain, joint and muscle aches and more It is sometimes necessary, however, for patients to seek additional treatment before they find full relief If that is the case, our valued partnership with the WCA makes it simple to connect those patients with our specialists to get the additional support and ca re they need

Our specialty clinics strive to balance clinical expectations and patient needs in providing patients with high-quality care and service

Orthopedics & Sports Medicine BayCare Clinic addresses a variety of bone, joint, and muscle problems

through surgical and non-surgical treatment options, including regenerative medicine. Our orthopedic surgeons and sports medicine specialists aim to minimize pain, improve mobility and function and get patients back to their normal activities.

BayCare Clinic Pain & Rehab Medicine physicians focus on spine and musculoskeletal care. They offer the highest quality clinical care to a complex patient population, often using a combination of pharmacology and interventional techniques to improve pain and restore function.

BayCare Clinic Neurological Surgeons treat a variety of conditions, including back pain, neck pain, disc herniations, spinal stenosis, spinal instability, peripheral nerve entrapment, head injuries, spinal injuries, and more

T o simplify the referral process, BayCare Clinic offers an online referral portal for you to connect with our providers on your patient’s behalf The secure site allows you to upload medical information and send images (such as X-rays) without worry

We truly believe everyone benefits when patients find the relief they need, which is why we are constantly exploring ways to collaborate with other top-tier health care organizations like the WCA to make access to high-quality, specialized care more convenient Our specialists are also dedicated to learning the most advanced evidence-based procedures and practice techniques to ensure our patients get the best possible clinical outcome and satisfaction

Government Affairs Update

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

Worker’s Compensation Medical Fee Schedule Makes Brief Legislative Appearance.

With approximately one month left in the 2023-2024 legislative session, the Workers Compensation Advisory Council (WCAC) dropped a package of changes to the Wisconsin worker’s compensation system in the lap of the Wisconsin Legislature. This package had mostly non-controversial provisions such as PTSD coverage for firefighters but also contained a medical fee schedule that would have dramatically reduced the compensation of providers caring for injured works.

The WCAC is made up of equal representatives from labor and management. Wisconsin Manufacturers and Commerce leads the management side of the WCAC and various Wisconsin labor groups comprise the labor side. Four statewide health care associations serve as non-voting liaisons to the WCAC with the intent of providing input on WCAC policy discussions. These groups are the Wisconsin Chiropractic Association, the Wisconsin Medical Society, Wisconsin Hospital Association, and the American Physical Therapy Association - Wisconsin Chapter. It is worth noting that none of the health care provider groups were asked for their input by the WCAC or brought to the table in discussions over a medical fee schedule.

Joint Senate & Assembly Labor Committee Hearing

While the WCAC develops and drafts the worker’s compensation legislation for consideration by the Wisconsin Legislature, the respective Labor Committees in each chamber technically introduce them as legislation. On Thursday, February 8th, 2024 the respective Labor Committees held a joint public hearing to introduce the WCAC drafts as Senate Bills 991 and 992. WCAC representatives from both labor and management testified in favor of the bills primarily because of the medical fee schedule provision. Provider groups, including WCA member Dr. Jeff Wilder, all testified against the fee schedule (see WI eye video right) but in support of the other non-controversial provisions.

The non-medical fee schedule bill - AB 1073 (SB 991) - passed both houses of the Legislature and is awaiting the Governor's signature. AB 1074 (SB992) the bill that contains the medical fee schedule has not move out of committee and appears dead for the session.

Senate Bill 788: Relating to Delegation of Adjunctive Services to a Medical Assistant Passes Legislature.

Legislation that clarifies the requirements under which a chiropractor can delegate adjunctive services to a person trained as a medical assistant passed both houses of the Wisconsin Legislature last month and is headed to the desk of Governor Evers for his signature.

The WCA worked with Rep. Nate Gustafson (R-Fox Crossing), Senator Rachel Cabrael Guevera (R-Appleton) and the Medical College of Wisconsin to advance Senate Bill 788. Current law allows a chiropractor to delegate adjunctive services to a chiropractic technician, a chiropractic radiological technician and other licensed health care providers. Because medical assistants are not technically licensed in Wisconsin, current law required them to get a CT license and take continuing education courses to maintain that license.

“We appreciate the work of Rep. Gustafson and Senator Cabral Guevera in getting this bill passed this session,” said WCA Executive Director John Murray. “This gives chiropractors more options when making staffing decisions in their clinics."

"Pre Authorization" Bill Stalls at the End of Session

With the 2023-2024 session of the Wisconsin Legislature wrapping up later this month, it appears that Assembly Bill 507 - known as the "pre-authorization" bill -- has stalled and is likely dead for the session. See a summary of AB 507

Despite strong support from provider groups including the WCA and a unanimous vote in the Assembly Health Committee, the bill was not scheduled for a vote in either house of the Legislature.

"We knew that moving AB 507 was going to be difficult given the opposition from the insurance industry," said WCA Executive Director John Murray. "The unanimous vote in the Assembly Health Committee was reason for optimism, albeit short lived."

So what's next for AB 507?

Provider groups will likely push to bring it back next session with a renewed focus on overcoming the immense influence of the insurance lobby (see page 9 for more editorial comments on this topic from the WCA Executive Director).

ACA Update

Dr. Gene Yellen Shiring, Delegate, American Chiropractic Association

Recognizing Chiropractic Leadership At The National Level

Editor's Note: the message below was sent to all ACA members in Wisconsin by ACA delegate Dr. Gene Yellen Shiring.

Good morning Wisconsin ACA friends and colleagues,

I recently returned from the ACA annual meetings in Washington and am proud and excited to announce that our very own Dr. Leo Bronston from Onalaska, WI was elected President of the American Chiropractic Association!

Leo has served our profession tirelessly for decades both at the state and national levels. He has served as a member of the Board of Directors of the Wisconsin Chiropractic Association, as the Alternate Delegate and Delegate to the ACA, and as a member of the ACA Board of Governors for the past five years prior to his election as President.

Few individuals in Wisconsin have ever demonstrated greater dedication and devotion to advancing the profession to the benefit of both patients and doctors as Leo.

Not only that, but in another remarkable accomplishment, Leo was recently appointed by the AMA Board to Trustees to the to serve on the Current Procedural Terminology (CPT®) Editorial Panel. Dr. Bronston will be the first doctor of chiropractic to join the Panel.

Dr. Leo Bronston | Onalaska, WI

President of the American Chiropractic Association

The CPT Editorial Panel maintains the CPT code set, which is widely used across the healthcare industry to report procedures and services and to process claims. The panel is composed of 21 members, including representatives of 12 medical specialties and individuals representing groups such as the Blue Cross Blue Shield Association, America’s Health Insurance Plans, the American Hospital Association, and private health insurance plans. Dr. Bronston was appointed to serve as one of two representatives from the CPT Health Care Professionals Advisory Committee (HCPAC).

Please join me in congratulating Dr. Leo on his extraordinary honor of being elected by his peers as President as well as his appointment by the AMA giving chiropractic a seat at the table of the CPT Panel!

I encourage you to send him a personal note of thanks for his years of service at drbronston@bronstonchiro.com.

Yours in Health,

Eugene Yellen-Shiring, D.C., F.I.C.C. Delegate, American Chiropractic Association

Embracing A Personalized Approach to Health and Nutrition for Tailored Wellness

In the ever-evolving landscape of healthcare, the traditional "one size fits all" approach is no longer the optimal approach for treating health concerns. Instead, a paradigm shift that’s centered on personalized health and wellness is occurring. Precision medicine and personalized nutrition are at the forefront, and practitioners are taking a closer examination of an individual's unique traits, characteristics, and exposures to craft a tailored health plan. By doing so, practitioners are finding success in how they approach medicine, treatment, and overall well-being.

The personalized health approach extends beyond surfacelevel considerations, delving deep into the cellular level to account for all attributes that make each patient distinct. This comprehensive approach aims to optimize health plans, from determining the ideal dosage of medicine to tailoring disease treatment plans, dietary recommendations, and supplement regimens to meet specific needs.

Precision in Nutrition: Nutrient-Gene Interactions

At the core of personalized health is the intricate synergy between nutrients and genes, explored through the fields of nutrigenomics and nutrigenetics. Nutrigenomics studies how nutrients influence gene expression and protein levels, with specific elements like vitamin A, vitamin D, genistein, and omega-3 fatty acids showcasing their impact.1

Nutrigenetics, on the other hand, investigates responses to dietary nutrients based on genetic differences, uncovering insights into how genes influence metabolism. For instance, single nucleotide polymorphisms (SNPs) in genes like MTHFR and CYP1A2 can affect the body's response to vitamin folate and caffeine, respectively.1 Dietary choices can also alter gene expression. For example, one study found that over-consumption of fried foods and sugar, along with a sedentary lifestyle, can increase the expression of genes involved in obesity.2

Genetic Programming: Epigenetic Modifications

Epigenetic modifications, a form of genetic regulation without direct DNA sequence changes, contribute to unique gene expression profiles among individuals. DNA methylation, a major epigenetic mechanism, influences gene expression by silencing or enhancing it.4

Specific methylation patterns during development stages can impact the later onset of conditions like metabolic disorders, cardiovascular diseases, cognitive disorders, and even cancer.5-7 Although currently challenging for the general population, advances in technology may one day allow

optimization of medicine and nutrition recommendations based on an individual's methylation profile.

The Gut Microbiome: Tailoring Health from Within

A diverse and healthy gut microbiome emerges as a unique component in personalized health. Comprising specific bacteria shaped by genetics, dietary choices, lifestyle, medications, and environmental exposures, the gut microbiome modulates immune response, inflammation, and cognitive functions.8-11 Studies demonstrate the potential of tailoring dietary recommendations and medications, as well as for gastrointestinal conditions, based on an individual's unique microbiome composition.9-10

Why Personalized Nutrition Matters

While generalized nutrition recommendations serve educational purposes for large groups, personalized nutrition can be the more beneficial approach for practitioners to take for its ability to consider and optimize individual characteristics and requirements. This approach fosters a deeper connection between individuals and their bodies, demystifying health topics like weight loss, exercise, and detoxification to help patients achieve measurable improvement. Beyond personal empowerment, personalized nutrition holds promise in achieving better outcomes for complex, chronic diseases, alleviating burdens on both individuals and the global economy.12

References

1. Farhud, D.D., Yeganeh, M.Z., Yeganeh, M.Z. (2010). Nutrigenomics and Nutrigenetics. Iranian J Publ Health, 39(4):1-14.

2. Qi, Q., et al. (2014). Fried food consumption, genetic risk, and body mass index: gene-diet interaction analysis in three US cohort studies. Br Med J, 348:g1610.

3. Mullins, V.A., Bresette, W., Johnstone, L., Hallmark, B., Chilton, F.H. (2020). Genomics in Personalized Nutrition: Can You “Eat for Your Genes”? Nutrients, 12:3118.

4. Moore, L.D., Le, T., Fan, G. (2013). DNA Methylation and Its Basic Function. Neuropsychopharmacol, 38:23-38.

5. Samblas, M., Milagro, F.I., Martínez, A. (2019). DNA methylation markers in obesity, metabolic syndrome, and weight loss. Epigenetics, 14(5):421-444.

6. Stoll, S., Wang, C., Qui, H. (2018). DNA Methylation and Histone Modification in Hypertension. Int J Mol Sci, 19(4):1174-1190.

7. Jin, Z., Liu, Y. (2018). DNA methylation in human diseases. Genes Dis, 5(1):1-8.

8. Valdes, A.M., Walter, J., Segal, E., Spector, T.D. (2018). Role of the gut microbiota in nutrition and health. BMJ, 361:k2179

9. Behrouzi, A., Nafari, A.H., Siadat, S.D. (2019). The significance of microbiome in personalized medicine. Clin Transl Med, 8:16.

10. Kashyap, P.C., Chia, N., Nelson, H., Segal, E., Elinav, E. (2017). Microbiome at the Frontier of Personalized Medicine. Mayo Clin Proc, 92(12):1855.

11. Leshem, A., Segal, E., Elinav, E. (2020). The Gut Microbiome and IndividualSpecific Responses to Diet. mSystems, 5:e00665.

12. National Center for Chronic Disease Prevention and Health Promotion. (2022). About Chronic Diseases. https://www.cdc.gov/chronicdisease/about/index.htm.

WCA Help Desk Updates

Tammy McKeown, C.T. | Membership Services Director | wcahelp@wichiro.org

| 608-292-1804

New Federal Reporting Requirement for Beneficial Ownership

Information Through the Financial Crimes Enforcement Network

Congress enacted the bipartisan Corporate Transparency Act to curb illicit finance. This law requires many companies doing business in the United States to report information about who ultimately owns or controls them.

Effective January 1, 2024, many companies in the United States must report information about their beneficial owners—the individuals who ultimately own or control the company—to the Financial Crimes Enforcement Network (FinCEN), a bureau of the U.S. Department of the Treasury.

Filing is simple, secure, and free of charge. Beneficial ownership information reporting is not an annual requirement. Unless a company needs to update or correct information, a report only needs to be submitted once.

Your clinic/company may need to report information about its beneficial owners if:

1. it is a corporation, a limited liability company (LLC), or was otherwise created in the United States by filing a document with a secretary of state or any similar office under the law of a state or Indian tribe; or

2. it is a foreign company and was registered to do business in any U.S. state or Indian tribe by such a filing.

Reporting clinic/companies report beneficial ownership information electronically through FinCEN’s website: www.fincen.gov/boi The system provides a confirmation of receipt once a completed report is filed with FinCEN.

(The WCA Help Desk advises you to print/keep this in your clinic compliance manual, once submitted.)

Be sure to review FinCEN’s Small Entity Compliance Guide, which provides information to help small businesses comply with this reporting requirement. There are twenty-three types of entities that are exempt from beneficial ownership information reporting requirements, including publicly traded companies, nonprofits, and certain large operating companies. The WCA Help Desk recommends members consult with their Accountant to make sure you meet these reporting requirements/regulations.

Additional Information can be found at: https://www.fincen.gov/

If you have any questions, please contact Tammy McKeown, C.T., at wcahelp@wichiro.org or 608-292-1804.

New to Practice & Recent Grads

SUPPORTING YOU Through Every Stage of Your Career.

Established Practice & Seasoned Professionals

ELEVATE YOUR CLINICAL SKILLS

Access quality education programs and seminars designed to hone your clinical expertise and lay the foundation for building a successful practice.

NAVIGATE WITH CONFIDENCE

Utilize Help Desk resources and tools to navigate complex issues such as Medicare/ Medicaid, HIPAA compliance, personal injury, and workers' compensation, ensuring you stay in compliance and protect your license.

MAXIMIZE YOUR PROFITABILITY

Discover cost-effective business solutions tailored for new member clinics, ranging from essential malpractice insurance to seamless credit card processing and everyday office necessities.

ADVOCACY AND PROTECTION

Rest assured knowing we've got your back. We advocate for chiropractic care at both the state and national levels, protecting your scope of practice and expanding access to chiropractic care for all.

INVEST IN YOUR TEAM

Address the growing needs of your staff with training programs designed to reduce turnover through continuing education seminars, webinars, and certification courses.

STREAMLINE OPERATIONS

Access efficient and affordable business tools, including malpractice insurance, credit card processing, and everyday office essentials, to ensure your practice runs smoothly and profitably.

BUSINESS GROWTH STRATEGIES

Take advantage of hiring assistance services and explore opportunities to buy or sell equipment (or your practice) with WCA Classifieds, simplifying transitions and growth strategies for your business.

SEEKING FAIR REIMBURSEMENTS

Join us in our legislative advocacy efforts aimed at securing higher reimbursements for chiropractic services at the state capitol, ensuring you’re fairly compensated for your expertise and services.

SAre You Using Social Media Compliantly in Your Practice?

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

ocial media has become integral to our daily lives, transforming how we communicate, share information, and connect with others. Chiropractic practices have recognized the importance of engaging with patients and the public through social media platforms. While the benefits of using social media in healthcare are numerous, healthcare professionals and organizations must employ responsible and ethical practices when navigating this digital landscape.

Patient Confidentiality

One of the foremost responsibilities of healthcare practitioners on social media is to protect patient confidentiality. Sharing patient information, even unintentionally, can lead to severe legal and ethical consequences.

To maintain patient privacy: (The HIPAA Journal, 2024)

• Avoid discussing specific patient cases: Never post identifiable information about patients, including their names, photographs, or other identifying details. Even general descriptions should be avoided to prevent potential breaches.

• Seek informed consent: If you wish to share a patient's story or experience, obtain explicit consent from the patient beforehand. Ensure they understand the implications and consequences of sharing their information on social media.

• HIPAA and social media cases are on the rise. In October 2019, a dental practice was fined $10,000 for impermissibly disclosing PHI on a social media review site; while in January 2016, a nursing assistant was fired from her job and sentenced to 30 days in jail for posting a video of a patient online.

Provide Accurate Information

Healthcare professionals are responsible for providing accurate and reliable information to the public. Misleading or false information can harm patients, erode trust, and tarnish the reputation of healthcare organizations.

To provide accurate information:

• Cite reputable sources: Always verify the credibility of sources before sharing medical information or advice. Use peer-reviewed journals, official medical guidelines, or information from recognized healthcare institutions.

• Fact-check before posting: Take the time to fact-check any medical claims or statistics before sharing them on social media. Misinformation can have real-world consequences.

• Correct mistakes promptly: If you discover you've shared incorrect information, correct it promptly and transparently. This demonstrates your commitment to accuracy and integrity.

Maintain Professionalism

Social media platforms are public spaces where chiropractors represent themselves, their organizations, and the chiropractic profession.

To maintain professionalism:

• Set clear boundaries: Distinguish between personal and professional accounts. Use separate profiles for professional content to maintain formality and focus on healthcare-related topics.

• Use a respectful tone: Engage with others respectfully, even in the face of criticism or differing opinions. Maintain a courteous and professional demeanor at all times.

• Avoid conflicts of interest: Disclose any financial relationships or conflicts of interest that could affect the credibility of your content.

Foster a Positive Online Presence

A positive online presence can enhance a healthcare practice's reputation, attract patients, and foster trust within the community. To cultivate a positive presence:

• Engage with the community: Actively participate in conversations related to healthcare topics, answer questions, and provide valuable insights.

• Share educational content: Regularly share educational and informative content, such as articles, videos, or infographics, that benefit your audience and showcase your expertise.

The responsible use of social media in chiropractic practices is a balancing act that requires careful consideration of patient privacy, accuracy, professionalism, and community engagement. By adhering to ethical guidelines and best practices, chiropractors can harness the power of social media to educate, inspire, and connect with patients while upholding their commitment to patient care and privacy. When used responsibly, social media can be a valuable tool for enhancing healthcare communication and patient outcomes.

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.

The 'Back to Basics' Podcasts Series

hosted by WCA President Dr. Chris Resch

The Wisconsin Chiropractic Association podcast “Back to Basics” brings you conversations with leaders in the chiropractic profession hosted by WCA President Dr. Chris Resch. This spring, we are featuring two additional episodes to our podcast library featuring Dr. Jeff King and Dr. Jason Mackey.

Episode 3 Featuring Dr. Jason Mackey

In this episode, I spoke with Dr. Jason Mackey from Luedtke, Storm Mackey Chiropractic in Madison, Wisconsin.

Dr. Mackey is a 2005 graduate of Palmer College of Chiropractic. He sees a variety of patients with musculoskeletal conditions with a specialty in sports injuries. He is a managing partner at LSM in which they have 19 clinics in and around the Madison area.

During our conversation, Jason has a story about his chiropractic inspiration and shares his enjoyment about helping acute patients. Additionally he shares more about the multidisciplinary professions that LSM has added to their clinics along with some great advice for the new chiropractor. I hope you enjoy my conversation with Dr. Jason Mackey.

Episode 4 Featuring Dr. Jeff King

Dr. Jeff King is Doctor of Chiropractic at the Medical College of Wisconsin which is affiliated with Froedtert hospital in Milwaukee, Wisconsin. He is a 2011 Graduate of Logan University where he obtained his Doctor of Chiropractic degree and Master’s Degree in Sport Science and Rehabilitation. He sees all sorts of Spine conditions, but enjoys specializing in headaches and sports injuries.

In this episode, Dr. Jeff King speaks in-depth on the multidisciplinary team based approach to patient care; how he communicates with patients and offers reassurance regarding their condition and their treatment; and the Fellowship Program at the Medical College of Wisconsin. Jeff then provides Advice to students on how to “get noticed” when it comes to applying for a position within an established practice or medical organization.

A Hidden Factor in Chronic Neck Pain

Dr. Nelson Marquina, MSc, PhD, DC | Chief Technology Officer of Laser Biotech International

Do you have chronic neck pain patients that are not responding to your usual chiropractic treatment? It may be time to look beyond the typical sources such as the thoracic and lumbar spine, pelvic tilt/rotation, knee, or pedal biomechanics. It may be time to look up! Consider the musculoskeletal kinematic chain and the neurological interactions between the cervical spine, the cranium, and the temporomandibular joint. Even the shoulder girdle may be involved, but, in this article, we’ll focus on one important and often overlooked source.

The CDC states that at any given time in the US about 10% to 20% of the population experiences neck pain.

On average, that’s about 1 in 8 people or about 52 million potential patients. We don’t have good estimates about how many of these people with neck pain are chronic neck pain sufferers that have tried numerous treatments without resolution, including chiropractic.

The National Institute of Dental and Craniofacial Research (part of NIH) estimates about 5% to 12% prevalence of temporomandibular joint and muscle disorder (TMJD) with women about twice as much as men. Statistically, we do not know how many chronic neck pain patients are also experiencing TMJD, but understanding their neuromusculoskeletal connections we can arrive at a clinical view. Moreover, this understanding can provide clinical ways to help chronic neck patients.

Neck pain and TMJ pain are interconnected through various mechanisms:

1. Muscular Interactions: The muscles of the jaw and neck are closely related anatomically and functionally. Dysfunction in the TMJ, such as muscle tension or misalignment of the joint, can lead to compensatory changes in the muscles of the neck, resulting in neck pain.

2. Posture: Poor posture associated with TMJ disorders, can contribute to neck pain. Patients with TMJ pain may adjust their head to an anterior position to alleviate discomfort in the jaw, leading to increased strain on the neck muscles and exacerbating or maintaining neck pain.

3. Nerve Irritation: Nerves supplying the cervical spine and the TMJ overlap or share pathways. Irritation or compression

of these nerves due to TMJ dysfunction may result in referred pain, where pain originating from the jaw is felt in the neck, and vice versa.

4. Shared Risk Factors: Some risk factors predisposing individuals to TMJ disorders, such as stress, bruxism (teeth grinding), and may also contribute to neck pain.

5. Central Sensitization: Chronic neck pain conditions can lead to central sensitization, where the nervous system becomes hypersensitive to pain signals. This can result in amplification of pain perception, making it difficult to distinguish between sources of pain in the neck or in the TMJ.

See Dr. Marquina at the WCA Spring Convention

continued on page 41

See Dr. Marquina at the WCA Spring Convention on Friday, April 12 for "Chronic Migraine Headaches: Manual Medicine Solutions" and Saturday, April 13 "TMJ Pain and the Craniocervical Junction: When Connections Go Wrong." Sponsored by Laser Biotech International

Neck Pain - Cont. from page 40

The relationship between chronic neck pain and the TMJ is complex and multifactorial. Effective pain management may involve addressing both the TMJ dysfunction as a root cause and the neck pain secondary to the complex of connections. The NIH states there is no evidence for dental bite treatments or surgery or implants to help with TMJ dysfunctions. The NIH does recommend manual medicine, TENS and acupuncture.

As a side note, the American Dental Association states, “The dentist should counsel the patient that TMJ disorders are often managed, rather that resolved, and that symptoms of TMJ disorders may persist, change, or recur intermittently” and “The dentist may prescribe or administer physical medicine (therapy) modalities.”

Some of the areas to test/check:

1. Profile from the mandibular condyle to C1 to C7 to shoulder to hip to knee

2. Muscles of mastication and head movements

3. Scoliosis, kyphosis, head forward posture

4. Shoulder levels

5. If lateral radiograph, the bite plane between C1 and C2

6. Visual midline alignment of teeth pairs 8/9 with 24/25

7. Hyoid for proper mobility: neutral and swallowing

8. Q-angle, especially in female patients: load and noload

9. Foot pronation/supination: load and no-load

Change Healthcare Systems Cyberattack Shuts Down Payment Processing

Dr. Mario Fucinari, DC, CPCO, CPPM, CIC

Arecent cybersecurity attack renews the warnings to ensure your required HIPAA compliance plan and manual are updated and active.

On February 21, 2024, Change Healthcare (a subsidiary of Optum) experienced a cybersecurity attack. Some software systems, providers, hospitals, and clearinghouses have been affected by this attack. As of March 8, 2024, Change Healthcare stated that there is no indication that any other UnitedHealth Group systems have been affected by this attack. They have not verified whether patient information was compromised.

Change Healthcare announced that BlackCat/ALPHV identified itself to the company, claiming responsibility for the cybercrime. According to the US Department of Justice, BlackCat/ALPHV is the second most prolific ransomwareas-a-service entity in the world, with over 1000 victims of cybercrimes across the globe.

The restoration of the Change Healthcare systems has caused a shutdown of claims processing and prior authorization of benefits for some plans, including Medicare Advantage plans. The company expects to begin testing and reestablishing connectivity to its claims network and software on March 18, 2024.

Workarounds have been established for several payers, including National Government Services (NGS). Keep in mind that if you choose to submit paper claims to NGS, Medicare payment will occur 29 days from the date the paper claim is received, whereas the payment for electronically submitted claims is only 14 days.

As an alternative, providers can use the NGSConnex for Part B claim submissions if they are affected and choose not to wait until the Change Healthcare system is restored.

In 2023, a record-setting 725 healthcare security breaches were reported to the Department of Health & Human Services Office for Civil Rights, according to a report from The HIPAA Journal. Last year, an average of 370,000 healthcare records were breached every day.

This is an opportunity for you to ensure that your system is safe. Perform Live Updates for your Network Security software. Providers and staff should be diligent in not clicking on links in emails or on social media, downloading attachments, or clicking on any links in the email. A HIPAA requirement is that you also conduct a Security Risk Assessment annually for your office.

While the effects of this cybersecurity event are ongoing, providers and staff must work to protect the health information and financial records of the office and their patients. Breaches of this type are all too common and may result in significant interruptions in patient care and ensuing fines.

Dr. Mario Fucinari is a Certified Professional Compliance Officer, Certified Physician Practice Manager, Certified Insurance Consultant, and a Medicare Carrier Advisory Committee member. He is the author of the “HIPAA for the Chiropractic Profession” 2024 edition, which provides information, forms, policies, and the steps necessary for HIPAA compliance. Books and other information are available at www.AskMario.com. Questions can be sent directly to Dr. Fucinari at doc@askmario.com

EXPLORE

CHIROONE.COM/CAREERS-DC

The Most Overlooked Cause of Neck Problems

Dr. Tim Bertelsman, DC, CCSP, DACO, Re-shared from www.chiroup.com

Problem: Deep Neck Flexor Weakness

The pervasive glow of screens and the demands of modern life are natural triggers for poor posture and painful neck dysfunction. Chiropractors often focus on the bony aspects of neck pain; however, experts suggest that approximately 80% of functional neck stability comes from the cervical muscles.1

While the proper function of all cervical muscles is necessary, multiple reviews have concluded that weakness of the deep neck flexors is profoundly connected to neck pain and headaches.2-6

The deep neck flexors include four muscles behind the trachea on the front of the cervical spine. The group consists of the longus colli, longus capitis, rectus capitis, and longus cervicis. Due to their proximity to the spine and short length, the deep cervical flexor muscles are primary stabilizers of the cervical spine.

This blog highlights the importance of these muscles. In less than 3 minutes, you’ll learn the specific recipe for identifying and resolving deep cervical flexor problems, including:

• A simple cervical deep neck flexor test

• The best exercises for deep neck flexors

Assessment: Cervical Deep Neck Flexor Endurance Test

The Deep neck flexor endurance test is a maneuver for assessing the suspect muscles. This chiropractic assessment starts with the patient in a supine, hook-lying position. The patient performs chin retraction and then actively lifts their head an inch off of the table. The clinician places their flat hand on the table below the patient’s occiput. If the patient’s head begins to lower or their anterior neck skin folds separate, they are reminded to “tuck your chin and hold your head up.”

The deep neck flexor endurance test is timed until the

patient’s head touches the clinician’s hand. The deep neck flexor endurance test norms for men is about 40 seconds and 30 seconds for women. Those with neck pain average closer to 20 seconds. Low endurance suggests weakness of the deep neck flexor muscles with a predisposition to over-utilize the SCM, platysma, and hyoid - resulting in an upper crossed posture and neck pain.7,8

Treatment: Deep Neck Flexor Exercises

Strengthening the deep neck flexors can help improve neck posture, pain, and function. The Deep neck flexor strengthening exercise helps enhance neck stability. This exercise essentially asks the patient to practice the assessment described above.

While lying supine, the patient performs a "chin tuck" by retracting their head to create a double chin. The patient then lifts their head, bringing their chin toward their chest without lifting their shoulders - as though they are looking at their toes. The patient holds this position for 3-4 seconds, then lowers their head and repeats as directed for three sets of ten repetitions daily.

Outcomes: Exercise & Manual Therapy

Multiple recent studies have concluded that deep neck flexor exercises improve posture, reduce pain, and lower disability.9-14 Several studies have concluded that deep cervical flexor endurance training is more potent than conventional manual therapy (PT) for patients with neck pain and headaches. 11,12

“Compared with manual therapy, deep cervical flexor muscle strength training showed a greater reduction in pain intensity [in 80 cervicogenic headache patients].”12

~Pain Research and Management. Aug 14, 2023

*Note: Manual therapy included oscillatory mobilization performed by a licensed physical therapist.

Outcomes: Exercise & Manipulation

One recent trial of chronic neck pain patients compared the utility of deep neck flexor strengthening vs. manual therapy (upper thoracic manipulation and upper cervical mobilization) and concluded:

continued on page 47

Neck Problems - Cont. from page 45

“There are no differences between groups in short and medium terms. Manual therapy achieves a faster reduction in pain perception than therapeutic exercise. Therapeutic exercise reduces disability faster than manual therapy.”14

The authors concluded that manipulation provides faster pain relief when used in isolation, while exercises targeting the deep flexor muscles of the neck enhance function more expediently.

Fortunately, evidence-based chiropractors are not limited to a single tool. Effectively managing spinal problems requires a comprehensive strategy that typically includes manipulation combined with the most appropriate chiropractic exercise protocol.

Simplify: Automate Your Chiropractic Exercises And Education

The good news for our subscribers is that every single one of these steps is automated within ChiroUp.

• Assess & Treat with the help of ChiroUp’s condition reference.

• Educate your patients in 4 clicks through ChiroUp’s condition reports (branded to your clinic).

• Track your outcomes with ChiroUp’s automated post-care survey & view results on your personal clinic dashboard

If you’re not yet a ChiroUp subscriber, does your current exercise software or process do all that?

Stop bouncing from system to system when you can streamline everything from the marketing to the assessment to the followup - all from within ChiroUp. See how easy we are to implement by checking out our free 14-day trial - no credit card required!

Current practices for sale:

Broker service includes:

• Practice appraisal

PRACTICE SALES AND APPRAISALS

* Stevens Point/Plover * Manitowoc * Sheboygan * Elkhorn

• Organize practice information into package for buyers

• Discreetly advertise and market the practice through most effective channels

• Screen and qualify potential buyers , and consult throughout the process

• Provide assistance to prospects with their due diligence and assist in making offer

• Draft contractual aspects involved

• Structure the closing, and assist with ownership transition

Having brokered over 475 successful chiropractic transactions, our process ensures a smooth transaction from beginning to completion.

Contact Loren Martin

Practice Opportunities, Inc.

WCA Member and Licensed Wisc

Phone: (952) 322-1177

www.practiceop.com

Email: martin@practiceop.com

WCA Member

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.

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 tenens 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

STUCK OR PLATEAUED?

Running a chiropractic practice is not easy. 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 608-316-6972 or spavlik@lsmchiro.org for more information.

DOC FOR A DAY - WE'VE GOT YOU COVERED!

Our professional locum tenens doctors are ready to fill in for you while you are away. Vacation, surgery and recovery, maternity leave, and semi-permanent coverage. All of our Docs are licensed, insured, experienced and have had background checks. Contact us to schedule your time off today! Call or Text Maggie: 847-367-9641 or Email: info@docforaday.com

BUYING OR SELLING A CHIROPRACTIC PRACTICE?

Current Wisconsin Practices for Sale:

• Stevens Point/Plover - Associate-to-own considered. Div./Drop/Instrument adjusting. Also dry needling, ART, FM, Nutri, laser, decompression. Skilled staff. Balanced payor mix approx. 50% insurance. Participates in major insurance plans.

• Elkhorn - 493 Quality referral practice in highly desirable area. Long established practice with solid reputation. Skilled staff. Neatly maintained free-standing building. 436 patient visits per month. $213,000 gross with low overhead. Asking $89,000. Financing avail.

• Manitowoc area - 28 year established practice with excellent reputation. Located along beautiful Lake Michigan. 1,500 sq ft prime location. Rent only $1,400/mo. Div/Cox/FD, therapies. Gross $243,177. Net $123,080.

• Sheboygan - Free-standing Low volume practice by choice. Established 40 yrs. Doctor retiring. Poised for growth. Fully equipped office. Sale includes free-standing building with 2 apartments up, all for only $230,000. Financing available

Contact Loren Martin: Practice Opportunities, Inc.

P: 952.322.1177 | Email: martin@practiceop.com | Website: www.practiceop.com. WCA Member/Licensed Broker

JOIN OUR COMMUNITY OF OVER 150+ MISSIONDRIVEN 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!

• 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 collaboration with our existing high-performing professional network. Be a part of a high-energy, fast paced, and successful culture. Corporate support including billing team of over 30 people, marketing team of over 120 people, HR, maintenance, IT, practice development, and more! Contact: maithy.ta@medullallc.com or Call: 316-218-2977

ASSOCIATE WANTED - RACINE, WI

Do you find joy in helping people feel, move and live better through chiropractic care? Join us in that mission at Daniels Chiropractic Office as an Associate Chiropractor. Become part of our 75-year legacy of serving the Racine community with compassionate, high-quality chiropractic care.

If you want to join us in helping people get better through chiropractic care, Dr. John wants to hear from you!

Text or Call Dr. John at: 262-989-4613 OR Apply at: www.danielsdc.com/now-hiring

EQUIPMENT FOR SALE - FRANKLIN, WI

Digital X-Ray For Sale: *** Asking price: $12,500 OBO ***

Used Rayence DR system with HCMI Radiographic System

Includes the following items:

• Control system running on Windows 10

• Grid Cabinet system

• Tubestand / Collimator system

• True Flat Panel DR Digital Xray package

• Caliper, lead apron, and gonadal shield

If Interested, Email: drheathersweet@gmail.com

To view images of the Digital Xray >>

EQUIPMENT FOR SALE - ONALASKA, WI

Erchonia EVRL for sale. Very limited use, New $15,000. Asking $9,000. The EVRL red & violet handheld laser has become Erchonia's most popular handheld device by offering the versatility of red and violet wavelengths taking outcomes to a whole new level. By combining these two specific

wavelengths into one treatment modality, patients received better results during clinical studies. The violet is also shown to be effective with its anti-bacterial & anti-microbial properties.

Specifications:

• 7.5 mW Line Generated Violet Laser diode with Patented Optics

• Wavelength: 640 nm & 405 Nm

• Modulation: Constant Wave (CW) & Pulsed

• Laser Class 2 / Device Class II (USA)

Please email Dr. John Anderson: jranderson7@hotmail.com

or Call: 608-385-8747

EQUIPMENT FOR SALE - NEKOOSA, WI

Transworld Model 325V X-Ray w/ bucky. Like New, limited use on X-Ray tube. Perfect for private practice.

• Originally installed January 1984

• Cronex Hiplus screen cassettes

o 2 - 8x10

o 2 - 14x17

o 1 - 14x36

*Make an offer. Call: 715-886-3400 if interested.

To view images of the Xray >>

OFFICE SPACE AVAILABLE - MADISON, WI

Great opportunity to lease office space along busy High Point Rd, right off the Beltline Highway, on Madison’s west side. The current chiropractic office is 1785 square feet and is ideal for your next office location. There is a possibility of an additional 1550 square feet. Ample onsite parking for customers, employees, many surrounding cafes, and restaurants make this the ideal location.

For more details, visit our website.

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

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.

If interested, Call Dr. Ryan at: 608.751.3124 OR Email: ryanlaurawyatt@hotmail.com

EQUIPMENT FOR SALE - APPLETON, WI

1. Hill Anatomotor Traction & Massage Table

- Table includes cervical & lumbar traction, massage rollers, vibration, and heat.

- Comparable units sell for $2500 in good working condition similar to this unit. Missing one part that can be easily sourced from Hill for $140 to complete the unit. Asking $2,000.

2. Bar Ray Heavy Duty Steel - 5 Level Film Storage Unit

- Comparable units are for sale online for $1600. Asking $400 each (Qty 3).

3. Maxalt Single & Double X-Ray Viewbox

- Comparable units sell for 4-5x more when new.

- Single: **Asking $25 each (Qty 1).

- Double: **Asking $50 each (Qty 6).

Pictures available upon request. Text Nathan: 920-202-1586.

PRACTICE FOR SALE - ADAMS, WI

Practice for Sale by sole proprietor. Close to Northern Bay Condominiums/Golf Resort, Sand Valley Golf Resort, and the Wisconsin Dells. Located in the city of Adams. This area has a great school district, small-town feel for raising a family, and local hospital to partner with for PT and X-Rays. 28-year established family referral practice. Balanced mix cash and insurance. Clinic is fully furnished in a great location with good visibility within a professional building with low overhead. Great for someone starting out that wants to have their own practice. Doctor is retiring and can provide pictures of the office upon request.

Asking $50,000. If interested, Call: 608-548-1277 or Email: drslea@yahoo.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

ASSOCIATE WANTED - WAUKESHA, WI

Throm Health and Wellness has the opportunity for an enthusiastic associate chiropractor to join our well-established and flourishing practice in beautiful Wausau, WI. We are looking for someone fun, family-focused, professional, and interested in staying in the area long-term. Base salary, plus incentives, IRA match, paid malpractice insurance. If interested, Call Dr. Dan: 715-302-3066 or Email: danthrom@yahoo.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

To view images of the laser >>

BUSINESS OPPORTUNITY - MADISON, WI

Small clinic in Madison, Wisconsin for Sale by the Owner. This is a rare opportunity to own a turn-key business, established in 2007. Drug & Alcohol Testing 24/7 is a recognized name in the industry with many long term, loyal clients. This opportunity includes everything you need to take it from here with unlimited income due to the many facets of the testing/screening business. To assist in the transition, Owner is offering one year consulting at a reduced rate ~ including the first 60 days hands-on training and support. 79 Service Contracts, 7 Collection Site Agreements in 2023 and after-hours Clientele! This Clinic supports “employment” by offering background checks, pre-employment drug screening, finger printing, DOT physicals, blood draws and more. $150,000 includes all equipment, website, contracts, trained and certified staff and current lease (expires 6/30/25).

Please contact Terri Stoudt at: (608) 819-8383

CHIROPRACTOR NEEDED TO PERFORM DOT PHYSICALS - MADISON, WI

Our small, privately owned clinic is in need of a chiropractor to perform DOT physicals. Must have or attain a Federal Certification in accordance with the Federal Department of Transportation Regulations. We will provide the exam room, supplies, internet access and contractual clients. You would have the opportunity to grow your own practice (if you currently own your own clinic). However, must be available 2 mornings per week ~ 9:00 AM to 12:00 PM. Prefer a person of faith, grace and compassion, who is honest and delivers personable, caring service ~ always putting the Patient first. Please respond to: tstoudt@drugandalcohol24-7.com [Put "Doctor" in the subject line of email]

ASSOCIATE WANTED - MT. PLEASANT, WI

We are seeking a skilled and motivated associate chiropractor to join our team of multidisciplinary healthcare professionals. As a Chiropractor in our multidisciplinary clinic, you will play a crucial role in providing high-quality patient care, collaborating with other healthcare professionals, and contributing to the overall success of our clinic. We offer a unique opportunity for a chiropractor looking to excel in a collaborative and dynamic environment.

• Salary $80,000 - $100,000 depending on qualifications.

• Miscellaneous benefits include but are not limited to 401k, PTO, student loan forgiveness, health insurance etc. Contact Nic at: nkampfer@advancedcarespecialists.com

POSITION WANTED - WAUPACA, WI

PASSIONATE ABOUT PREGNANCY AND PEDIATRIC CARE?

Roots Wholistic Health in North Central Wisconsin is looking for an Associate Doctor! We love the buzz of a family-focused clinic and are excited to add your energy! We offer a flexible schedule and base salary plus bonus opportunities. We also include continuing education and malpractice insurance coverage.

Simply visit our website to:

• Check out pics and videos of office and staff.

• Salary and employment details.

• How to apply!