Texas Chiropractic Association
Texas Journal of Chiropractic Volume XXVII, Issue 1 Jan / Feb 2012
TCA Leadership for a New Health Care Era
Ron Poole TCA Executive Director
Jorge Garcia D.C. TCA President
Jack Albracht D.C. President-elect
James Welch D.C. Secretary
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TexasChiropractic Chiropractic Association Texas Association
TCA Mid-Winter Conference February 17–19, 2012
REG I DISC STRATIO O N Sheraton Arlington, Arlington, Texas Janu UNT EN DS ary 2 5, 20 More details to follow. Call the TCA office for details 512-477-9292. 12
There’s Something for Every Interest Make sure that you save the date and make plans to attend the TCA Mid-Winter Conference in Arlington in February. You won’t want to miss this one! David Fletcher DC-- The Power of Communicating Practice Value with Every Type of Patient: Enabling the Critical Shift of the Day 1/Day 2 patient experience
A Chiropractor, performance and stress management specialist. Dr. Fletcher lectures throughout the global chiropractic community on the devastating effects of spinal nerve tension. His practice reflects his passion for working with stress related disorders. Edward (Ned) Hallowell M.D.--
SHINE,'Special'Help'Integra2ng'Neurological'Experience
People who listen to Dr. Hallowell come away stimulated, inspired and empowered to change their lives. He is a charismatic speaker, best selling author, Dr. Ned Hallowell offers a guide that shows how to get the most out of life with Attention Deficit Disorder. A graduate of Harvard College and Tulane School of Medicine, Dr. Hallowell is a child and adult psychiatrist and the founder of The Hallowell Center for Cognitive and Emotional Health in Sudbury, MA and New York City. He has been prominently featured in the media including 20/20, Oprah, CNN, PBS and NPR as well as 60 Minutes, Dateline, Good Morning America, US News and World Report, Newsweek, the Harvard Business Review, The Today Show, and the New York Times. Janet McClain and Betty McInturff D.C. -- Medicare and Ethics Hours Janet McClain has been with the American Red Cross for 37 years and began working with the Chiropractic community teaching the National Red Cross new Back Injury Prevention program since 1988. Betty McInturff, D.C. graduated LACC in 1987 and taught at Cleveland Chiropractic College, Los Angeles. In 2005 Betty joined the American Red Cross as a volunteer Protect Your Back Instructor and Instructor Trainer and has been instrumental in keeping the teaching materials updated. Kelle Plotner D.C. -- CA Boot Camp Dr. Plotner has been a chiropractor for over 20 years after starting her career as a CA. She takes pride in her ability to roll up her sleeves and train offices on how to put systems and procedures in place. She was on "Ask Dr. Kelle," a talk radio show for women, answering calls about various medical topics.
The Texas Chiropractic Association represents chiropractic professionals throughout the state.
Texas Chiropractic Association MidWinter Conference Schedule Overview Friday Feb 17, 2012 12:00 pm – 5:00 pm Conference Registration and Information
1:00pm – 5:00pm David Fletcher, D.C. The Power of Communicating Practice Value with Every Type of Patient Enabling the Critical Shift of the Day1/Day 2 Patient Experience
Saturday Feb 18, 2012
First formed in 1916, this historic association has existed for nearly 100 years and has represented the interests of Texans who desire safe and effective health care from chiropractic professionals. TCA serves to protect chiropractic professionals, their patients, and the right f o r Te x a n s t o c h o o s e chiropractic as one of their health care options.
8:00 am – 5:00 pm Kelle Plotner D.C. CA Boot Camp
8:00 am – 5:00 pm Janet McClain D.C., Betty McInturff D.C Medicare and Ethics Hours
8:00 am – 11:00 am
ABOUT OUR COVER
1:30 pm – 5:00 pm
The healthcare world continues to change daily. The TCA leadership is working to adapt to this change and chart a new course for the association in the coming decade.
David Fletcher, D.C. The Power of Communicating Practice Value with Every Type of Patient Enabling the Critical Shift of the Day1/Day 2 Patient Experience
Executive Director, Ron Poole
Edward Hallowell M.D. SHINE, Special Help Integrating Neurological Experience
9:00 am – 12:30 pm TCA Board Meeting
TCA President, Dr. Jorge Garcia
Sunday Feb 19, 2012 8:00 am – Noon Janet McClain and Betty McInturf D.C. Ethics, Risk Management, Records Keeping and Coding
12:00 pm Final Attendance & End of Conference
TCA President-elect, Dr. Jack Albracht TCA Secretary, Dr. James Welch and the TCA Board of Directors are at the helm as TCA sails new waters.
Texas Chiropractic Association Mid-Winter Conference REGISTRATION
N TIO DS *** Register before January 25, 2012 for reduced rates! *** A R N IST NT E 012 Feb 17-19, 2012 REGISTER ONLINE at www.chirotexas.org or G RE COU 25, 2 FAX COMPLETED FORM to: 512.477.9296 or y DIS nuar Sheraton Arlington, MAIL TO: Texas Chiropractic Association Ja Arlington, Texas 1122 Colorado St., Ste. 307, Austin, TX 78701 PLEASE TYPE OR PRINT CLEARLY. USE ONE FORM PER DOCTOR. Doctorʼs Name ____________________________________ License Number _______________________ Spouseʼs Name ___________________________________ CAʼs Name ___________________________ (if Attending)! !
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!
!
!
!
!
(if Attending)
Mailing Address ___________________________________ City, State, Zip _________________________ Phone _____________________ Fax _____________________ E-Mail ____________________________ REGISTRATION FEES REGISTRATION RATE BEFORE JANUARY 25, 2012 DOCTOR ! TCA Member! ! Non-Member!
____ @ $165* $_______ ____ @ $310* $_______
* Cost includes TBCE 8 hour Medicare and 4 hour Ethics class Other Registrants ! CA! ! ! Non-Member
____ @ $ 95 $_______ ____ @ $135 $_______
REGISTRATION RATE AFTER JANUARY 25, 2012 DOCTOR ! TCA Member! ! Non-Member!
____ @ $210* $_______ ____ @ $360* $_______
* Cost includes TBCE 8 hour Medicare and 4 hour Ethics class Other Registrants ! CA! ! ! Non-Member
____ @ $125 $_______ ____ @ $160 $_______
TBCE REQUIRED HOURS ONLY
HOTEL INFORMATION
tel 26 o H ry a e! nu Ja adlin De
Sheraton Arlington 1500 Convention Drive Arlington, TX 76011 (817) 261-8200
Please Call and ask for the TCA Room Rate of $107 per night for Single or Double Occupancy. Deadline for TCA Special Room Rate is Jan 26, 2012 TCA Members who are 70 years of age, or older, are invited to attend the seminar FREE OF CHARGE (excluding accommodations and meals). If you have allowed your TCA membership to lapse, you may renew as a retired D.C. For $60 Annually. Donʼt forget to call the Sheraton Arlington Hotel NOW to reserve your room at the discounted TCA rate of $107 per night.
Payment Method Check is inclosed for $_____________________________ CHARGE $__________________ to my credit card: Card Number: ___________________________________ Expiration date: __________________________________
! !
TCA Member! ! Non-Member! !
____ @ $75 $_______ ____ @ $100 $_______
(For D.C.ʼs needing ONLY 8 hour Medicare & 4 hour Ethics class.)
Name on Card: ___________________________________ Signature:_______________________________________
CANCELLATION/REFUND POLICY: A full refund (less a $50 processing fee per registrant) will be granted if a written request is received by February 1st, 2012. No refunds will be granted after February 11, 2012. Refunds will be processed AFTER the seminar. TCA reserves the right to cancel if necessary. Should cancellation become necessary, registrants will be notified
Texas Chiropractic Association
Texas Journal of Chiropractic Volume XXVII, Issue 1
Texas Journal of Chiropractic The Official Publication of The Texas Chiropractic Association
1122 Colorado, Suite 307 Austin, TX 78701 Phone: 512 477 9292 Fax: 512 477 9296 E-mail: info@chirotexas.org www.chirotexas.org Executive Officers President: Jorge Garcia D.C. President Elect: Jack Albracht D.C. Secretary: James Welch D.C.
TCA Staff Executive Director: Ron Poole Membership Development: Amy Archer Editor: Chris Dalrymple D.C.
Board of Directors District 1! District 2! District 3! District 4! District 5! District 6! District 7! District 8! District 9! District 10! District 11! District 12!
Paul Munoz D.C. Jon Blackwell D.C. Jason Clemmons D.C. Mark Bronson D.C. Dr. John Quinlan D.C. Cody Chandler D.C. Lorin Wolf D.C. Shawn Isdale D.C. Mark Roberts D.C. Shane Parker D.C. Max Vige D.C. Yvonne Landavazo D.C.
Policies Annual subscription to the Texas Journal of Chiropractic is included in TCA membership dues. Contact the TCA for subscription rates for non members. The print Texas Journal of Chiropractic is published up to six times per year by the Texas Chiropractic Association under the supervision of the TCA Publication Committee. Opinions expressed are those of the contributors and do not necessarily reflect the policy of the Texas Chiropractic Association or the Texas Journal of Chiropractic.
January/ February 2012 Inside TCA Names New Executive Director TCA Announces “New” TCA TMA v TBCE (I) Appeals Report TMA Claims a Victory in Court Quick Decision Awards TMA v TBCE (II) to TMA What Limits? New Medicare ABN Forms Required TBCE Publishes Rules Update Foster Kids in Texas At Risk for Overmedication Highmark and Medicare in Texas Supreme Court Announces It Will Decide Health Care Reform The Future of Health Care Professionals? Healthy People 2010 Missed the Target HHS Launches Healthy People 2020 Enough Opioids to Medicate EVERY American Every Four Hours for a Month Flu Vaccine Effectiveness? Texas' Tort Law Fails to Reduce Health Costs, Attract Doctors College News US Senate Calls for More DOD DCs Drug Deaths Now Outnumber Traffic Fatalities The TBCE Reports ACA's Medicare Audit Defense Taskforce The Chiropractic Development Initiative Publication of an advertisement does not imply approval or endorsement by the Texas Chiropractic Association. The association shall have the absolute right at any time to reject any advertising for any reason.
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For advertising rates contact the TCA Office. All advertising material must be in graphics ready format and submitted as a .jpg, .jpeg, .gif, .swf, or .png file type. Copyright 2012 All Rights Reserved: Texas Chiropractic Association
Texas Chiropractic Association Names New Executive Director T h e Te x a s Chiropractic Association has named Ron Poole of Austin as Executive D i r e c t o r Ron Poole following a nationwide search of nearly six months. Mr. Poole will be responsible for the general and business management of the state association for chiropractic professionals. A results-oriented business executive with an entrepreneurial background and a successful track record for improving a wide variety of organizations, Poole joins the TCA with experience in strategic marketing, management consulting, and business communications that spans nearly three decades. Mr. Poole spent 15 years in the advertising agency business, then 10 years with Computer Sciences Corporation in a marketing capacity. He most recently worked for the State of Texas Health and Human Services enterprise while owning his own company providing automotive products and services. Mr. Poole holds a BBA from the University of Houston, and a MBA from www.chirotexas.org
Houston Baptist University. Prior to that he served in the US Navy submarine service. T h e Te x a s C h i r o p r a c t i c Association represents chiropractic professionals throughout the state. First formed in 1916, this historic association has existed for nearly 100 years and has represented the interests of Texans who desire safe and effective health care from chiropractic professionals. TCA serves to protect chiropractic professionals, their patients, and the right for Texans to choose chiropractic as one of their health care options.
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TCA Announces “New” TCA D r. J o r g e G a r c i a , T C A President, recently outlined some of the changes that are in the works at the Texas Chiropractic Association. Says Dr. Garcia: “TCA is stepping up its game in its service to the chiropractic profession.” A NEW STRUCTURE This process began in the Summer of 2011, early in Dr. Garcia's two-year term as president. "This summer I introduced an extensive, standing committee structure. The purpose of the committee structure is to foster continuous Doctor involvement, oversight and 3
input in multiple areas of the Association as it affects the practicing DC," Dr. Garcia said. A NEW ADMINISTRATOR T h e Te x a s C h i r o p r a c t i c Association also began a search for a new executive director this past summer. As the previous article reports Mr. Ron Poole of Austin has been named the New Executive Director of TCA . A NEW OFFICE STAFF In the process there has been significant change in the office staff of the TCA and now "when you call the TCA office you can expect prompt and courteous service from Amy, or Gloria, or part-time assistant Skylar Isdale." In the interim between the changes in leadership, various “TCA past presidents have been asked to help oversee the transition to our new office leadership. We thank these hardworking pastpresidents for again offering their services to the profession long after their original tenure." A NEW TCA All of this is part of what will become, in Dr. Garcia's words, "a New TCA that will be bigger, better and offer more services than ever before. We are excited about this new direction and positive impact the New TCA will have for our Members." Texas Journal of Chiropractic
A NEW DIRECTION But, other than new staff and leadership just what IS changing about the Texas Chiropractic Association? Says Dr. Garcia, "Following TCA’s Annual Convention of June of this year the TCA Executive Officers, Board of Directors, and I, made a commitment to you to move forward with the Chiropractic Development Initiative (CDI). The CDI is a 10 year commitment to positively affect changes in statute, regulation, as well as government and public perception and accomplish five specific actions: 1. Allow patients the full benefit of Chiropractic Care based on the Doctor’s level of education, training and experience, without discrimination. 2. Expand patient access to Chiropractic Care whenever the patient chooses, without discrimination. 3. Ensure Chiropractic Doctors’ rights to get paid from all payment systems without discrimination. 4. Provide a clear understanding of all regulations and guidelines so that Chiropractic Doctors can practice without fear. 5. Foster community and governmental respect for Chiropractic Doctors that is
Texas Journal of Chiropractic
consistent with other healthcare providers." WORKING WITH REGULATORY AGENCIES Much of this new direction involves working with the regulatory agencies that affect the profession. Dr. Garcia notes that "in recent months the TCA has worked cooperatively with the
Texas Board of Chiropractic Examiners to establish rules that won’t limit your ability to treat patients based on the current nationally accepted standards in the profession." The TCA has worked diligently to call the attention of the profession to these changes and has worked closely with the regulatory agency to develop suitable rules. Says Dr. Garcia "If not for the TCA
Call for Keeler Award Nominations Established in 1934 by Dr. Clyde Keeler, The Texas Chiropractic Association’s award designating the Chiropractor of the year, The Keeler Plaque, is Texas Chiropractic’s most prestigious award. Nominations for the Keeler Plaque should be sent to: Dr. Curtis McCubbin Secretary, Keeler Plaque Committee P. O. Box 272 Hunt, Tx 78024 All nominations will be held in strict confidence to assure that the recipient will be surprised when their name is announced. A candidate shall be: A member in good standing in the TCA Of good moral character A promoter of chiropractic advancement in at least one of the three years immediately proceeding the year in which the award is to be presented. Such advancement may be in research, public relations, school participation, promotion or support. The candidate’s main endeavor must be in the practice of chiropractic and must have promoted chiropractic throughout their career. Civic, church or community involvement, individually or within organizations or groups, and holding offices in local, state or national chiropractic organizations, chiropractic boards, and chiropractic college boards may also be considered.
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you might not know about the proposed rules changes, let alone had any way to change them on your own." WORKING WITH LITIGATION--A STRONG DEFENSE Within the profession most are aware of the strong defensive position that TCA has taken in defending the chiropractic profession against the litigative actions of the Texas Medical Association.
Communicating with the profession is one of the charges of our association. Dr. Garcia points out that "over the past several months
chiropractors in your neighborhood, your town, your city, your county. In coming years we hope that almost all chiropractors will choose to become a part of t h e Te x a s C h i r o p r a c t i c Association. VOLUNTEERS WORKING TOGETHER
“The bottom line is t h i s … a s a Te x a s Chiropractor, we need your talent, input, and contributions on our team."
Our efforts are reported nationwide and "TCA also hired one of the strongest appellate law firms in the nation to argue the appeal of the TMA lawsuit. Imagine if your rights to diagnose your patients were not protected," asks Dr. Garcia.
A strong defense of the profession is of benefit to all in the profession. Defense of the profession is everyone's concern and is a part of the direction of the new TCA. WORKING WITH LEGISLATION As always, working in the legislative process will be a significant part of the new TCA's work and the new TCA is already gearing up and planning for upcoming legislative processes in the coming year(s).
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WORKING WITH COMMUNICATION
the TCA has been increasing the amount of relevant news, communication and feedback to its members. It has been reaching out to all Texas Chiropractors on a monthly basis in order to give Texas DC’s the information they need ...." In the coming "new TCA" this will continue to be a significant portion of the association's efforts.
And lest you think that the Texas Chiropractic Association is a large army of paid employees Dr. Garcia points out: "I think it’s important to remember that all of T C A’ s l e a d e r s h i p positions are voluntary. The Executive Officers, Board of Directors and Committee members are full-time practicing Chiropractors serving their fellow DCs, largely at their own expense." When volunteers come together to protect, defend, and advance something that they are passionate about the level of achievement may be astounding.
ARE YOU PART?
SUCCESS OF ALL
Dr. Garcia, in his letter to the membership, points out that the "TCA is you and me, pulling together as a team. As a team member, you have my commitment."
D r. G a r c i a n a m e s t h e objective and the needs of the association: "As a team, we are committed to the success of this profession for many years to come. Our long-term success hinges on this commitment. The bottom line i s t h i s … a s a Te x a s Chiropractor, we need your
The TCA is not some nebulous group of individuals in a distant realm, it is the 5
Texas Journal of Chiropractic
talent, input, and contributions on our team." YOU CAN HELP The easiest way is to become an active part of the chiropractic professional trade association, especially now while it is working to construct itself to best fit the needs of the profession. Your input should be a vital part of that construction CLICK HERE to join the TCA membership as a member or affiliate member. You may also help, Dr. Garcia notes, by choosing to "donate generously and encourage others to also donate to the Defense Fund: The Chiropractic Defense Fund was established specifically to pay for legal expenses, lobbying efforts, and public relations of protecting and advancing the profession." The Defense fund is an ongoing need and not just a short term project. All are encouraged to regularly contribute some amount to the chiropractic defense fund. Of what value is the defense of your profession to YOU?
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TMA v TBCE (I) Appeals Report The final court arguments of TMA v. TBCE (I) took place in Austin on September 14, Texas Journal of Chiropractic
Call for Nominations for Young Chiropractor of the Year Established over half a century ago, this award recognizes doctors who have shown outstanding dedication and who have made longlasting contributions to the profession and their community, and who are under 40 years of age, or in active practice for fewer than 10 years at the time of the award’s receipt. Send nominations to:
Dr. John Quinlan, D.C.
120 S. Denton Tap Rd, Suite 410 Copal, TX 75019
Phone: 972-304-5900 Fax: 972-304-6047 drquinlan@quinlanchiropractic.com 2011. The TCA submits the following report: "There were four parties to the appeal (TCA, Texas Board of Chiropractic Examiners, Texas Medical Board, and Texas Medical Association), and each party had an attorney representing them. A three judge panel heard the arguments and will render a decision. Chief Justice Jones .... Justice Pemberton .... and Judge Henson .... were the judges." "The primary issue discussed by the court and the attorneys was diagnosis. MUA received a fair amount of discussion, and needle EMG received surprisingly little discussion." "There were four issues that TCA and the TBCE brought in the appeal -- that the TBCE rule is proper and should be upheld in its entirety. The District Court judge (Judge Yelenosky) had ruled that the TBCE rule should be struck down in four areas. Judge Yelenosky said that rule 6
should not allow DCs to 1) diagnose subluxation complexes, 2) diagnose conditions beyond the spine and musculoskeletal system for the purpose of referral, 3) perform MUA, and 4) perform Needle EMG." "The discussion regarding diagnosis focused on the statutory language and the distinction between a preliminary diagnosis and a definitive diagnosis.”
The law “should not allow DCs to 1) diagnose subluxation complexes, 2) diagnose conditions beyond the spine and musculoskeletal system for the purpose of referral.” --Judge Yelenosky
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Judge Yelenosky had decided that “DCs could almost always form a preliminary diagnosis … for the purpose of referral to another health care provider, but could only “definitively” diagnose (which he took to mean an absolute certain diagnosis) a patient when the diagnosis would require chiropractic treatment." Judge Yelenosky “said that it would be improper for a DC to perform the tests necessary to determine with absolute certainty …. Judge Yelenosky reasoned that since DCs can’t treat tumors or cancer, then there was no reason to permit DCs to engage in those types of diagnostic tests.” Regarding whether or not chiropractors may diagnose subluxations TCA “explained that a “subluxation complex” is a term that is specific to D C s i n t h e l a w. T h e Chiropractic Act is the only place where you will find that term.” “Since DCs are the only health care providers able to treat subluxation complexes, it stands to reason that DCs should be able to diagnose them. He also brought up the fact that the Texas legislature appeared to intend to permit DCs to diagnose almost any condition, because the Chiropractic Act permits DCs to draw blood for diagnostic purposes. That section of the Act does not limit the purpose for which the blood can be drawn." www.chirotexas.org
"The discussion of MUA dealt with both the language of the s t a t u t e a n d b r i e fl y w i t h legislative intent. … Judge Ye l e n o s k y s a i d t h a t t h e Board’s rule allowing MUA was improper because MUA is in the surgery section of the CPT codebook. … TCA argued that Judge Yelenosky’s decision was wrong because Chiropractic Act does not prohibit MUA, and in fact it expressly permits 'manipulation,' without any limit. It does not say manipulation 'but only when conscious.'” TCA further stated “that the part of the Chiropractic Act w h i c h d e fi n e s ' s u r g i c a l procedure' as being whatever is in the CPT codebook was unconstitutional. [While] it was common for the legislature to 'delegate' the responsibility for defining certain words to an agency or another part of the government .... it is important to realize that the CPT codebook is written by the American Medical Association.” “That CPT codebook actually determines the scope of chiropractic, because it defines what is (and is not) a 'surgical procedure.' Since surgery is prohibited by DCs, the AMA actually has the power to define what DCs can do, simply by changing what is in the surgery section of the CPT codebook.”
TMA (or the AMA) to define the scope of its competitors’ practice. In fact, the Supreme Court has declared those sorts of Legislative delegations to private parties (like the American Medical Association, who creates and publishes the CPT codebook) unconstitutional several times in the past." "At the end of the argument, the court raised an interesting question as to the degree of deference owed the Board's interpretation of the Chiropractic Act as set forth in the definition of "incisive" and other portions of the rule.” "Deference is the idea that the court should trust the TBCE’s interpretation of the Chiropractic Act. The TBCE alone has the responsibility to interpret it, enforce it, and make sure that the Act makes sense. The courts have consistently said that if an agency’s interpretation of its own statute is reasonable (even if the court disagrees with the way the agency interprets it), then the court should defer to the agency, and let the agency make the decision. That principle of deferring to the agency is even stronger when the subject matter is complex, or where the subject matter requires special knowledge like it does here."
“[T]he Supreme Court has never permitted the legislature to allow a competitor like the
"The case is now fully before the court. ...TCA members should be very proud of the presentation that was made on their behalf."
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Texas Journal of Chiropractic
Texas Chiropractic opractic A Association
The STARS of TCA
The Stars of TCA Program gives special recognition to those who generously contribute to TCA. Their contributions fund special initiatives that advance the Chiropractic Profession in Texas.
Star Levels Diamond Sapphire Platinum Gold TCA’s Top Donor receives The TCA’s Gavel Award in appreciation of noteworthy financial support.
Call TCA: 512-477-9292 and the details will be handled for you.
Thank You for Your Contributions! Texas Journal of Chiropractic
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TMA Claims a Victory in Court T h e Te x a s M e d i c a l Association reports on their website that "an Austin state district judge ruled in TMA’s favor in early December and granted the association's motion to stop chiropractors from performing vestibular testing. Judge Rhonda Hurley's ruling invalidates the Texas State [sic] Board of C h i r o p r a c t i c Examiners' (TBCE) vestibular testing rule by declaring it to be beyond chiropractors' lawful scope of chiropractic." "TMA took the TBCE to court ... after TBCE adopted rules allowing chiropractors to perform the procedure. TMA argued that state law does not authorize chiropractors to perform vestibular testing. The vestibular system is a component of the inner ear and communicates with the central nervous system. Tests of vestibular function are diagnostic tests designed to evaluate the function and structure of the inner ear and/ or brain, and they include hearing evaluations because the hearing and balance functions of the inner ear are closely related." "The vestibular apparatus is not part of the musculoskeletal system because the muscles that connect the eyes to the skull do not 'move the body' or www.chirotexas.org
'maintain its form,'" TMA said in its motion." Despite case law, it is the opinion of the Texas Medical Association that "Chiropractors are not authorized to diagnose medical conditions, including defects in the vestibular apparatus, because the Chiropractic Act does not include the diagnosis of diseases within the definition of chiropractic. Even if chiropractors can use the word 'diagnosis' in a rule, any such diagnosis must be limited to the biomechanical condition of the spine and musculoskeletal system." The TMA motion added that the issue of whether "diagnostic testing by chiropractors ... for chiropractors to be able to be primary care doctors is a question for the legislature and not the court." T h e Te x a s M e d i c a l Association states "this is the fourth part of TBCE’s Scope of Practice Rule that a court has declared invalid and void because it exceeded the scope of chiropractic as defined by law. The first three parts of the rule unlawfully authorized chiropractors to perform manipulation under anesthesia and needle electromyography, and to diagnose diseases," but the historic nemesis of the chiropractic profession fails to report that these rules are still under appeal and have not YET been fully decided. It is 9
clear, however, that the medical profession jealously protects that which it perceives belongs to them alone.
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In Quick Decision TMA v TBCE (II) Awarded to TMA By Clem Martin D.C.
Judge Rhonda Hurley of the 98th District Court, Travis County, Texas, took less that 48 hours to rule against the TBCE and the People of Texas. This report provides a bit of the history surrounding this case. On Dec. 15, 2008, a scope of practice question was placed before the TBCE; "is v i d e o n y s t a g m o g r a p h y, electronystagmography and electronic balance testing within scope of Title 3, Subsection C, Chapter 2 0 1 . 0 0 2 o f t h e Te x a s Occupations Code." The TBCE is required by law to investigate and respond to all questions of scope pertaining to the practice of chiropractic. After almost a year long investigation of the vestibular system and its integration with chiropractic applications, the Board unanimously voted that vestibular testing with video/ electronystagmography and electronic balance testing was within the scope of chiropractic. Texas Journal of Chiropractic
On April 6, 2010 the TBCE held a public hearing allowing interested parties to comment upon the proposed amendment to 22 TAC Rule 75.17 including vestibular instrumentation testing within scope of chiropractic. The hearing offered an opportunity for those with concerns to offer positional statements. This hearing was attended by interested practicing chiropractors and representatives of both the Texas Medical Association and the Texas Medical Board. Written objections had been filed by the Texas Board of Audiology, American Academy of Otolaryngology, American Otology Society and the Texas Medical Board. Parker Chiropractic College filed a statement in support of the TBCE's position. Upon the TBCE's passage of Rule 75.17(3)(C) [The Vestibular Rule], the Texas Medical Association filed suit in Travis Count seeking Summary Judgment to overturn the TBCE Scope Rule. The TMA argued that the purpose of vestibular testing was to diagnose problems with the brain, inner ears or eyes. They hypothesized that the ears, eyes and brain were "not a part of the spine nor biomechanics of the musculoskeletal system of the human body." Expert witnesses were deposed by both sides. Appearing for the TBCE was Texas Journal of Chiropractic
Professor Fredrick Carrick, DC, MS, PhD and Brandon Brock DC, Board Certified in Ve s t i b u l a r t e s t i n g . B o t h performed superbly under intense examination by Plaintiff (TMA) attorney, David Bragg. Mr. Bragg represented the TMA and TMB in the MUA, NEMG and diagnosis suit. Both Dr. Carrick and Dr. Brock carefully defined the significance of the Vestibular System in human segmental movement, positioning, and other bodily functions. Appearing for TMA was an Austin area Otolaryngologist, James Wallace MD and also from the Austin area, Bridgett Wallace, PT. By happenstance just a few weeks prior, in November 2011, the Discovery Channel telecast segments of Dr. Carrick’s management of some concussed Hockey players. The telecast showed videonystagmography and electronic balance testing in use by Dr. Carrick. One of these patients was a well known professional hockey player and MVP, Sidney Crosby. The segment focused on Crosby's injury and his long term treatment, without significant improvement, at the University of Pennsylvania Medical Center. Mr. Crosby consulted with Dr. Carrick and was very shortly returned to peek performance. He scored four goals in the first game of his return to competition. Unfortunately, these telecasts were not admitted into evidence for TBCE. 10
The Vestibular system of the human being is an integral part of its ability to position, to posture and to control its muscular movement within t h e g r a v i t y fi e l d o f i t s environment. When determining how the musculoskeletal system maintains segmental positioning and movement, we must look to the ocular, labyrinthine canals and the proprioceptive input into the vestibular system. E l e c t r o n y s t a g m o g r a p h y, Videonystabmography and balance testing permit sophisticated evaluation of the function of the vestibular system pre- and postintervention. As of this moment it is not known what course of action the TBCE will take. Like Hamlet's, to be or not to be, our Board must decide whether or not to appeal this "quick decision." To deny the assessment of the vestibular system to those who are legislatively charged to use "objective or subjective means to analyze, examine, or evaluate the biomechanical condition of the spine and musculoskeletal system of the human body" and who are charged to perform "nonsurgical, nonincisive procedures ... to improve ... the biomechanics of the musculoskeletal system" is to deny them access to a key regulating feature of the musculoskeletal system.
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Denial of vestibular testing is a severe handicap to the chiropractic profession, but it can be a much greater liability to the health and well being of the People of Texas.
injuries, diseases and disorders involving the biomechanics of musculoskeletal system.
While the Texas Medical Association would have the court system determine scope of practice issues, this position ignores the fact that the legislature has vested the Board system with the authority to determine scopeof practice issues and demonstrates the desire of some to have someone other than the duly appointed experts determine the scope of chiropractic practice. In reality, it is the desire of the majority to control the actions of the minority through any means necessary.
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What Limits? By: Roland R. Hicks, DC, CCSP, DACBN, RN, BSN
Regarding the practice of chiropractic, there are some who tell us that "...what is in the chiropractic statute is extremely limiting." If that is the perspective from you wish to look at it then the results of the various court judgments thus far are the results you would expect. A “condition” is defined as "situation, mode of being." I see the term "condition" in a broader sense. A biomechanical condition is a broad term that includes all www.chirotexas.org
The Chiropractic Act:
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does not state which diseases or disorders chiropractic doctors may, shall, or shall not address; nor does the act limit the diseases and disorders which affect the biomechanical condition of the musculoskeletal system; The act does not state that the chiropractor can only treat the effects (symptoms) of the musculoskeletal condition or that they must forsake the effective cause (etiology) of the condition.
Is it in the public interest to have healthcare providers treating only the latent effects of conditions, or is it in the best interest to have health care providers treating the causality? By law we are able to evaluate health issues which affect the biomechanical condition of the musculoskeletal system and t o t r e a t t h e e ff e c t s t h e biomechanical condition has upon the spine and musculoskeletal system. The TBCE got it right.
chiropractic care of the biomechanics of the musculoskeletal system, we should be able to evaluate those systems that have an effect on the musculoskeletal condition. Note I did not say treat, I said evaluate. If a chiropractic treatment focused upon the musculoskeletal system then affects multiple other systems then so be it. That is what chiropractic manipulation is all about--that is what we expect. I would like to be shown the s p e c i fi c p a r t o f t h e Chiropractic ACT, not some interpretation of it, that limits our ability to evaluate systems which affect the biomechanical condition of the spine and musculoskeletal system.
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NEW MEDICARE ABN FORMS REQUIRED The latest version of the Advance Beneficiary Notice of Noncoverage (ABN)—release date of 3/2011 printed in lower left hand corner—is now available. Mandatory use of this version began on January 1, 2012. All ABNs with the release date of 3/2008, that are issued after January 1, 2012, will be considered invalid.
If DCs are to be considered the authority in the 11
Texas Journal of Chiropractic
The ABN is used for a service that is normally a covered service, but isn't payable because it’s “not medically necessary.” "If you have reason to believe that the treatment of a Medicare beneficiary for a particular treatment date is maintenance care, therefore being considered not reasonable and necessary and not payable by Medicare, you would have the beneficiary sign an Advance Beneficiary Notice (ABN) prior to providing care. The ABN is the form that is used when a
normally covered service (such as spinal manipulation) will be denied due to lack of medical necessity. Using the ABN in this manner is mandatory if payment is collected for the service," the American Chiropractic Association reports. The CMS d e fi n e s Maintenance Therapy as: "Chiropractic maintenance therapy is not considered to be medically reasonable or necessary under the Medicare program, and is therefore not payable.” “Maintenance therapy is defined as a treatment plan that seeks to prevent disease, promote health, and prolong and enhance the quality of life; or therapy that is performed to maintain or Texas Journal of Chiropractic
prevent deterioration of a chronic condition. When further clinical improvement cannot reasonably be expected from continuous ongoing care, and the chiropractic treatment becomes supportive rather than corrective in nature, the treatment is then considered maintenance therapy." "The ABN may also be used for non-covered services (anything that is NOT spinal CMT—CPT codes 98940, 98941, 98942). This includes
date s i h rt k Fo form! o o L our on y exams, modalities, x-rays, labs, etc. Using the ABN in this manner is purely voluntary." The ACA has provided links to several files to explain the use of the ABN: Te m p l a t e A B N a n d Instructions for Completion:
The ACA provides more details: Under Medicare, the only covered service for doctors of chiropractic is manual manipulation of the spine to correct a subluxation (CPT codes 98940, 98941, 98942). Only active care (acute and chronic) is payable. Maintenance care is not payable, although it is still spinal manipulation and therefore normally a covered service. When
notifying
the
beneficiary, you must use the ABN developed by CMS. "Blanket" ABNs are not permissible. The ABN is date-of-service specific, meaning that you can't just have one signed every once in a while and be on target—you have to have a reasonable expectation that that particular visit is not payable.
Customizable/Fillable ABN Sample ABN template form for maintenance care Sample ABN template form for covered AND non-covered services (Note that ABN use for non-covered services is OPTIONAL) Instructions on filling out the ABN 12
Once an ABN has been signed for the purpose of indicating maintenance therapy, that ABN is valid for that series of maintenance treatment, until there is an exacerbation or any provision of active care, for up to one y e a r. O n c e t h e r e i s a n exacerbation or new active treatment, any maintenance
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care following would require a newly delivered ABN. The proper delivery of an ABN is very formalized and detailspecific -- Instructions on how to complete the ABN If the beneficiary chooses to select the "Option 2" box, indicating they wish Medicare not be billed, then you can NOT bill Medicare. Please note this is a decision to be made by the beneficiary; you should not influence their choice. Doctors must verbally review the form with patients prior to their signing. • A Spanish-language version is available. More Resources: Instructions for completing the ABN New CMS ABN Form New CMS ABN Form in Spanish CMS Announcement of new ABN form CMS' Beneficiary Notices Initiative Webpage Full text of Medicare Claims Processing Manual Chapter 30, Financial Liability Protections
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TBCE Publishes Rules Update T h e Te x a s B o a r d o f Chiropractic Examiners published Final/Adopted Rules changes to rules 80.1, 81.1, and 81.3. These new chiropractic rules now read: 80.1 Delegation of Authority a) The purpose of this section is to encourage the more effective use of the skills of licensees by establishing guidelines for the delegation of health care tasks to a qualified and properly trained person acting under a licensee's supervision consistent with the health and welfare of a patient and with proper diligence and efficient practice of chiropractic. This section provides the standards for credentialing a chiropractic assistant in Texas. (b) Except as provided in this section, a licensee shall not allow or direct a person who is not licensed by the board to perform procedures or tasks that are within the scope of chiropractic, including: (1) rendering a diagnosis and prescribing a treatment plan; or (2) performing a chiropractic adjustment or manipulation. (c) A licensee may allow or direct a student enrolled in an accredited chiropractic college 13
to perform chiropractic adjustments or manipulations. (1) For students that have not completed an outpatient clinic at a chiropractic college, the chiropractic adjustment or manipulation must be performed as part of a regular curriculum; and the chiropractic adjustment or manipulation must be performed under the supervision of a licensee who is physically present in the treating room at the time of the adjustment. (2) For students that have completed an out-patient clinic at a chiropractic college, the chiropractic adjustment or manipulation must be performed under the supervision of a licensee who need not be physically present in the treating room at the time of the adjustment or manipulation, but must be on-site at the time of the adjustment or manipulation. (3) The requirement that the supervising licensee must be physically present in the treating room does not apply to chiropractic college clinics. (d) In delegating the performance of a specific task or procedure, a licensee shall verify that a person is qualified and properly trained. " Q u a l i fi e d a n d p r o p e r l y trained" as used in this Texas Journal of Chiropractic
section means that the person has the requisite education, training, and skill to perform a specific task or procedure.
the training of a doctor of chiropractic in order to protect the health or safety of a patient, such as:
(1) to perform activities that are outside the licensee's scope of practice;
(1) Requisite education may be determined by a license, degree, coursework, on-the-job training, or relevant general knowledge.
(1) taking the patient's medical history;
(2) to perform activities that exceed the education, training, and skill of the person or for which a person is not otherwise qualified and properly trained; or
(2) Requisite training may be determined by instruction in a specific task or procedure, relevant experience, or on-the-job training. (3) Requisite skill may be determined by a person's talent, ability, and fitness to perform a specific task or procedure. (4) A licensee may delegate a specific task or procedure to an unlicensed person if the specific task or procedure is within the scope of chiropractic and if the delegation complies with the other requirements of this section, the Chiropractic Act, and the board's rules. (e) A licensee may allow or direct a qualified and properly trained person, who is acting under the licensee's supervision, to perform a task or procedure that assists the doctor of chiropractic in making a diagnosis, prescribing a treatment plan or treating a patient if the performance of the task or procedure does not require Texas Journal of Chiropractic
(2) taking or recording vital signs; (3) performing radiologic procedures; (4) taking or recording range of motion measurements; (5) performing other prescribed clinical tests and measurements; (6) performing prescribed physical therapy modalities, therapeutic procedures, physical medicine and rehabilitation, or other treatments as described in the American Medical Association's Current Procedural Terminology Codebook, the Centers for Medicare and Medicaid Services' Health Care Common Procedure Coding System, or other national coding system. (7) demonstrating prescribed exercises or stretches for a patient; or (8) demonstrating proper uses of dispensed supports and devices. (f) A licensee may not allow or direct a person: 14
(3) to exercise independent clinical judgment unless the person holds a valid Texas license or certification that would allow or authorize the person to exercise independent clinical judgment. (g) A licensee shall not allow or direct a person whose chiropractic license has been suspended or revoked, in Te x a s o r a n y o t h e r jurisdiction, to practice chiropractic in connection with the treatment of a patient of the licensee during the effective period of the suspension or upon revocation. (h) A licensee is responsible for and will participate in each patient's care. A licensee shall conform to the minimal acceptable standards of practice of chiropractic in assessing and evaluating each patient's status. (i) It is the responsibility of each licensee to determine the number of qualified and properly trained persons that the licensee can safely www.chirotexas.org
supervise. A licensee must be on-call when any or all treatment is provided under the licensee's direction unless there is another licensee present on-site or designated as being on-call. (j) A licensee's patient records shall differentiate between services performed by a doctor of chiropractic and the services performed by a person under the licensee's supervision. RULE §81.1Definitions The following words and terms, when used in this c h a p t e r, s h a l l h a v e t h e following meanings, unless the context clearly indicates otherwise: ( 1 ) A PA - - A d m i n i s t r a t i v e Procedure Act, Government Code, Chapter 2001; (2) Board--Texas Board of Chiropractic Examiners;
(B) includes the amendment or repeal of a prior rule; and (C) does not include a statement regarding only the internal management or organization of the Board and not affecting private rights or procedures. 81.3 Petition for Adoption of Rules (a) As authorized by the APA, §2001.021(a), an interested person by petition to the Board may request the adoption of a rule. (b) Form for submission. A person must submit a petition for adoption of rules in writing via mail, fax, e-mail, or handdelivery to the Executive Director or General Counsel of the Board. The petition shall contain the following information as applicable and except as may be waived by the Board:
(3) Person--An individual, partnership, corporation, association, governmental subdivision, or public or private organization that is not a state agency;
(1) the name and contact information of the petitioning party and his or her interest in the adoption of the rule;
(4) Rule--A statement by the Texas Board of Chiropractic Examiners of general applicability that:
(2) a statement of the legal authority and jurisdiction under which the petition is filed;
(A) implements, interprets or prescribes law or policy; or describes the procedure or practice requirements of the Board;
(3) the exact language of the proposed rule requested to be adopted;
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(4) a statement and legal references regarding whether, to the petitioner's knowledge, the requested rule is in conflict with any existing rule, ruling, order or opinion of the Board or any other rules or statutes; and (5) a statement of the purpose of the requested rule. (c) Consideration and Disposition. During the sixty (60) day period following receipt of the petition by the Board, the Rules Committee shall meet to consider the petition. Not less than ten (10) days prior to such meeting, the Board shall notify the petitioning party in writing of the date, time and place the petition shall be considered. (1) At this meeting, the petitioning party may be given an opportunity to present matters to the Rules Committee, at the Committee's discretion. (2) The Committee, at the conclusion of the meeting, shall decide whether to deny the petition or to recommend to the Board at the next board meeting to publish the requested rule in the Texas Register for comment. If the Committee decides to deny the petition, the Committee shall state its reasons for denial in writing to the petitioning party. A recommendation by the Rules Committee to Texas Journal of Chiropractic
publish the requested rule for comment shall constitute initiation of rulemaking for purposes of §2001.021(c)(2) of the APA. (3) At the next board meeting following the Rules Committee meeting, the Board shall consider the Rules Committee's recommendation. The Board shall then decide whether to deny the petition or to publish the requested rule in the Texas Register for comment. If the Board decides to deny the petition, the Board shall state its reasons for denial in writing to the petitioning party.
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Foster Kids in Texas At Risk for Overmedication It is REPORTED HERE that "the Government Accountability Office just released a study looking at foster kids around the country, and how they are prescribed psychiatric medications." "According to the study, about a third of all children in foster care have been prescribed at least one mind-altering drug, a rate at least five times higher than non-foster kids."
drugs. Even more startling is the number of children who were prescribed at least five different psychiatric drugs at the same time. Foster kids in Texas are 53 times more likely to be on five different drugs at the same time, compared with
Of all the states examined in the study, foster children in Texas were the most likely to receive powerful psychiatric drugs. Even more startling is the number of children who were prescribed at least five different psychiatric drugs at the same time. Foster kids in Texas are 53 times more likely to be on five different drugs at the same time, compared with non-foster kids. That’s not a typo: 53 times more likely. non-foster kids. That’s not a typo: 53 times more likely." "This will obviously raise all sorts of questions, about child welfare, about state economics (tax payers are buying those drugs), and about the relationship between the drug companies p r o fi t i n g f r o m t h e s e prescriptions (hugely in the case of Texas) and the politicians putting forth these dangerous policies."
"Of all the states examined in the study, foster children in Texas were the most likely to receive powerful psychiatric
In a related story the Houstonpress.com REPORTS H E R E t h a t " t h e Te x a s
Texas Journal of Chiropractic
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Attorney General's Office says a drugmaker lied in order to push an antipsychotic on foster children." "Johnson & Johnson .... through its subsidiary Janssen Pharmaceuticals, blew the doors off the market with its Risperidone tablet, available in a rainbow of colors and sold under the name Risperdal." "Of course, one of the biggest problems with schizophrenia, besides its soul-crushing dreadfulness and tendency to tear families apart, was that there was only so much of it to go around. Eventually, Janssen would have to expand Risperdal's usage and penetrate new markets. Bipolar. Dementia. Attentiondeficit. And, just for the heck of it, stuttering," the report cites. "Old people and kids were virgin territory; hopefully there were enough psychiatrists out there to find enough things wrong with them that could be treated by a little Risperdal. The problem was, the FDA had denied Janssen's application for pediatric use, which meant that — even though the drug could be prescribed off-label — it couldn't legally be marketed for anything other than schizophrenia in adults," the story states. "Janssen got around that prohibition by simply ignoring it and getting down to the business of figuring out how www.chirotexas.org
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to infiltrate a state's Medicaid formulary and position Risperdal as the preferred drug for a variety of conditions. And the best way to do that was to get state mental health experts and i n fl u e n t i a l d o c t o r s a t universities to spread the gospel." "With its huge Medicaid population, encompassing prisons, psychiatric hospitals and foster care, Texas was the best state for this. Once a Risperdal-friendly system was installed in Texas, it could be exported to other states," the story tells us. The report continues: "so Janssen reps went to Texas .... They came out in spades; from the state Department of Mental Health and Mental Retardation; from t h e U n i v e r s i t y o f Te x a s system; from state chapters of national mental health advocacy groups. They all helped Janssen market offlabel Risperdal use in children b y, i n s o m e c a s e s , downplaying the side effects of severe weight gain, diabetes, tremors and the growth of (sometimes lactating) breasts in males." The report notes that "before any major studies got off the ground, Janssen had already created Risperdal's advertising platform — 'One Complete Antipsychotic' — and set its sights on corralling key opinion leaders who could deliver the message." Texas Journal of Chiropractic
"In 2003, when the whistle was blown and the connection between the experts and the drug companies was revealed, state attorneys general licked their lips in anticipation of filing fraud suits to recover Medicaid costs." "The Texas Attorney General's Office filed its suit in 2004, alleging that Janssen's marketing suppressed information about Risperdal's side effects, manipulated or concealed clinical trial results and created 'the false impression that valid and wellsupported scientific evidence' supported the prescribing of the drug to children." The report states "enter the Texas Medication Algorithm Project, or TMAP. With the Tri-University Guidelines in place, Janssen now had to find key opinion leaders in order to move Risperdal to the top of the state's preferreddrug list. The idea was to claim Texas, and then export TMAP to as many other states as possible; ultimately, at least 16 states incorporated the project." "Prior to TMAP, Medicaid guidelines called for doctors to prescribe generic, conventional antipsychotics; they couldn't touch the much more expensive secondgeneration drugs, called "atypicals," until two or three conventionals had failed. The drug companies' .... had to persuade KOLs that the exorbitant upfront cost would actually save money in the long run because of the 18
atypicals' relative lack of side e ff e c t s a s c o m p a r e d t o conventionals." "... in 1996, TMAP positioned both atypicals like Risperdal and the generic conventionals at Stage One, meaning physicians would be able to pick either one as a first choice for patients. But after Dr. Steven Shon and his fellow KOLs accepted $300,000 from J&J and other companies in 1997, conventionals dropped to Stage Four in 1998." "Janssen also desperately wanted to corner the pediatric market. Although Risperdal was already being used offlabel to treat children, the company didn't have enough data on pediatric safety and efficacy for FDA approval. When the company sought the pediatric nod in 1996, the FDA responded somewhat incredulously: 'You never state for what child or adolescent psychiatric disorders Risperdal would be intended. Indeed, you acknowledge that you have not provided substantial evidence from adequate and well-controlled trials to support any pediatric indications nor developed a rationale to extend the results of studies conducted in adults to children. Yo u r rationale...appears to be simply that, since Risperdal is being used in pediatric patients, this use should be acknowledged some way in labeling.'"
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"Allegations triggered an investigation into TMAP's reach into the foster care system by the Texas Health and Human Services C o m m i s s i o n ' s O f fi c e o f Inspector General and the Texas Comptroller's Office.” “The latter turned up some weird stuff, like the case of a six-year-old who'd received 60 prescriptions (including antipsychotics and mood stabilizers) in the course of a year. The child was eventually admitted to a hospital emergency room and treated for psychotropic poisoning.” The comptroller's investigators were alarmed by the numbers they crunched for fiscal 2004: 6,913 foster children accounting for 65,469 prescriptions of antipsychotics. The average number of prescriptions for all psychotropic drugs (not just antipsychotics) for the 686 kids aged zero to four was 6.7. The number of Risperdal prescriptions alone was 23,812, which cost the state roughly $4.5 million."
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Highmark and Medicare in Texas "Highmark Inc. announced ... that its Medicare division has won a five-year contract to process Medicare parts A and B claims for seven southern and western states, and says it will add 500 jobs because of the new contract." www.chirotexas.org
"Highmark Medicare Services Inc. will be the new Medicare Administrative Contractor for the Centers for Medicare & Medicaid Services in Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma and Texas." "It already holds a similar Medicare processing contract for the mid-Atlantic region that includes Pennsylvania, New Jersey, Maryland, Delaware, and Washington, D.C. The 500 jobs will be split among Pittsburgh, Harrisburg and other locations." More information has been made available regarding this contract. Here are some questions and answers provided by the company: Q: What company has been awarded the contract for the Jurisdiction H A/B MAC workload?
New Mexico, Oklahoma, and Texas. Jurisdiction 7 was comprised of Arkansas, Louisiana, and Mississippi. Q: What responsibilities will HMS perform under the new contract? A: HMS will process Part A and Part B Medicare claims from health care providers located in the Jurisdiction H service area. HMS will also enroll health care providers in the Medicare program, educate providers in Medicare billing requirements, assist Medicare providers with their questions, audit Medicare cost reports, and perform other critical Medicare fee-forservice program functions for providers located in Jurisdiction H. Q: Who are the incumbent Medicare claims contractors in these states that will be affected by this award?
A: Highmark Medicare Services (HMS), of Camp Hill, PA, has been awarded the Jurisdiction H A/B MAC contract.
A: The incumbent Medicare claims contractors are as follows:
Q: Which states are included in the Jurisdiction H A/B MAC service area?
Pinnacle Business Solutions, Inc. (PBSI) holds the Part A Fiscal Intermediary contracts for Arkansas, Louisiana, and Mississippi.
A: Seven states – the States of Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas - comprise Jurisdiction H. In this contract award, CMS is consolidating two former MAC jurisdictions. Jurisdiction 4 was comprised of Colorado, 19
PBSI also holds the Part B carrier contracts for Arkansas and Louisiana. Cahaba Government Benefits Administrators (Cahaba GBA) holds the Part B carrier contract for Mississippi. Texas Journal of Chiropractic
TrailBlazer Health Enterprises (TBHE) is the incumbent contractor for A/B MAC Jurisdiction 4 (Colorado, New Mexico, Oklahoma, and Texas). Q: What are the major differences in contracting process for the A/B MACs compared to the older fiscal intermediary (FI) and carrier contracts? A: The claims administration workload for each A/B MAC is being awarded through full and open competition conducted in accordance with federal procurement law. Based on structured evaluation criteria, the CMS contracting officer selects the proposal that represents the best value for the government. The A/B MAC contracts are for the administration of both Medicare Part A and Part B c l a i m s i n a s p e c i fi c geographic jurisdiction. MACs are able to earn incentive payments if their performance exceeds contract requirements. Under the requirements of the prior Medicare legislation dating to 1966, the FI and carrier contracts were not, for the most part, awarded through competitive procedures. In addition, only health insurance companies could serve as a Medicare carrier. The contracts for the FIs and carriers do not allow for performance incentives; rather, the contracts were Texas Journal of Chiropractic
largely restricted to reimbursement for costs incurred in administering Medicare claims. Q: What type of contract has been awarded for the Jurisdiction H A/B MAC workload? A: The Jurisdiction H A/B MAC was awarded under a cost-plus-award-fee contract. The period of performance for the contract is a base period with four 1-year options. The total value of the contract for the five year period, inclusive of all options, is estimated at $406 million. Q: Where is the Jurisdiction H A/B MAC contractor’s headquarters? A: HMS’ operations are headquartered in Camp Hill, Pennsylvania. For more information regarding HMS, please see www.highmarkmedicareservic es.com Q: When will the new Jurisdiction H A/B MAC begin operations and how will the implementation impact the provider and beneficiary communities? A: Barring any delays, the implementation activities of the A/B MAC that are needed to move the Part A/Part B workload for Arkansas, Louisiana, and Mississippi will begin immediately; CMS expects to complete the transfer of these workloads to HMS by early 2012. The 20
transition of the Part A and Part B workloads for Colorado, New Mexico, Oklahoma, and Texas is not expected to be complete until late July 2012. CMS has considerable experience in overseeing successful contractor transitions. CMS will work with all stakeholders to ensure a smooth implementation and minimal impact to the provider and beneficiary communities. Q: How will staffing be affected as work moves from the current MAC, FIs, and carriers to the Jurisdiction H A/B MAC? A: With the award and implementation of the new contract, the A/B Jurisdiction H MAC will be performing the claims administration work that had been distributed among three contractors. Fewer staff will be required to perform the full scope of activities because of the consolidation of the contracts. For more specific questions regarding staffing please contact the Contracting Officer, Kathy Markman, Kathy.Markman@cms.hhs.go v or 410-786-8916. Q: How many beneficiaries and providers are there in Jurisdiction H? What percent of the national claims workload is accounted for in this Jurisdiction? A: CMS estimates that – www.chirotexas.org
About 4.9 million Medicare Fee-for-Service beneficiaries reside in Jurisdiction H. Approximately 1,300 Medicare hospitals will be served by the new MAC. The new MAC will serve approximately 147,000 physicians and other Part B practitioners that furnish health care services to Medicare beneficiaries in this jurisdiction. Jurisdiction H accounts for approximately 13.2% of all Medicare fee-for-service claims nationally. Q: Did the winning contractor include any subcontractors in its proposal? If so, what services will the subcontractor(s) provide? A: Yes. HMS will subcontract with Reed & Associates, CPAs, Inc. (Reed), a womanowned small business with a main office in Manassas, Virginia. Reed will serve as an independent certified public accounting to perform certain CMS-required reviews of the internal controls implemented by HMS, and to make recommendations concerning these control processes.
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June 8-10, 2012 www.chirotexas.org
Supreme Court Announces It Will Decide Health Care Reform The Supreme Court has announced it will consider the Affordable Care Act (ACA) during its current session. Oral arguments are expected to be heard this spring. The US Supreme Court has agreed to provide the last word on whether healthcare reform's requirement for individuals to obtain insurance coverage or else pay a penalty is constitutional. The decision to take up the issue was posted on the high court's Web site. Arguments should be heard in the Spring. A decision voiding the individual mandate would reportedly weaken, if not gut, the rest of the Affordable Care Act (ACA). The Supreme Court had received 6 different petitions to rule on the individual mandate from various winners and losers of federal appellate cases. The Supreme Court stated that it will rule on whether the mandate is severable from the rest of the law. The Supreme Court typically intervenes when appellate courts reach opposing conclusions on a legal question, and that has 21
happened with th e AC A litigation. A law called the AntiInjunction Act prohibits legal attempts to restrain the assessment or collection of a tax. The plaintiffs in one ACA suit allege that the ACA is just such a tax. The Obama administration asked the Supreme Court to decide whether the Anti-Injunction Act should block legal challenges to the ACA. The administration has argued that it should not. The Supreme Court said that it also will decide this question.
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The Future of Health Care Professionals? A Washington think tank, the Bipartisan Policy Center, has released a preliminary report, The Complexities of National Health Care Workforce Planning, a review of existing work force employment and training. The report concludes that work force planning does not sufficiently account for new t e c h n o l o g y, r e g i o n a l differences and potential consumer engagement in health care delivery. Nor does current training adequately emphasize teambased care models expected to become more prevalent through the health system reform law. Texas Journal of Chiropractic
Extensive research exists on the supply of and demand for physicians and nurses, but not for chiropractors, home health aides, psychologists and others with less demanding licensing requirements, the report found. Information on certain health professionals is "limited, inconsistent, p r o f e s s i o n - s p e c i fi c a n d noncomparable," in part because states have different methods of collecting data. The report notes that "health care leaders should agree on a common objective and define demand based on where the health system is going, not where it's been .... Demand for many health professionals is expected to continue to grow in part because more than 30 million Americans will gain coverage under the health reform law beginning in 2014. Health care employment was 10.5% of the total work force in 2008 and is projected to increase to 11.9% by 2018." Health care leaders should not hesitate to ramp up health professional training whenever possible. Even if allied health professionals and others help relieve physicians' workloads, the nation still faces a significant shortage of doctors. Physician supply is on track to increase slightly but interprofessional education is lacking. A table of the projected demand for health professionals reflects that the Texas Journal of Chiropractic
demand for registered nurses will increase by some 600,000 from 2008 levels. Licenses practical and vocational nurses will see a demand increase of some 155,000; Physicians and surgeons by 145,000; Pharmacists by 46,000; Physical therapists by 56,000; Physicians assistants by 29,000 and Chiropractors by 10,000.
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Healthy People 2010 Missed the Target The American Medical Association reports that "the nation's health improved during the past decade as adult cholesterol levels decreased and fewer people smoked cigarettes, according to the final review of Healthy People 2010. Such improvements led to an increase in life expectancy. But the country fell short of meeting Healthy People 2010 goals in some of the most critical areas, including reducing obesity and health disparities." "Obesity prevalence increased across all age groups during the last decade. Minorities, people with low incomes and those with limited education experienced widening disparities in areas such as coronary heart disease deaths and exposure to tobacco smoke."
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"Obesity increased across all age groups from 2000 to 2010 in the U.S." The report notes that the “final review of Healthy People 2010 ... shows that targets were met for 23% of the 733 objectives. For objectives in which the goal was not achieved, progress was made in nearly half of the cases." "The nation's health got worse for 24% of objectives, and there was no change for 5% of the initiatives." "Among the key findings: Life expectancy for the U.S. population increased from 76.8 years in 2000-01 to 77.8 years in 2006-07. That i m p r o v e m e n t r e fl e c t s declining death rates for a variety of conditions, including f e m a l e b r e a s t c a n c e r, coronary heart disease, prostate cancer and stroke,” the report shows. "Deaths due to prostate cancer decreased beyond the Healthy People target, falling from 31.1 deaths per 100,000 people in 1999 to 23.5 deaths per 100,000 in 2007. Death rates related to other cancers improved, but did not exceed the goals set for them." "The number of adults and teenagers who smoke also declined. In 2008, 21% of adults 18 and older smoked cigarettes compared with nearly one in four in 1998. In 2009, 19% of students in grades nine through 12 www.chirotexas.org
smoked, down from 35% in 1999."
revised in 10 year increments ever since.
"Overall, disparities remained unchanged for about 80% of the objectives, according to the report."
The 2020 version identifies nearly 600 objectives in 42 topic areas.
"Health disparities worsened in 13% of the objectives. Deaths due to coronary heart disease is one area where disparities increased for minorities and people with no more than a high school degree. Also concerning to public health experts is that little progress was made meeting nutrition and weight targets." "The amount of obese adults 20 and older climbed from 23% between 1988 and 1994 to 34% between 2005 and 2008. During that period, obesity among children 6 to 11 increased from 11% to 17%."
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HHS Launches Healthy People 2020 The Department of Health and Human Services (HHS) has updated its Healthy People program to reduce health risk factors and disparities, providing new topics and objectives for 2020. The Healthy People initiative began in 1979 with a Surgeon General's report, which set public health targets to be reached by 1990. It has been www.chirotexas.org
"In announcing the new update, the department claimed that "the country has either progressed toward or met" 71% of the Healthy People 2010 targets." Adult smoking rates declined from 23% in 2000 to 21% in 2008, falling well short of the goal of 12%. The record for diabetes was even worse. Healthy People 2010 set a target of 3.8 new-onset diabetes cases per 1,000 a d u l t s f o r t h i s y e a r, a reduction from the 2000 rate of 5.7 cases per 1,000. Instead, the rate increased by 40% to the current level of 8.0 per 1,000.
"This is the first time that oral health has made a government list for major health determinants .... Success in that area will be measured in parts by rates of people who have visited a dentist in the past year."
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Enough Opioids to Medicate EVERY American Every Four Hours for a Month Deaths caused by overdoses of prescription opioid painkillers more than tripled over a decade, to nearly 15,000 in 2008, CDC researchers found. That's up from 4,000 in 1999 Morbidity and Mortality Weekly Report noted.
Federal health officials have released a list of 12 "high priority" indicators of health, which the government will track over the next decade to determine the progress and status of the nation's health.
In 2008, there were 36,450 drug overdose deaths in the U.S. -- a close second to the leading cause of death from injury: motor vehicle crashes, which totaled 39,973 that year.
They are: Access to health services; Clinical preventive services; Environmental equality; Injury and violence; Maternal, infant and child health; Mental health; Nutrition, physical activity and obesity; Oral health; Reproductive and sexual health; Social determinants; Substance abuse; and Tobacco.
The totals have been driven largely by prescription painkiller abuse. The overdose death from these drugs has surpassed deaths tied to heroin and cocaine combined.
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The report added that "the national rate of sales in 2010 -- 7.1 kg per 10,000 population -- was equivalent Texas Journal of Chiropractic
to 710 mg of prescription opioids per person in the U.S. That's enough to medicate every American adult with a typical dose of 5 mg of hydrocodone (Vicodin, Lortab) every four hours for one month, they wrote." Much of the abuse can be attributed to "pill mills," or illegitimate pain clinics that dole out prescription opioids to nearly anyone who complains of pain. “Now the burden of dangerous drugs is created by a few irresponsible doctors rather than drug pushers on street corners," the report said.
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Flu Vaccine Effectiveness? WebMD.com reports that "a new analysis finds that the flu vaccine provides only moderate protection against the flu, noting that such protection is greatly reduced or absent during some flu seasons.” The analysis is published in The Lancet . "While the vaccine does work, and we still recommend that it be used, it does not demonstrate the kind of efficacy that has often been reported."
"The researchers screened 5,700 articles and studies, identifying just 31 that used highly specific diagnostic testing to confirm influenza." "Their review of these studies showed that the trivalent inactivated vaccine (TIV) -which accounts for about 90% of flu vaccines given in the U.S. -- had 59% effectiveness in healthy adults between the ages of 18 and 65." "The vaccine's effectiveness in children, teens, and the elderly could not be determined because no trials involving these groups met the researchers' inclusion standards." "Ten studies examined the nasal spray flu vaccine in children between the ages of 6 months and 7 years, finding it was effective for of 83% of that group. The nasal vaccine is approved for use in healthy people ages 2 to 49." "The [nasal spray flu vaccine] works very well in children, but it has never been preferentially recommended." "We could potentially have a much greater impact in preventing influenza if we were to encourage the use of [the nasal spray flu vaccine] in that group."
"The researchers also say there is a lack of evidence for t h e e f f e c t i v e n e s s o f fl u vaccines in the most vulnerable groups, such as the elderly."
"Andrew Pavia, MD, who chairs the Pandemic Influenza Task Force of the Infectious Diseases Society of America, says the new analysis confirms what has been known about the current flu
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vaccine. 'Everyone agrees that we need better vaccines and we are making progress in that direction. We have known for years that the vaccine we have does not provide a first-rate level of protection in the elderly and the very young, but it does provide protection. It would be terrible if the message to the public was that getting vaccinated isn't important. In fact, he says, the less effective a vaccine is, the more important it is that as many eligible people as possible get vaccinated to protect those who are most vulnerable. With a vaccine that is less than perfect, which is most of our vaccines, much of the protection comes from having widespread coverage within a community," he says.
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Texas' Tort Law Fails to Reduce Health Costs, Attract Doctors The Austin AmericanStatesman reports that "a national report released Wednesday says the 2003 Texas law that limited damage awards in malpractice suits has caused health care spending to rise and has not significantly increased the number of doctors in Texas." "The report comes as Gov. Rick Perry has touted the benefits of the law on the www.chirotexas.org
presidential campaign trail, boasting that it has added 21,000 Texas doctors — a claim the report disputes. Supporters of the law also urged Congress to enact a similar provision for the nation as part of the federal health care law that passed in March 2010. That provision was not included." "The 24-page report by Public Citizen, A Failed Experiment, says that using Texas as a model would benefit doctors and insurers — not residents." "The report claims that Medicare spending in Texas has risen faster than the national average, and so have private health insurance premiums. It also says that, contrary to Perry's claims, the per capita increase in the number of doctors practicing in the state has been much slower since the state passed the so-called tort reform law than it was before the law."
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comprised of Parker faculty, staff, students, and alumni, select recipients based on anonymous applications, the student’s financial need, academic achievements, character, extracurricular participation, leadership, and more. The students were presented one of six types of scholarships including corporate partner, leadership, alumni, memorial, Parker Alumni Association, and endowment scholarships. “Ninety-five percent of Parker students qualify for financial aid,” said JoLynne Jensen, vice president of development at Parker University. “Their financial burden while in school is offset by the student scholarships funds. These 18 students were selected from a pool of 82 scholarship applicants.” Parker’s alumni continue to support future chiropractors by providing $7,000 in s c h o l a r s h i p s . D r. D o u g DeShazo, a ’95 Parker
have practiced in Lewisville, Texas for 22 years, presented two of four alumni scholarships including the Byroad Chiropractic Student Scholarship for $1,000 awarded to Gavin Wolff and the $1,000 Dr. Bernard Kunc Student Scholarship awarded to Atrelia Wadley. In addition, OTZ Health Education Systems represented by Dr. Francis M u r p h y, a ’ 9 5 P a r k e r graduate, awarded Steven Chalk with the $1,000 OTZ Health Education Systems Student Scholarship. A total of $8,000 in corporate partner scholarships were provided by companies supporting the chiropractic profession. Nicholas Speegle was awarded with a $2,000 scholarship from Erchonia Medical. Chiro One Wellness Centers presented a $1,000 s c h o l a r s h i p t o Va n e s s a
COLLEGE NEWS Parker University Presents $23,000 in Scholarships to Students Parker University College of Chiropractic recently presented $23,000 in scholarships to 18 students. The scholarships committee www.chirotexas.org
graduate, and his wife Diane DeShazo, awarded Aliena Johnston with a $4,000 DeShazo Chiropractic Student Scholarship. Drs. Brenda and Clark Byroad, who graduated from Parker in ’89 and ’87 and 25
Morales. Parker student, Angela Natoli, received a $1,000 scholarship from Drucker Labs. Protocol for Life Balance provided Matt Sleeman with a $1,000 scholarship. Evan Pulver was awarded a $2,000 scholarship from Standard Process. Texas Journal of Chiropractic
Thumper Massager presented Logan Spangler with a $1,000 scholarship. “This scholarship is a huge blessing,” said Natoli. “This trimester has been especially financially stressful as I had to make large, but necessary purchases, such as a portable table to practice on, board reviews, and board fees, amongst others things.” Four leadership scholarships were also presented, which included the $1,000 Dr. Phil Cook Student Scholarship awarded to Garett Williams. The scholarship was provided by Dr. Phil Cook, who has served on Parker’s Board of Trustees since 2007. Dr. Gilles Lamarche, vice president of Parker Chiropractic Wellness Clinics, Parker Research Institute, Parker Continuing Education, and Parker Seminars, presented the Dr. Gilles Lamarche Student Scholarship of $1,000 to Jean-Philippe Mercier. Dr. Rose Lepien, a ’91 Parker graduate and former Parker Board of Trustees member, provided $1,000 to Lauren Donbar, who was awarded the Dr. Rose Lepien Student Scholarship.
<<Parker University unveiled its new donor wall following the presentation of scholarships. PARKER HOMECOMING January to the Dominican Republic. I know this will be an experience I will never forget and I am excited to serve the people there as well as the things I will learn to help better serve my future patients. I'm so grateful to Dr. Lepien for providing me the means for this opportunity.” D r. F a b r i z i o M a n c i n i , president of Parker University and 1990 graduate of Parker, presented student, Jason Trainer, with the Dr. Fabrizio Mancini Student Scholarship of $1,000.
Parker University held its Homecoming 2011 on its campus in Dallas, Texas, on October 21 – 23, 2011. The event included educational opportunities with continuing education classes for doctors of chiropractic and massage therapists featuring topics such as active care, specialized techniques, nutrition, sports massage, animal massage, integrative care, and more. The event also consisted of chiropractic assistant tailored classes, which covered tips on Medicare, practice essentials, and clinical solutions.
Chelsea Verslues received the fourth scholarship awarded in memory of Dr. Matthew Cacka, a 2007 graduate of Parker. Verslues was awarded $1,000 for the Dr. Matthew Cacka Memorial Scholarship. Parker student, Corey Todhunter was awarded a $1,000 scholarship provided by the Parker Alumni Association.
“This scholarship means opportunity to me,” said Donbar. “It has given me the opportunity to pay for experiences I may not have had otherwise such as a mission trip I plan to attend in
In addition, Foot Levelers awarded a $1,000 endowment scholarship to Craig Raschke. Nicole Jones received $1,000 from the Dr. Leander Eckard Endowment Scholarship.
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Pamela Waters presents in one of the massage therapy classes, “Going to the Dogs – Animal Massage” “It was so nice to see both chiropractors and massage therapists sitting together in Dr. Jeff Rockwell's class discussing how to enhance postural stability,” said Dr. Drew Riffe, director of Parker
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University School of Massage Therapy. Chiropractic, massage therapy, and other health and wellness exhibitors presented cutting-edge products and technologies.
Homecoming attendees in a class instructed by Dr. Jack Dolbin The homecoming celebration also provided the opportunity for Parker alumni and friends to reconnect with classmates and colleagues as well as network with new contacts during the alumni and friends reception, the alumni luncheon, the Parker University School of Massage Therapy reunion dinner, and the 25 year class reunion celebrating the class of 1986.
Alumni and Friends gather in the courtyard during reception
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Parker University held additional festivities throughout the week in celebration of homecoming including a new logo unveiling p r e s e n t a t i o n , fi t n e s s competition, cooking demonstration, Parker employee spirit banner competition, all-school assembly featuring Dr. Jack Dolbin, student scholarship presentation and luncheon, intramural basketball games, and Parker gear fashion show.
The award will be presented in Las Vegas, Nevada, at the Parker Starlight Soiree on January 20, 2012, which will be held during Parker Seminars Las Vegas. More than 400 guests are expected to attend the private, Las Vegas-style, “red carpet” event to celebrate the profession, honor the fourth inductee into the Drugless Research Hall of Fame, network with leaders in chiropractic, and support chiropractic research.
DRUGLESS RESEARCH HALL OF FAME
“The chiropractic community has such a dedicated group of professionals and some of the most dedicated are those who work tirelessly to conduct research,” said Dr. Gilles Lamarche, vice president of Parker Seminars, Parker clinics, research, and continuing education at Parker University. “Research further establishes chiropractic in the health care realm and is urgently needed to support why and how chiropractic works. It’s our honor to award individuals that continuously play a large role in research efforts within the profession.”
Parker University is accepting nominations for the coveted Drugless Research Hall of Fame Award. Founded by Parker University College of Chiropractic, the award is an innovative recognition platform designed to s h o w c a s e s i g n i fi c a n t contributions in drug-free research worldwide. Previous Drugless Research Hall of Fame Inductees include Dr. Ronald Rupert, Dr. Cheryl Hawk, and Dr. Arlan W. Fuhr. Nominees for the fourth inductee should be individuals who are doctors of chiropractic, have been involved with drugless research over a period of 5 years or more, have made s i g n i fi c a n t a n d l a s t i n g contributions to chiropractic care through their research, and have not previously received this award.
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PARKER ALUMNI ASSOCIATION APPOINTS EXECUTIVE COMMITTEE The Parker Alumni Association re-elected Dr. Vincent Scheffler ’07 and Dr. Scott Garber ’02 to serve on its executive committee. They also selected a new member to join the executive
Texas Journal of Chiropractic
committee, Dr. Steven Brooks ’99. Re-elected as president, Dr. Scheffler, practices in Dallas, Texas, at Reagan ChiroSport C e n t e r . D r . S c h e f fl e r specializes in sports specific rehabilitation, is a Certified Strength and Conditioning Specialist (CSCS) through the National Strength and Conditioning Association, and is a Certified Chiropractic Sports Physician (CCSP). A new member of the executive committee, Dr. Brooks, was selected to serve as vice president of the alumni association. Dr. Brooks has been practicing at Sunset Chiropractic in San Angelo, Texas for more than 10 years. From 2004 – 2009, he was awarded as San Angelo’s Favorite Chiropractor. He specializes in golf fitness and is a level one, certified Titleist Performance Institute (TPI). Dr. Garber was selected to serve another term as treasurer and also spearheads the New England chapter of the Parker Network, which enables alumni and friends of Parker to remain connected to the institution and active within the chiropractic community. Dr. Garber practiced for many years in Australia before returning to the United States and setting up his clinic, Chiropractic Works, in Lenox, Massachusetts. Membership in the Parker Alumni Association is allinclusive and welcomes Texas Journal of Chiropractic
Parker graduates, doctors of chiropractic, chiropractic assistants, massage therapists, corporations, and wellness supporters to join them in their pursuit of excellence. In all its endeavors, the alumni association strives to support and encourage all members to achieve the highest level of success in their fields.
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US Senate Calls for More DOD DCs The American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC) applauded a Senate proposal calling for greater utilization of the services provided by doctors of chiropractic within the Department of Defense (DoD). The U.S. Senate Committee on Appropriations recently filed a report to accompany fiscal year 2012 spending legislation which included language urging DoD to expand the use of services delivered by doctors of chiropractic to troops in combat settings. The language, included in S e n a t e R e p o r t 11 2 - 7 7 , specifically urges DoD to address musculoskeletal injuries, prevalent in the forward combat areas, by "increasing the use of chiropractic care" and "to expand the utilization of alternative medical treatment 28
options such as chiropractic health care services at military treatment facilities to help mitigate these injuries." The services provided by doctors of chiropractic are available at 60 military treatment facilities worldwide. ACA and ACC are hopeful that the subcommittee's support for the services provided by doctors of chiropractic will spur further expansion of chiropractic's presence in both the DoD and the Department of Veterans Affairs (VA). "The Association of Chiropractic Colleges welcomes this strong endorsement from the Senate Appropriations Committee for the vital role that chiropractic care can continue to play in addressing musculoskeletal injuries to our troops," said Richard Brassard, DC, President of the ACC. "Studies have shown what the chiropractic profession and the Department of Defense have known for years, that doctors of chiropractic are a key part of our military health care system that cares for our soldiers, sailors, airmen and marines in times of war both here and overseas. We are honored to be a part of the DoD health care provider team." While the congressional report's language does not have the force of law and does not compel DoD to take action, such report language www.chirotexas.org
often initiates federal departments and agencies to take action based on congressional findings and requests.
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Drug Deaths Now Outnumber Traffic Fatalities The LA Times reports that "propelled by an increase in prescription narcotic overdoses, drug deaths now outnumber traffic fatalities in the United States .... Drugs exceeded motor vehicle accidents as a cause of death in 2009, killing at least 37,485 people nationwide, according to preliminary data from the U.S. Centers for Disease Control and Prevention." "While most major causes of preventable death are declining, drugs are an exception. The death toll has doubled in the last decade, now claiming a life every 14 minutes. By contrast, traffic accidents have been dropping for decades because of huge investments in auto safety." "Public health experts have used the comparison to draw attention to the nation's growing prescription drug problem, which they characterize as an epidemic. This is the first time that drugs have accounted for more fatalities than traffic accidents since the government started tracking drug-induced deaths in 1979." www.chirotexas.org
"Fueling the surge in deaths are prescription pain and anxiety drugs that are potent, highly addictive and especially dangerous when combined with one another or with other drugs or alcohol. Among the
"In April, the White House Office of National Drug Control Policy a n n o u n c e d initiatives aimed at s t a n c h i n g prescription drug abuse. The plans i n c l u d e … voluntary courses to train physicians on how to safely prescribe pain drugs, a curriculum that is not widely taught in medical schools." most commonly abused are OxyContin, Vicodin, Xanax and Soma. One relative newcomer to the scene is Fentanyl, a painkiller that comes in the form of patches and lollipops and is 100 times more powerful than morphine. Such drugs now cause more 29
deaths than heroin and cocaine combined." "The seeds of the problem were planted more than a decade ago by well-meaning efforts by doctors to mitigate suffering, as well as aggressive sales campaigns by pharmaceutical manufacturers. In hindsight, the liberalized prescription of pain drugs "may in fact be the cause of the epidemic we're now facing," said Linda Rosenstock, dean of the UCLA School of Public Health. "In some ways, prescription drugs are more dangerous than illicit ones because users don't have their guard up ... People feel they are safer with prescription drugs because you get them from a pharmacy and they are p r e s c r i b e d b y a d o c t o r. Younger people believe they are safer because they see their parents taking them. It doesn't have the same stigma as using street narcotics." "The triumph of public health policies that have improved traffic safety over the years through the use of seat belts, air bags and other measures stands in stark contrast to the nation's record on prescription drugs. Even though more people are driving more miles, traffic fatalities have dropped by more than a third since the early 1970s to 36,284 in 2009. Drug-induced deaths had equaled or surpassed traffic fatalities in California, 22 other states and the District of Texas Journal of Chiropractic
Columbia even before the 2009 figures revealed the shift at the national level, a c c o r d i n g t o t h e Ti m e s analysis."
i n s a t i a b l e , " J o s e p h T. Rannazzisi, a top DEA administrator, told a group of pharmacists at a regulatory meeting in Sacramento.
"The rise in deaths corresponds with doctors prescribing more painkillers and anti-anxiety medications. The number of prescriptions for the strongest pain pills filled at California pharmacies, for instance, increased more than 43% since 2007 — and the doses grew by even more, nearly 50%, according to a review of prescribing data collected by the state."
"In April, the White House O f fi c e o f N a t i o n a l D r u g Control Policy announced initiatives aimed at stanching prescription drug abuse. The plans include …. voluntary courses to train physicians on how to safely prescribe pain drugs, a curriculum that is not widely taught in medical schools."
"Those prescriptions provide relief to pain sufferers but also fuel a thriving black market. Prescription drugs are traded on Internet chat rooms that buzz with offers of "vikes," "percs" and "oxys" for $10 to $80 a pill. They are sold on street corners along with heroin, marijuana and crack. An addiction to prescription drugs can be costly; a heavy OxyContin habit can run twice as much as a heroin addiction, authorities say." "The most commonly abused prescription drug, hydrocodone, also is the most widely prescribed drug in America, according to the U.S. Drug Enforcement Agency. Better known as Vicodin, the pain reliever is prescribed more often than the top cholesterol drug and the top antibiotic." " We h a v e a n i n s a t i a b l e appetite for this drug — Texas Journal of Chiropractic
"What's really scary is we don't know a lot about how to reduce prescription deaths," said Amy S.B. Bohnert, a researcher at the University of Michigan Medical School who is studying ways to lower the risk of prescription drugs. "It's a wonderful medical advancement that we can treat pain," Bohnert said. "But we haven't figured out the safety belt yet."
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"Did you know that you can keep up with the rules that the TBCE has proposed or adopted online? The TBCE uploads all proposed and adopted rules onto our homepage at www.tbce.state.tx.us under the 'Rules--Recent & Proposed Changes link" FOUND HERE "Additionally, you can view current rules from the Secretary of State website (www.stos.state.tx.us/tac), which is linked to our homepage under the 'Statutes and Rules' link." "All proposed and adopted rules are published in the Texas Register. Current and past issues of the Texas Register are available at www.sos.state.tx.us/texreg. If you'd like to be notified by email whenever the TBCE proposes/adopts/withdraws a rule or schedules an open meeting or public hearing, your can contact the Texas Register at ... register@sos.state.tx.us."
The TBCE Reports T h e Te x a s B o a r d o f Chiropractic Examiners recently released their August 2011 issue of their newsletter Texas Chiropractic Board Report. This article summarizes some of the key points of information provided by the TBCE. HOW DO I FIND PROPOSED AND ADOPTED RULES? 30
WHAT'S A RAD TECH AND WHEN DO THEY RENEW THEIR REGISTRATIONS? "All individuals who take xrays in a chiropractic clinic must be qualified to do so, either by their licensure as a DC, a nurse or other health care professional or must be c e r t i fi e d b y t h e Te x a s Department of State Health Services. All individuals who are certified by DSHS as www.chirotexas.org
chiropractic radiologic technologists (Rad Techs) must also register with the TBCE each year. Those registrations ... must be renewed annually by January 1 of each year. ... There is no online renewal for radiologic technologists, so the forms must be completed and submitted with the required fee to the Board via regular mail."
lead to disciplinary action agains you for practicing outside the scope of practice or deceptive advertising." CAN A TEXAS DC SOLICIT A CAR ACCIDENT VICTIM?
CAN A TEXAS DC PERFORM CHIROPRACTIC ON ANIMALS?
T h e Te x a s P e n a l C o d e prohibits a Texas attorney or medical professional (including chiropractors) to communicate with potential clients within 30 days of an accident or arrest. This law is commonly referred to as the 'Barratry Law.'"
"In Texas, the application of chiropractic techniques or musculoskeletal manipulation to animals is considered the practice of veterinary medicine and falls under the regulation of the Texas Board o f Ve t e r i n a r y M e d i c a l Examiners. Therefore, having a Texas DC license does NOT confer upon a Texas DC the right to practice on animals, even with the consent of the animal's owner.
The Barratry law was challenged and overturned in District Court, but "in June 2011, the U.S. Court of Appeals for the Fifth Circuit reversed the district court judge's ruling and held that the Barratry Law is indeed constitutional. Violations of the Barratry Law could result in a fine up to $4000, up to one year in jail, or both." WHAT IS REQUIRED FOR A PRE-PAYMENT PLAN?
Anyone who wants to apply chiropractic or musculoskeletal manipulation techniques to animals can do so ONLY under the direct or general supervision of a licensed doctor of veterinary medicine who has an established veterinarian/client/ patient (animal) relationship. ... Note that you may not advertise animal chiropractic services using your Texas DC license or referring to yourself as a chiropractor. Doing so could
CLICK HERE FOR RULE 80.13 WHICH BECAME EFFECTIVE MARCH 9, 2011.
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"Prepaid treatment plans must specify a limited, defined number of visits. Most importantly, the plan must be cancelable by either party at any time for any reason without penalty of any kind to the patient. Upon cancellation of the plan, the patient must receive a complete refund of all fees paid on a pro rata basis of the number of 31
treatments provided compared to total treatments contracted. (Note if the fees are based on a discount, you may not retroactively cancel the discount.)" "The proposed treatment plan must be in the patient's file, including enumeration of all aspects of evaluation, management, and treatment planned to therapeutically benefit the patient relative to the condition determined to be present and necessitating treatment. Additionally a contract for services and consent of treatment document must be maintained in the patient's file that specifies the condition for which the treatment plan is formulated." "Finally, if nutritional products or other hard goods including braces, supports, or patient aids are to be used during the proposed treatment plan, the patient documents must state whether these items are included in the gross treatment costs of if they constitute a separate and distinct service or fee." Failure go comply with requirements/restrictions on prepaid treatment plans may result in a "maximum penalty [of] $1000 per violation and/or revocation." WHAT DO I NEED TO KNOW ABOUT RELEASING RECORDS?
Texas Journal of Chiropractic
CLICK HERE FOR RULE 80.3.
August 16, 2012 November 15, 2012
"Any time you receive a request for chiropractic records, accompanied by written consent from the patient, you must release the requested records within fifteen (15) business days, according to Board Rule 80.3. The only exception to this is if you determine that releasing information in the records would be harmful to the physical, mental, or emotional health of the patient. If you determine this exception applies, you must furnish the patient a written statement, signed and dated, stating the reason for the denial."
CLICK HERE FOR MORE I N F O R M AT I O N A N D AGENDAS WHEN THEY ARE PUBLISHED.
"If you charge fees for copying or releasing records, make sure you consult with subsection (e) of Board Rule 8 0 . 3 . Yo u m a y r e q u i r e prepayment, but if you don't receive payment within ten(10) days, you must notify the requestor in writing of the need for prepayment." "The most important thing to remember about records release is that chiropractic records may NOT be withheld base don a past due account, overdue balance, or lack of an LOP!!" WHEN ARE THE TBCE BOARD MEETINGS? Tentative Dates for 2012 are: January 16, 2012 February 23, 2012 May 24, 2012 Texas Journal of Chiropractic
HOW MANY DCs ARE THERE IN TEXAS? According to the TBCE, as of July 31, 2011 there were: 4975 Active DCs in Texas.
HOW MANY CHIROPRACTIC CLINICS ARE THERE IN TEXAS? According to the TBCE, as of July 31, 2011 there were: 3732 Active Chiropractic Clinics in Texas THE BOARD'S PURPOSE The TBCE reminds all that "the statute governing the Board and chiropractic in Texas is commonly referred to as the Chiropractic Act. The Chiropractic Act defines the legal scope of practice for Texas doctors of chiropractic as follows: 'a person practices chiropractic under this chapter if the person: (1) uses objective or subjective means to analyze, examine, or evaluate the biomechanical condition of the spine and musculoskeletal of the human body; (2) performs nonsurgical, nonincisive procedures, including adjustment and manipulation, to improve the subluxation 32
complex or the biomechanics of the musculoskeletal system." Says the TBCE: "The Board's purpose is to administer the Chiropractic Act as it is currently written. This includes writing and adopting rules administering and interpreting the Chiropractic Act. The Board cannot adopt any rule that is contrary to the Chiropractic Act or any other law in Texas. When the Board writes rules regarding scope of practice in Texas, the first and foremost consideration must be the limitations imposed on Texas DCs in the Chiropractic Act." "It is crucial to understand that none of the following define scope of practice: education, training, historical practice, c h i r o p r a c t i c p h i l o s o p h y, patient satisfaction, and good results. Only the legislature, through the Chiropractic Act, defines scope of practice," the TBCE states. Further TBCE states that "it is not the Board's place to protect chiropractic or to petition for changes to scope of practice. The mission of the board is to promote, preserve, and protect the health, safety, and economic welfare of the people of Texas through the regulation of the practice of chiropractic. The Board's responsibility is to interpret the Chiropractic Act (as it is currently written) and to adopt a scope of practice rule that is in accord with the Act." www.chirotexas.org
T h e Te x a s B o a r d o f Chiropractic Examiners states that "organizations including, but not limited to, the Texas Chiropractic Association and the Chiropractic Society of Te x a s a r e t h e p r o p e r organizations to promote and protect chiropractic in Texas and to petition the Legislature for any expansion of scope." The TBCE addresses the apparent confusion of some regarding the scope of chiropractic in the State of Texas that has resulted in at least two lawsuits by the Texas Medical Association and others. Says the TBCE "it has become clear that there is no common understanding of what the legal scope of p r a c t i c e f o r Te x a s chiropractors is or has been for several years. Therefore there exists a need for the Board to clarify scope ensuring that clarification is within the bounds of the Chiropractic Act." The TBCE, in addressing this scope of practice issue in the recent months notes that "one effect the proposed rule changes seem to be having is to bring into focus the fact that some chiropractors in Texas may have been practicing beyond what the law allows for several years. Put another w a y, some Te x a s chiropractors are just now realizing that they have misunderstood or have been misinformed or uninformed about their legal scope for a long time, according to what the Chiropractic Act Allows." www.chirotexas.org
Elsewhere in their newsletter the TBCE points out that there are 4975 active doctors of chiropractic and 3732 actively registered chiropractic clinics. They further list the "TBCE Board Disciplinary Actions Taken During Fiscal Year 2010", listing some 152 disciplinary actions against members of the chiropractic profession in Texas. If all disciplinary actions were against "active doctors" then this results in a percentage of doctors disciplined of about 3% of all DCs in 2010. The disciplinary rate against medical doctors in Texas is REPORTED HERE to be 2.61 PER 1000 MDs from 2008 to 2010, and there are 63,495 medical physicians. If the 3% rate is for ALL 4975 DCs in the State of Texas then the disciplinary rate per 1000 DCs is MUCH LOWER than that of medical physicians, a fractionof-1% per 1000 DCs. The chiropractic profession is not nearly as "offensive" as the medical physician community. "The point is," the TBCE states, "that it is not the Board that is limiting scope via these proposed rule changes, but it is the current Chiropractic Act--the statute, the current law--that is limiting scope. The Board is only attempting to make clear what the actual law and legal scope of chiropractic in Texas really are." T E N W AY S T O AV O I D DISCIPLINARY ACTION [According to the Texas Board of Chiropractic Examiners] 33
Excerpted from the article of the same name. ITEMS IN ALL CAPS ARE EDITORIAL S U M M A RY A N D N O T A PART OF THE ORIGINAL TBCE ARTICLE. 10. Notify Patients of Change in Employment or Address "Board Rule 75.2 requires licensees to give a patient 'adequate notice and the opportunity to obtain the services of another chiropractor' whenever the licensee will not continue treating the patient. Additionally, the licensee must show 'reasonable cause' for the discontinuing of treatment and must provide 'for the orderly transfer of [the] patient's records.' Failure to do these things may result in the licensee being disciplined for Patient Abandonment." "If you are going to change employment, leave practice, or move, notify your patients early and often! Phone calls, signage, emails, postcards, and advertisement are all good ways to notify patients. You may also think about distributing an email address or phone number where you will be able to be reached so that patients can contact you to obtain records in the future. Most complaints we receive that result in disciplinary action for Patient Abandonment stem from a patient who wants a copy of their records but can't find the licensee."
Texas Journal of Chiropractic
DON'T BE PERCEIVED AS ABANDONING YOUR PATIENTS! CHECK HERE FOR RULE 75.2 AND PRACTICE PROPER DILIGENCE! 9. Report Changes of Address to the Board Within 30 DAYS "Board Rule 73.1 requires licensees to maintain a current physical home and business address with the Board. The same rule also requires licensees to notify the Board in writing of any change in address within 30 days of that change. Additionally, Board Rule 74.5 requires a facility to notify the Board in writing of any change in street or mailing address or ownership within 30 days of that change." "Please note that merely submitting a change through Te x a s O n l i n e w h e n completing a license or registration renewal will NOT change your address with the Board." WHEN YOUR ADDRESSES CHANGES, DIRECTLY LET THE TBCE KNOW OF THAT CHANGE! CHECK HERE FOR RULE 73.1 AND CHANGE YOUR ADDRESS APPROPRIATELY! 8. Respond to Board Inquiries "When the Board sends a licensee or facility a notice of Texas Journal of Chiropractic
complaint or a request for information or records, the licensee or facility must respond in writing within fifteen (15) days, pursuant to Board Rule 75.6. This is not discretionary, and failure to do so may result in disciplinary action." "Ignoring a notice of complaint or a request for information is never a good idea. Your response is your opportunity to present your side of the story or to present mitigating evidence. If you need additional time to file a response, contact Board staff about your situation." DO NOT IGNORE CORRESPONDENCE FROM THE TBCE! CHECK HERE FOR RULE 75.6 AND R E S P O N D APPROPRIATELY!
S TAY W I T H I N Y O U R LIMITATIONS.
6. Ensure Documentation is in Compliance with Board Rules "Board Rule 80.5 states that documentation in patient records must support all diagnoses, treatments, and billing. Records must be timely, dated, accurate, signed or initialed by the licensee or the person providing treatment, and legible. (Electronic signatures are acceptable.) Records that are illegible and incomplete or that do not support all billing can easily land you and administrative penalty or other more severe disciplinary action!" CHECK HERE FOR RULE 80.5 AND MAKE SURE YOU MEET ITS REQUIREMENTS AT ALL TIMES!
7. Practice Within your Scope of Practice 5. Ensure Billing is Done Properly
"All diagnoses and treatment provided under you DC license must be within your scope of practice. ...just because you learned something ... or just because you have been properly trained ... does not mean that it is within your scope of practice! Scope of practice is set out in the Chiropractic Act ...."
"If you overcharge a patient or bill for services not rendered, you may be subjected to disciplinary action for Grossly Unprofessional Conduct under Board Rule 75.1. Also ensure that any billing done pursuant to a pre-paid treatment plan complies with Board Rule 80.13."
THE STATE OF TEXAS HAS GIVEN YOU AUTHORITY TO PRACTICE A LIMITED PURPOSE AND PROCEDURE, KNOW AND
"Other common billing violations that can subject a licensee to disciplinary action involve improper coding. Always make sure to use the
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proper codes! For example, don't bill a 99205 for an examination that is more appropriate to bill as a 99203. (Ensure that your documentation backs up all billing, as stated above.)" CHECK HERE FOR RULE 75.1 AND AVOID GROSSLY UNPROFESSIONAL CONDUCT! CHECK HERE FOR RULE 80.13 TO MAKE SURE YOUR P R E - PA I D T R E AT M E N T P L A N S C O M P LY W I T H G O V E R N M E N T REGULATIONS. 4. Release Chiropractic Records and Billing in a Timely Manner "Upon request from a patient or his/her representative, you must release records within fifteen (15) business days of that request, under Board Rule 80.3. Fees that you may charge are described in that rule. Note that you may NOT withhold records because the patient has a balance with your office or because you were not given a Letter of Protection! ... you MUST release the records." "The only exception is if you determine that access to the information would be harmful to the physical, mental, or emotional health of the patient. In that case, the denial of release and underlying reason must be given to the patient in writing." www.chirotexas.org
" A d d i t i o n a l l y, y o u m u s t release billing upon request. It is a violation of Board Rule 75.1 (Grossly Unprofessional Conduct) to fail to disclose the full amount charged for any service rendered or goods supplied when a patient so requests. (This does not mean that you must release billing codes, but you must release billing amounts.) Additionally, remember that you are supposed to disclose in writing to the patient, on the date of providing goods or services to a patient, the full amount of the charges, pursuant to Board Rule 77.3!" CHECK RULE 80.3 HERE AND RELEASE YOUR RECORDS AS REQUIRED! CHECK RULE 75.1 HERE TO AV O I D G R O S S LY UNPROFESSIONAL CONDUCT! CHECK RULE 77.3 HERE AND R E A S O N A B LY C A L C U L AT E YOUR NOTIFICATION OF PATIENT BILLING! 3. Renew your LIcense on Time "You must renew your license each year in order to practice c h i r o p r a c t i c . I n Te x a s , practicing with an expired license is the same thing as practicing with NO license! Each year, on or before the first day of your birth month, you must renew your license. ... Failing to renew your license can have many 35
unintended consequences. First, you will have to pay late fees on the renewal of your license. Second, you may have to pay an administrative penalty (separate from the late fees) if disciplinary action is taken against you. Third, if you allow your license to expire for more than a year, the only way to reinstate your license is to submit to reexamination and compliance with the current requirements and procedures for obtaining an initial license. Finally if you practice with an expired license, you open yourself up to liability for any billing that you submit during that time period." I T ' S Y O U R B I R T H D AY ! RENEW YOUR TBCE LICENSE BEFORE DAY 1 OF YOUR BIRTH MONTH! 2. Register Your Facility (And Don't Forget to Renew the Registration!) "Board Rule 74.2 is very clear: A facility shall not provide chiropractic services without first being registered by the board. Additionally, you must renew that facility registration each year. If you are a DC, then your facility registration will be due at the same time as your license renewal. If you are a non-DC facility owner, then your facility registration will be due on September 1st." CHECK RULE 74.2 HERE AND KEEP YOUR
Texas Journal of Chiropractic
FACILITIES REGISTERED-EACH ONE OF THEM!
1. Communicate with Your Patients
care and therefore not reimbursable. Determining whether the clinical documentation supports the level of spinal manipulation reported is also a central focus," the ACA reports.
"The number one way that you can avoid disciplinary action is to communicate with your patients. Many complaints that are received by the Board are submitted by patients as a result of a miscommunication or misunderstanding with the licensee. A simple conversation with a patient is a great proactive way to ensure that the patient is aware of and understands treatment, diagnoses, billing, etc."
"A major ADT priority has been to identify experts to assist DCs. ... The ADT also has reorganized and developed new resources for the ACA website. These resources identify the provider's type of records request and then highlight the appropriate resources and contacts that will be most helpful to that individual provider. Tips on responding to records requests are included, along with information about the Medicare appeals process that is available to doctors."
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ACA's Medicare Audit Defense Taskforce In an article entitled "ACA's Medicare Audit Defense Taskforce" by Kara Webb, the American Chiropractic Association reports in their November 2011 ACANews that "over the past several months, an increasing number of doctors of chiropractic have been forced to deal with intrusive Medicare audits and reviews as pre-payment and post-payment reviews are on the rise across the country." "For DCs, these reviews are generally focused on determining whether the care rendered was maintenance Texas Journal of Chiropractic
Medicare reviews and audits. ... The ADT has held several meetings over the past few months to revamp ACA's online resources, identify legal, statistical and documentation experts, and to strategize a multifaceted approach for assisting DCs with documentation reviews, audits and appeals."
"ACA strong suggests that doctors who receive a request for records from CMS or a CMS contractor visit ACA's Medicare appeals website at w w w. a c a t o d a y. o r g / auditdefense. Information and resources to address the most common audit and appeals questions are readily available on the website as part of ACA's member benefits." The ACA reports that "in Spring of 2011, the Audit Defense Taskforce (ADT), a subcommittee of the Medicare Committee, was created to assist doctors dealing with 36
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www.chirotexas.org
The Chiropractic Development Initiative It's Time for Chiropractors to "STOP Playing Defense"...
It's no secret that for many years, Chiropractors and their patients have been discriminated against. Like the victims of a "school yard bully", you put up with it. You put up with it from insurance carriers, from attorneys, from the legislature, from other professionals...sometimes you even put up with your own patients kicking you around. Underappreciated...underpaid.. .under-utilized, many smart, well-educated Chiropractors, who are in the business of helping sick people get well, have to fight every day to keep their doors opened and to meet their obligations. Many get frustrated, blame the system, blame the government, some even blame the profession. "This isn't why I went to school!" Some even quit.
podiatrists, nurses, physical therapists, as well as doctors of osteopathy and optometry. We're always "playing defense". Every year, we hear "the sky is falling", and to some degree, it may have been, but it's Time To Stand Firm ... and Move the Profession Forward.
This year TCA did just that. Call it a "line in the sand". "No more!" "We've been kicked around enough!" For the first time in many years TCA was on offense. Support came in from all over the state from Doctors and patients alike. What an exciting time to be a Chiropractor in Texas! We believe that what is happening
www.chirotexas.org
What is the Long Term Plan? The Chiropractic Development Initiative (CDI)
TCA is moving forward with the Chiropractic Development Initiative (CDI), which is the 10 year commitment to positively affect changes in statute, regulation, as well as government and public perception based on 3 beliefs: • We believe that the people of Texas should be afforded the full benefit of Chiropractic Care based on the level of education, training and experience of Doctors of Chiropractic. •We believe that the people of Texas should be afforded access to Chiropractic Care free of restrictive limitations or discriminatory payment provisions.
It seems that every year, the job gets harder, more is required, the pay goes down and the fight gets just a little d i r t i e r. E v e r y l e g i s l a t i v e session, it seems that we are fighting for our professional lives. Bill after bill comes up aimed at limiting our ability to practice Chiropractic and our ability to help our patients. We aren't alone in this, as the same groups were successful with tightening their grip on the
we treat, we believe that Chiropractors and Chiropractic patients can and will reap the benefit.
right now in Texas has farreaching effects. We believe that we have a REAL opportunity to move our profession forward in a positive direction! TCA's new direction and new vision includes the announcement of a new Executive Director just weeks away. With the continuous and sustained efforts of not only the Doctors, but also the patients 37
•We believe that Chiropractic Doctors of Texas should be afforded the level of authority, respect, and esteem equal to the dramatic impact they make on the healthcare system. What Will It Take For CDI to be a Success? CDI is a long-term plan, which means that it will require continued and sustained support from Doctors, patients, vendors, and institutions. Rather than a fundraising Texas Journal of Chiropractic
campaign, or a yearly strategy, or a session by session plan, the CDI must be sustained and continual forward movement for our profession and the patients we serves. CDI will r e q u i r e massive and continuous action, grassroots efforts and financial contributions. It requires banding together with your fellow Doctor for the "greater good". Why Should I Support CDI? Whether you have an all-cash practice, or a practice that only accepts insurance, CDI protects and promotes your rights and your patients' rights. You benefit, whether you adjust one bone, every bone, or no bones at all. If you practice Chiropractic, in any form or fashion, you benefit and your patients benefit.
for TCA, you might not know about the proposed rules changes, let alone had any way to change it on your own. TCA stands up for your patients! TCA was responsible for c r e a t i n g T e x a s ' fi r s t Chiropractic patient advocacy site, Mytexasdoctor.org. This allows Chiropractic patients to voice their support of Chiropractic to their elected state officials at key times during a legislative session as well as during election campaigns. This year, over 17,000 emails were sent to officials from all over the State. TCA stands up for Chiropractic!
Why Should I Support the TCA? TCA is Your Source for Information! CA members are the first to know about changes in legislation, regulation, and legal opinions that affect your practice. You have a direct line to this vital information. TCA stands up for you! Every day TCA is watching out for you! In recent months, TCA worked cooperatively with the Texas Board of Chiropractic Examiners to establish rules that don't limit your ability to treat patients based on the current accepted standards in the profession nationally. If not Texas Journal of Chiropractic
Many would agree that Texas has always seemed to be a "testing-ground" state. If the TMA/AMA are successful in taking away practice rights of Chiropractors in Texas, other states will certainly follow suit. It is no secret that progress like this has a cost, but the cost of "backing down" could be catastrophic to the Chiropractic profession as a whole.
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It's Time to Pull Together ... And Move the Profession Forward We believe that today's Chiropractic Doctor i s extremely well educated, highly skilled and uniquely qualified to serve as a conservative portal of entry Doctor for the health care system in Texas. We believe that the people of Texas should have the right to access you as the doctor of their choice. We b e l i e v e t h a t a t t h e c o r e of TMA's opposition is the desire to take away Texans' rights to choose you as their Doctor (portal of entry or otherwise) and ultimately, to take away your right to be a Doctor at all. We believe that the TMA is one of the most militant, aggressive anti-chiropractic associations in the world. Their goal is to destroy chiropractic in Texas. The goal of the TCA is to save Chiropractic in Texas and to move the profession forward f o r t h e b e n e fi t o f o u r patients. Join and support the TCA today. The bottom line is this...the profession needs your talent, input, and contributions on TEAM TCA! It's Time for All of Us ... To Take Continuous, Massive Action Be a Member of TEAM TCA and Encourage Others to Join! We believe that to save our profession and move it www.chirotexas.org
forward, we need to come together and act as one. We believe that to accomplish this unified action, we must bring our best minds together, and h a v e o p e n a n d h o n e s t discussions so that every voice may be heard. We believe that the best and only vehicle in Texas to accomplish this purpose is the Texas Chiropractic Association. If you're not a member, the time to become one is NOW. Take Action Today! CLICK HERE to download a membership application and fax or mail it to the TCA office or simply CLICK JOIN to join online. If you are a member, please call your DC friends and the colleagues in your area and make sure they join as well. G i v e t o t h e PA C a n d Chiropractic Development Fund and Encourage Others to Give as Well! We believe that money above and beyond dues income will be critical to accomplish the massive action necessary to move the profession forward. We believe that this will have to be a long and sustained effort, that fundraising will need to be ongoing and sustainable and that we all need to commit to the long haul. PAC money is used for direct contributions to Political Candidates and Elected Officials in Texas. www.chirotexas.org
Chiropractic Development Funds (formerly Defense Fund) are used to fund our actions in the courts systems, in the legislature, and in public relations. Every dollar counts! Fill out the enclosed TCA Stars form and give as much as you can monthly through our EZ pay system or CLICK HERE. Get Involved and Do Your Best to Help the Chiropractic Development Initiative Succeed! We believe that every level of involvement is important including joining TCA, staying informed and being part of the discussions. We also believe that many Doctors have the talent and resources to give much more. What is your talent or strength? Right now, TCA needs Doctors in the areas of Legislative and Political Action, Public Relations, Insurance Relations, Legal and Litigation Oversight, Education, Public Outreach, Vendor Relations, Member Services and Fundraising. W h a t t i m e , t a l e n t a n d resources can you offer? Would you consider serving on or even chairing a TCA committee in your district or at a State level? Contact the TCA office at (512)477-9292 and we'll help you get more involved in your area of interest.
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Isolated Nutrients V. Whole Diet Medpagetoday.com reports "there's little that individual vitamins and nutrients can do to prevent stroke, but overall healthier diets may lower the risk, an Australian researcher found." " I n a r e v i e w, n e i t h e r antioxidant vitamins nor Bvitamins were associated with stroke prevention, but a healthy diet, such as the Mediterranean diet, did appear to diminish risk." "The overall quality of an individual's diet and balance between energy intake and expenditure seem to be more important determinants of stroke risk than individual nutrients and foods." "Randomized trials have shown that beta-carotene, the biologically active metabolite of vitamin A, won't prevent stroke; in fact, it appears to up the risk of all-cause and cardiovascular death." "Similarly, large randomized controlled trials have shown that vitamins C and E won't prevent stroke, either .... vitamin E may even increase the risk of death." "Calcium could also increase the risk of stroke, and trials have shown that it may increase the risk of heart attack by 31%." "While B-vitamins reduce stroke risk, he found, in places
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with low folate intake, treating deficiency may lower stroke risk. Similarly, vitamin D deficiency is also associated with a higher stroke risk, as well as other related factors such as hypertension and cardiovascular disease." "The relationship between stroke risk and sodium and potassium intake is a bit clearer; high salt intake -about 5 g per day -- has been associated with a 23% increased risk of stroke in observational studies, and also carries clear heart disease risk .... At the same time, upping potassium intake could diminish risk." "Studies have shown a 21% lower risk of stroke with a higher intake of the mineral, and the benefits may come through its ability to help lower blood pressure." "Patients who eat a lot of fat overall don't appear to be at a heightened risk of stroke .... In fact, a high intake of the vilified trans- or saturated fats doesn't appear to up the risk. But polyunsaturated omega-3 fatty acids from marine life have been shown to reduce the risk of heart events and death, and those found in plants have been shown to diminish stroke risk." "Eating lots of carbohydrates has been associated with other poor outcomes that could be related to stroke risk, such as higher blood sugar levels and increased body weight, but high fiber intake appears to Texas Journal of Chiropractic
lower risk factors such as blood pressure and cholesterol." "When it comes to specific foods, a few have been repeatedly linked with a lower risk of stroke, such as chocolate, coffee, and tea. Cocoa, for instance, may be protective via its antihypertensive or antiinflammatory properties." "One major stroke risk trial ... found that greater intakes of fish and fruit were each associated with a lower risk of stroke, while a handful of observational studies have shown that eating too much meat may up the risk of ischemic stroke." " I t ' s n o t c l e a r, h o w e v e r, whether the type of meat, be it red or processed, for instance, has a specific effect on stroke risk." "Finally, while not directly related to stroke risk, sugary drinks have been linked with several other risk factors, including adiposity, metabolic syndrome, diabetes, and heart disease. But whole grains, on the other hand, can protect against heart events." "There have been some c o n fl i c t i n g r e s u l t s a s t o whether a "healthy" diet can diminish stroke risk -depending on how that diet is defined .... The Women's Health Study, which defined a healthy diet as one with high fiber, folate, and omega-3 intake paired with low 40
consumption of bad fats, was associated with a higher risk of stroke over 10 years, but the Nurses' Health Study and the Health Professionals' FollowUp found that a diet high in fruits, vegetables, and fiber and low in fat and red meat was associated with a lower risk of stroke." "Yet other studies have shown that unhealthy "Western" diets are clearly associated with an increased risk of stroke." "Two popular healthy diets -the DASH diet (which focuses on reducing hypertension) and the Mediterranean diet -- have been shown to reduce stroke risk, and the latter has also been shown to diminish heart disease and death." "Though over-nutrition has clearly been associated with an increased risk of stroke -likely through its effects on o b e s i t y, h y p e r t e n s i o n , hyperlipidemia, and diabetes -poor nutrition can also play a role in risk."
The association of chiropractic professionals in Texas for nearly 100 years. The Texas Chiropractic Association Join with your colleagues in working to support and promote chiropractic in Texas. The profession needs your voice added! www.chirotexas.org
Cleared for Takeoff
Texas Chiropractic Association Serving Texas Chiropractors and their patients for nearly 100 years! Are You supporting your profession? www.chirotexas.org 1122 Colorado, Suite 307 Austin, TX 78701 Phone: 512 477 9292 Fax: 512 477 9296 E-mail: info@chirotexas.org