July/August 2012
Convention 2012 TMA Motion Denied! Chiropractic IN the Movies Supreme Court Upholds Health Reform Texas Privacy Law Effective Sept 1st
The Texas Chiropractic 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. ABOUT OUR COVER The TCA annual convention was held in Austin, Texas early in June. This issue shares reports and photos from convention. The food and fellowship this year offered one of the best conventions in many years. Grab some chips
POLICIES Annual subscription to the Texas Journal of Chiropractic is included in TCA membership dues. subscription rates for non members.
Contact the TCA for
The print-format Texas Journal of Chiropractic is published up to six times per year by the Texas Chiropractic Association under the supervision of the TCA Communications 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. Publication of an advertisement does not imply approval or endorsement by the Texas Chiropractic Association. The association shall have the absolute right at any time to reject any advertising for any reason. For advertising rates contact the TCA Office, or check online at www.chirotexas.org. All advertising material must be in graphics ready format and submitted as a .jpg, .jpeg, .gif, .swf, or .png file type.
Texas Chiropractic Association
Texas Journal of Chiropractic Volume XXVII, Issue 4
July/August 2012
Texas Journal of Chiropractic The Official Publication of The Texas Chiropractic Association
Inside
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 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. Nancy Hinders D.C. Jason Clemmons D.C. Mark McGarrah 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.
TMA Moves for Rehearing in TMA v TBCE!
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MOTION DENIED!!
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TCA Insurance Committee Report ! !
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Texas Council of Chiropractic Orthopedists!
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Discount Legally!
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TBCE PROPOSES RULES UPDATES!
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Lack of HIPAA Compliance Can Now Shut Down Your Practice, or Worse! ! ! ! 12 Convention Photo Pages Medical Inc. The Movie!
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Smart Training Addresses Needs of HB 300 New Web Address for Online Journal!
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Doing the Right Thing the Wrong Way Can Cost You
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Supreme Court Upholds Obama’s Healthcare Law 22 ACA Report !
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Thomas Hollingsworth D.C.
Policies
Coming Soon… A New Executive Director for the TCA. The ED Search Committee has worked these past months to search for and recommend a new ED for the TCA. Watch for an announcement in the coming weeks about the outcome of their efforts.
Annual subscription to the Texas Journal of Chiropractic is included in TCA membership dues. Contact the TCA for subscription rates for non members. T h e p r i n t Te x a s J o u r n a l o f 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 r e fl e c t t h e p o l i c y o f t h e Te x a s Chiropractic Association or the Texas Journal of Chiropractic.
Publication of an advertisement does not imply approval or endorsement by the Texas Chiropractic Association. The association shall have the absolute right at any time to reject any advertising for any reason. For advertising rates contact the TCA Office. All advertising material must be in graphics ready format and submitted as a .jpg, .jpeg, .gif, .swf, or .png file type. Copyright 2012 All Rights Reserved: Texas Chiropractic Association
TMA Moves for Rehearing in TMA v TBCE
MOTION DENIED!
T h e Te x a s M e d i c a l Association filed a motion for rehearing in the Court of Appeals. A motion for rehearing asks the court to reconsider part of its decision.
“The motion for rehearing filed by appellee Texas Medical Association is denied.”
In particular, TMA asked the Court of Appeals to reconsider its decision about whether TMA waived its argument that the Board’s rule improperly allows chiropractors to diagnose. In the trial court, TCA won a declaratory judgment saying that chiropractors can diagnose, and TMA did not appeal that decision. By not appealing that decision, TCA believes that the TMA waived its opportunity to do so. Now, TMA is arguing that the Board rule is invalid because chiropractors can’t diagnose at all. TMA effectively asked the Court of Appeals for the opportunity to reverse that declaratory judgment, even though TMA did not appeal the decision. The full motion may be found here.
www.chirotexas.org
CLICK HERE For the full court document
On motion by the Texas Medical Association to the Third Court of Appeals in Austin, on July 6, 2012, the court has ruled “The motion for rehearing filed by appellee Texas Medical Association is denied.” Pertinent excerpts from the newly issued opinion include: “We withdraw our opinion and judgment dated April 5, 2012, and substitute the following in its place. The motion for rehearing filed by appellee Texas Medical Association is denied.” “ T h e Te x a s B o a r d o f Chiropractic Examiners (TBCE), its executive director, and the Texas Chiropractic Association appeal a final district court judgment invalidating portions of TBCE’s recently adopted administrative rule defining the scope of practice of chiropractic. …The rule provisions at issue purport to authorize TBCE’s licensees to perform procedures known as manipulation under anesthesia and needle electromyography, and to “diagnose” certain conditions. We will affirm the judgment in 3
part and reverse and remand in part.” “In five issues on appeal, TCA challenges the district court’s judgment invalidating TBCE rules regarding needle EMG, MUA, and ‘diagnoses.’ TBCE brings three issues challenging only the portions of the judgment invalidating the needle-EMG and MUA rules.” “It follows that the three challenged rule provisions purport to authorize chiropractors to perform ‘incisive’ procedures that are beyond chiropractic’s statutory scope [and] authorize chiropractors to perform needle EMG, [stating] that a procedure involving a needle is ‘incisive’ only if it results in removal of tissue. In so doing, these rules exceed the statutory limits of chiropractic by, at a minimum, authorizing chiropractors to perform needle EMG with bevelededged needles that are made to cut or incise tissue. They were, accordingly, beyond TBCE’s statutory authority and void.” “In contrast to TBCE, TCA vigorously disputes that MUA is “described in the surgery section” of the CPT Codebook in any sense relevant to chiropractors. While not disputing that the “surgery” section of the book has contained a description of MUA at all times relevant to our inquiry here,TCA insists that the reference “does not encompass chiropractic Texas Journal of Chiropractic
procedures.” It emphasizes a cross-reference that appears in the 2007 CPT Codebook’s description of MUA …. there is no dispute that MUA was described in the “surgical” section of the CPT Codebook throughout the period at issue …. As there is no constitutional barrier … we must give it effect and hold that MUA is a “surgical procedure” excluded from the statutory scope of chiropractic practice. … Consequently, subsection 75.17(e)(2)(O), which purports to authorize chiropractors to perform MUA, is beyond TBCE’s statutory authority and void.” “In its remaining issues, TCA (but not TBCE) challenges the district court’s judgment invalidating rules authorizing chiropractors to make certain’”diagnoses.’” ”In their live pleadings, the Physician Parties sought two declarations that 75.17(d) was invalid for exceeding the scope of chiropractic practice and permitting chiropractors to practice medicine without a medical license, in turn violating the Medical Practice Act and, alternatively, article XVI, section 31 of the Texas Constitution.”
conditions, but not to “diagnose” them, and that “diagnose” is instead reserved to the practice of medicine and certain other health care professions. … Second, they sought a narrower declaration that 75.17(d) exceeded the statutory scope of chiropractic by permitting licensees to “diagnose” conditions beyond the biomechanical condition of the spine and musculoskeletal system.” “Subsequently, the Physician Parties filed a second motion for partial summary judgment seeking relief only as to two portions of 75.17(d)–(d)(1)(A), which authorized “analysis, diagnosis or other opinion” concerning a list of six specific subjects ‘regarding the biomechanical condition of the spine or musculoskeletal system’; and (d)(1)(B), which authorized ‘analysis, diagnosis or other opinion’ concerning a list of three specific subjects ‘regarding a subluxation complex of the spine or musculoskeletal system.’”
“First, they sought a declaration that 75.17(d)’s use of “diagnosis” in itself rendered this rule and various related rules invalid, reasoning that the statutory scope of chiropractic permits licensees to “analyze, examine, or evaluate” certain
“… In this motion, they relied on their narrower claim that these provisions exceeded chiropractic’s statutory scope of practice and also violated article XVI, section 31 of the Te x a s C o n s t i t u t i o n by permitting chiropractors to “diagnose” conditions, such as diseases, that were beyond the “biomechanical condition[s] of the spine and musculoskeletal system of the human body” that chiropractors were statutorily
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permitted to “analyze, examine, or evaluate.” … The Chiropractor Parties countered … that “diagnose” (which, again, they viewed as synonymous or implicit in “analyze,” “examine,” and “evaluate”) encompassed diagnosis of diseases and any other matter listed in 75.17(d)(1) and (2).” “Thus, the plain language of (d)(1)(A) limits chiropractors to diagnosing–i.e., “analyzing, examining, or evaluating”– biomechanical conditions of the spine or musculoskeletal system. … In other words, the non-exclusive list of example opinions or diagnoses cannot be read in isolation; rather, they must be read as being dependent upon or bounded by the restriction that they also regard the biomechanical condition of the spine or musculoskeletal system. To that extent, this complies with the statutory scope of chiropractic.” “The Physician Parties counter that this provision does not restrict chiropractors to the biomechanical condition of the spine or musculoskeletal system because it allows them to diagnose diseases without limitation. … Specifically, they assert that because “biomechanical” refers only to the application of mechanical principles–i.e., the action of forces on matter or material … to living bodies and does not involve diseases of any kind, chiropractors may not render a diagnosis, which by www.chirotexas.org
d e fi n i t i o n i n v o l v e s t h e identification of a disease. Relatedly, they point to the rule’s use of “pathology” and “etiology,” which also involve the study of disease … to argue that this provision of the scope-of-practice rule allows chiropractors to diagnose a wide range of diseases and conditions, including various cancers, arthritis, osteoporosis, gout, ALS, and bone fractures.” "But apart from the fact that the common, ordinary meaning of “diagnosis” also includes the identification of a “condition” or an “injury,” … the Physician Parties’ argument presumes that “disease” would extend beyond the biomechanical condition of the spine or musculoskeletal system of the human b o d y. T h i s construction, as previously suggested, ignores the plain language of the rule restricting any such diagnosis to the biomechanical condition of the spine or musculoskeletal system. The text and format of this provision plainly shows that “the system” discussed in each of the examples is “the biomechanical condition of the spine and musculoskeletal system” referred to at the beginning of the provision.” “Stated another way, each of the listed examples is limited to the Legislature’s standard of ‘biomechanical condition of the spine and musculoskeletal system.’ Thus, regardless of whether diagnosis, pathology, or etiology invoke concepts of www.chirotexas.org
disease as the Physician Parties suggest, the bottom line is that paragraph (d)(1)(A) limits chiropractors to diagnoses regarding ‘the biomechanical condition of the spine and musculoskeletal system’ as required by the statutory scope of chiropractic. Accordingly, the provision does not exceed the statutory scope of chiropractic.” “In a related argument, the Physician Parties challenge TBCE’s use of the phrase “could include, but are not limited to” in subpart (d)(1) of the scope-of-practice rule, s u g g e s t i n g t h a t i t , i n combination with the issues discussed above, eviscerates any purported limitation on chiropractors’ authority to diagnose by allowing chiropractors to “diagnose any diseases (pathology) that relate to the biomechanical condition of the spine and musculoskeletal system (redefined to include nerves and other tissues), determine their origins (etiology) and provide a prognosis on the disease’s effect.” “But this argument requires reading 75.17(d)(1) in an u n n e c e s s a r i l y strained manner.”"[The rule states] that chiropractors “may render an analysis, diagnosis, or other opinion regarding the findings of examinations and evaluations. Such opinions could include, but are not limited to, the following[.]” … [the words] ‘But are not limited to’ as it is used here merely 6
means that the list of examples that follows is not a comprehensive list of every type of authorized opinion– i.e., there could be other types of opinions that fit within the parameters of the provision that are not mentioned in the list.” “Also, use of this phrase does not alter the limitation in the rule that the “diagnosis” referred to must regard the findings of “examinations and evaluations,” … Thus, the plain language of 75.17(d)(1) provides that chiropractors may render diagnoses r e g a r d i n g fi n d i n g s a n d examinations within the statutory scope of chiropractic, and offers a nonexclusive list of examples of such opinions. It does not, by its plain language, allow them to render diagnoses that do not involve the statutory scope of chiropractic. As such, it does not exceed the statutory scope of chiropractic.” "We sustain TCA’s third issue.” “Relatedly, the Physician Parties argued successfully to the district court that the following paragraph of TBCE’s scope-of-practice rule, (d)(1) (B), also exceeds the statutory scope of chiropractic: (1) In the practice of chiropractic, licensees may render an analysis, diagnosis, or other opinion regarding the findings of examinations and evaluations. Such opinions could include, but are not Texas Journal of Chiropractic
limited to, the following: . . .(B) An analysis, diagnosis or other opinion regarding a subluxation complex of the spine or musculoskeletal system including, but not limited to, the following: ….” “Initially, the Physician Parties argue that this paragraph of the scope-of-practice rule is invalid because it allows chiropractors to diagnose a subluxation complex despite the fact that the statutory scope of chiropractic only allows chiropractors to treat the subluxation complex.” “… Stated another way, the Physician Parties argue that while chiropractors–again assuming our procedural limitations as to “diagnosis”– may diagnose the biomechanical condition of the spine or musculoskeletal system, they can only treat, but not diagnose, the subluxation complex. We find this argument unpersuasive.” “This argument suggests that the Legislature intended to allow chiropractors to treat a condition that is undisputedly unique to the practice of chiropractic, while also deliberately depriving them of the ability to analyze, examine, evaluate, or (given our procedural posture) “diagnose” that condition. We cannot see how a chiropractor would know to treat a subluxation complex if he had not first determined from an analysis, examination, or evaluation/ “diagnosis” that there was a problem with the Texas Journal of Chiropractic
subluxation complex that needed chiropractic treatment. A more logical interpretation, and one supported by the text of both the occupations code and TBCE’s scope-of-practice rule and by the summaryjudgment evidence, is that a subluxation complex is part of the biomechanical condition of the spine or musculoskeletal system of the human body and, thus, may be analyzed, evaluated, examined, and diagnosed by chiropractors.” “TBCE’s unchallenged definition of “subluxation complex” establishes that it is a–’neuromusculoskeletal condition that involves an aberrant relationship between two adjacent articular structures that may have functional or pathological sequelae, causing an alteration in the biomechanical and/or neurophysiological reflections of these articular structures, their proximal structures, and/or other body systems that may be directly or indirectly affected by them.’” “… The rule also defines “musculoskeletal system” as the “system of muscles and tendons and ligaments and bones and joints and associated tissues and nerves that move the body and maintain its form.” … “Neuro-” is a prefix meaning “nerve,” … and “articular” refers to joints, … To a certain extent, then, use of the prefix “neuro-” with the adjective “articular” in connection with 7
New Licensee and TCA Members May/June 2012 Jason Pellegrin Somphone Amphone Bradley Baker Benjamin Charlton Jamon Clayton Jesse Czajka Mitchell Dougherty Philip Elder Stephen Ford Juan Garcia Diana Godinez Asa Hadsell Lee Hartman Yvonne Hinojosa Ryan Huffman Ji Young Kwon Shukura Leo Taryn Lowery Bryant Mays Brian McGaughran Scott McLellan Nicole Minatrea Tankiso Mochache Jerald Naum Ashlee Niebuhr Tony Oberle James Palma, Jr. Christel Parish Alesha Paternostro Krista Perdue Nataly Perez Telila Robinson Gena Ross Daniel Scherer Philip Sledz Brock Stratton Whitney Tabler Barrett Terry William Ursprung Ian Veary Kristen Walters Christopher Warmath
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TCA Welcomes New Members: Dr. Omar Vela, Edinburg Dr. Jeff Williams, Amarillo Dr. Alan Thompson, Pasadena Dr. Jon Swanson, Austin Dr. Jay Morgan, Austin Dr. Lezlie Maloy, Dallas “musculoskeletal” is redundant in that TBCE’s definition of “musculoskeletal system” already includes both nerves and joints.” “Nevertheless, the bottom line here is that 75.17(d)(1)(B) allows chiropractors to diagnose a condition that under unchallenged rules is part of the musculoskeletal system of the human body. To that extent, it comports with the statutory scope of chiropractic.” “The Physician Parties also contend that the language of paragraph (d)(1)(B) allows chiropractors, in violation of the statutory scope of chiropractic, to diagnose neurological conditions, pathological and neurophysiological consequences that effect the spine and musculoskeletal system, and “other body systems” that are affected by subluxation.” “We disagree that this provision sweeps so broadly. Although the definition of ‘subluxation complex’ indicates that its existence may have functional or pathological consequences or that it may affect essentially every part of the body, the rule www.chirotexas.org
itself only allows chiropractors to render an analysis, diagnosis, or other opinion regarding a subluxation complex of the spine or musculoskeletal system. Accordingly, it does not exceed the statutory scope of chiropractic. We sustain TCA’s fourth issue.” “Having determined that, in the procedural posture of this appeal, the district court erred in its judgment invalidating subparts 75.17(d)(1)(A) and (B) of TBCE’s scope-ofpractice rule, we reverse that portion of the judgment.” In light of our reversal … we remand the case for further proceedings regarding the Physician Parties’ alternative constitutional challenges.” “Having otherwise overruled each of the Chiropractor Parties’ issues on appeal, we affirm the remainder of the district court’s judgment that subparts 75.17(a)(3), (c)(2) (D), (c)(3)(A), and (e)(2)(O) of TBCE’s scope-of-practice rule are void.”
certain carriers paying our patients d i r e c t l y . Unfortunately, this have left some doctors “holding the bag.” TCA has recently met with Te x a s D e p a r t m e n t o f Insurance regarding this matter. We have been informed by TDI that there is no statutory PIP/MEDPAY duty to honor an assignment of benefits.
TCA Insurance Committee Report
In any event, one must now look to the policy language to determine whether the insurance company states “we will honor or we won’t honor assignments.” If their policy language states that they will, and then breach your assignment, then there is potential for legal action. That said, there are still possible legal arguments to
TCA’s Insurance Committee has been receiving numerous calls and emails from TCA members with regard to some personal insurance protection (PIP) carriers not honoring/ ignoring assignment of benefits. This has resulted in 8
That means that there is no specific language in the insurance code/law that forces a carrier to honor our assignments. Prior to the 2007 legislative session, all carriers were required by law to use the Texas Standard Auto Policy, which had language specifically stating that PIP/ M E D PAY b e n e fi t s w e r e assignable. A bill during that legislative session allowed carriers to use “their own” forms. Some carriers copied and pasted some or all of the Texas Standard Auto Policy, and some re-wrote using their own verbiage.
Texas Journal of Chiropractic
be made, regardless whether carrier states they will honor or won’t. TCA is working on that issue right now and will continue to investigate this. In the meantime, TDI is sticking with their analysis and will not enforce assignment breaches. TCA is strongly recommending that all doctor’s offices continue to compile complaints regarding this matter. Please forward those to TCA Insurance Chair, Dr. Todd Whitehead. Please email to dr.whitehead@chiroamarillo.c om
Texas Council of Chiropractic Orthopedists The first time that the Texas Chiropractic College Post Graduate Department offered its series of lectures leading to the designation of Diplomate, there was a group of approximately 150 D.C.’s who enrolled with all intentions of completing the 320 hour course. Once a month, these D.C.’s, closed their respective practices, paid the tuition and made hotel reservations in Austin for the weekend. This continued for the next 3 years.
Texas Journal of Chiropractic
Although in any scholastic endeavor, there is attrition and the class decreased in size to about 50 and then to about 35. Each module of this series had an examination. New information was given by the very capable instructors who were already Diplomates in Orthopedics.
initiated the beginning of the Texas Council.
Successfully passing the individual module tests and the completion of the hours required, there was one more step to take before gaining the Diplomate status. A national examination was given.
Seminars were planned with courses ranging from the cervical spine to extremities, to the lumbar spine. Each member of the Council taught a portion of the seminar furnishing class notes and references. The treasury began to grow after paying TCA its portion of the expenses. No monies were reimbursed to the T.C.C.O. members for many years. Due to the expenses being decreased, the tuition of the course was decreased accordingly to help the field docs.
It was a two day affair with the written portion of the exam on day 1 and then a practical/oral examination on day 2. These were given only 1-2 times a year in different parts of the country. The results of those tests were reported to the student. If he/she passed, he/she was awarded the designation of Diplomate. If the student did not pass, he/she was able to retake the whole examination whenever it was offered. Now that the student had the status that he/she had worked and sacrificed, what was next? The last instructor for the group was Dr. Ronald Evans who had mentioned that in his state, there was a g r o u p o f orthopedic diplomates who formed a council to encourage education of Chiropractic. This seemed like a viable endeavor for the Texas group and Dr. Walter Brzozowske 9
Many meetings were held to discuss what this Council’s objectives and purpose would be. It was agreed that this Council would be a not-forp r o fi t a n d a n a p o l i t i c a l organization.
As a member of the American Council of Chiropractic Orthopedists, each member received a pamphlet with the most common orthopedic and neurological tests in an easy r e f e r e n c e g u i d e . The T.C.C.O. bought over 3000 of the pamphlets and mailed one to each licensed D.C. in the state of Texas as a gift. Some D.C.’s still use these in their offices. Worker ’s Compensation began to require additional education for its Designated Doctor program. Dr. Don Handley had a medical professional friend, Dr. Mark www.chirotexas.org
Taylor, who had influence with the AADEP group who was teaching the Designated Doctor course and invited the Chiropractic Orthopedists to teach during their seminars. This relationship has continued to this date. To become a member of the T.C.C.O., you must have completed the course in orthopedics, be a member in good standing of the T.C.A., complete the application and have a face to face meeting with the membership. With the short history of this organization, one can easily observe the level of commitment to education and the promotion for graduate study of Chiropractic Orthopedics. It is encouraged to become a member of the ACA’s Council on Chiropractic Orthopedists. T h e T. C . C . O . h a s b e e n elected as the only state organization with equal privileges and voting rights with the national organizations of A.C.C.O., the C.C.O. as well as the A.C.O (the Academy of Chiropractic Orthopedists) . This alone, bodes well with the character and zeal of its members. Throughout the years, the T.C.C.O. gave large sums of money to help T.C.C. in its fund raising projects, reference books for the library and speaking engagements from its members. Today, there are many of the members who now and in the past, have been selected to www.chirotexas.org
serve on governing boards of national organizations, r e p r e s e n t i n g Te x a s , t h e T.C.C.O. and Chiropractic. Congratulations to T.C.C.O. for 31 productive years of education and selflessly promoting Chiropractic in Texas and in the national arena.
Discount Legally “Is it possible to structure your fees to maximize reimbursements and still provide care to those without coverage at a fee they can afford and one YOU can live with? Is it possible to offer discounts to cash and Medicare patients for exams, x-rays and therapy without having a dual fee schedule or triggering an inducement violation with hefty fines and penalties? Ye s , it’s called ChiroHealthUSA. Patients have the option to join ChiroHealthUSA when your staff reviews your office financial policy. Membership in this Discount Medical Plan Organization (DMPO) constitutes a “contract” between your clinic, ChiroHealthUSA, and the patient. Now, the patient has access to reduced fees just like any other “network patient.”
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The existence of a contract allows you to set and offer these rates to our members, solving a host of legal and regulatory problems for you and your patients. For the record, we’re not a fan of discounting and think our doctors should be well for their services. That being said, there is not a doctor in practice that doesn’t offer discounts if they are part of a managed care plan or PPO. So, the issue isn’t IF you discount, but HOW you discount. More importantly are the discounts complaint with your State Board, as well as state and federal regulations and your PPO agreements. They can be with ChiroHealthUSA! The ChiroHealthUSA membership covers the patient and dependents for a small annual fee of $39.00 and the membership is effective instantly. Many patients save the enrollment fee on their very first visit!
TBCE PROPOSES RULES UPDATES TBCE Proposes Updates to Specialty Rule 75.15 TBCE Proposes Alteration of Chiropractic Scope of Practice Defined in Rule 75.17 TBCE Proposes Changes to Rule 80.7 Out of Facility Practice Texas Journal of Chiropractic
Lack of HIPAA Compliance Can Now Shut Down Your Practice or Worse BY: Dr. Ty Talcott and Martha Mckinney C.P.O. The risk Protecting the profession– relative to HIPAA, Medicare and Insurance compliance–is a major task, but if it is not taken seriously many more doctors will pay the individual price of major fines (HIPAA has a new 50k minimum fine, up to 250k), the loss of their license or their practice–OR worse yet–face criminal charges (now that the Justice Department is involved with the Office of the Inspector General [O.I.G.] to enforce many of the aspects of H I PA A a n d M e d i c a r e compliance as criminal fraud). This is real–our profession IS a target! Our intent is not to scare doctors (or their key staff or compliance officers), it is to prepare them. The myths The most disturbing myths are born of ignorance, denial or intentional and willful neglect. O f fi c i a l s o f H I PA A a n d Medicare have decided Texas Journal of Chiropractic
chiropractors and certain other specialists have ignored becoming compliant for too long, therefore deficiencies in compliance will be considered ‘willful’ in many cases. This is the reason they have asked the Justice Department to participate in the enforcement of criminal prosecution relative to their audits and investigative findings. Maybe the most damaging m y t h i s t h a t H I PA A compliance is accomplished in your office as long as you have ‘some kind’ of release form to be signed prior to releasing patient records and you don’t leave patient information (like patient charts) laying around the office or you have an EMR s y s t e m t h a t i s H I PA A compliant, etc.- nothing could be further from the truth! There is no way in an article to teach and train what it takes to make an office compliant. (It can at least be stated that there are eight required release forms you must have in your compliance manual–just one small fact known by few).
This was further confirmed for us this year during our time teaching HIPAA compliance for license renewal at the Minnesota Chiropractic Convention. Most disturbing is what my partner, Martha McKinney C . P. O . d i s c o v e r e d a n d realized–clinics are not aware of the new dangers posed by regulatory agencies and the need to protect themselves– NOW! In a past life Martha was a senior medical claims auditor for a major insurance company. She is still on those audit committees and has most recently been through the training for the most recent round of nationwide audits being launched by Medicare and the O.I.G. (the Office of the Inspector General (O.I.G.) is the enforcement arm for HIPAA and MEDICARE and they have now stated, to the auditors, that “when you find a problem in one area, check out the other”).
Think of it this way: It takes eight forms to fulfill the requirement of one ‘chapter’ of your compliance manual and there are about a dozen critical ‘chapters’ you need to have in your manual–each with requirements you must meet!
These trainings are taught by Medicare, the Justice Department and O.I.G. officials. She has already been called upon, as a senior auditor, for opinions relative to the new round of audits and knows of chiropractors in Texas who have been fined, reported, denied future payments and have had repayment demands issued.
Lack of knowledge is rampant in the chiropractic profession.
What she is learning is very, very concerning for our
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profession. We are officially a target of both HIPAA and Medicare, along with certain other specialists. New Medicare laws, such as the mandate that YOU must find your own billing errors and RETURN THE MONEY PA I D TO Y O U B Y MEDICARE, IN ERROR, WITHIN 60 DAYS or you have the potential of being charged with fraudulent billing, makes it that much easier to levy fines, report you to the board and /or charge you criminally. (This is mainly concerning chiropractors continuing to bill for adjustments after they have become ‘maintenance’ adjustments, per Medicare definition of maintenance– not your definition–and then failing to issue and ABN correctly and alter your billing coding correctly and therefore receiving money you are not entitled to under the Medicare system). Here are samples of other issues doctors did not realize: This year CHIROPRACTORS (ALONG WITH A FEW OTHER GROUPS) HAVE BEEN TARGETED BY NEW FEDERAL TASK FORCES of a u d i t o r s f o r H I PA A a n d Medicare compliance. As recently as May 2, 2012 task forces seized documents, filed charges against 107 suspects and suspended payments to 52 providers–in one day–across the U.S.A.
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There are required clinical fi l e a n d d e n i e d c l a i m s audits that must be performed by your office, documented and official corrective actions documented and followed through on a yearly basis.
HIPAA compliant that has nothing to do with all the other areas of required compliance listed above…Along with many others. The reality
There are basic required forms with required language that must be stored within y o u r H I PA A c o m p l i a n c e manual.
This is all happening because Medicare and HIPAA have been criticized for not finding and stopping those who are breaking the rules, thus allowing billions of dollars in fraud to continue.
That privacy policies should no longer be posted on the wall and given to each patient and this has been replaced by a new required procedure. That you must document follow up dates for certain HIPAA activities and they must be recorded in your compliance manual.
We have been telling everyone ‘this day is coming’ and that chiropractors ARE a target. This is very lucrative for the Medicare program. This most recent raid will net up to $450,000,000.000 dollars!
When and how to CORRECTLY use and audit ABN forms. That you must conduct and document HIPAA training and attendance of all team members yearly (plus there are required topics you must cover in that training). That there is an official process and there are required forms for naming your compliance officer and demanding confidentiality from outside vendors… That you must have a compliance manual with the proper headings in the index to assure the proper content. That just because a new EMR software system says it is 13
Health and Human services (the umbrella over the OIG) is touting a new data system aimed at allowing authorities to spot billing and documentation trends more quickly. They stated they have quadrupled the number of strike teams around the country. You need to get your internal H I PA A a n d M e d i c a r e programs in place ASAP! Update them and improve them with official, documented and recorded corrective actions stored in your compliance manual and stay vigilant. Document the changes you make, as they are your best chance of escaping fines and charges! Remember, if they come to your clinic, they can do so Texas Journal of Chiropractic
WITHOUT warning and their first demand will likely be for you to produce your compliance manual!
done for the last several years and they are out to STOP chiropractors from ignoring HIPAA rules.
No one can be 100% compliant and therefore safe, so, it is even more critical to do all you can to avoid fines and criminal charges. Effort goes a long way to avoiding fines and charges as this program was originally designed so doctors could police themselves. Showing you have documentation to prove you have been doing so can go a long way.
What can you do?
When deficiencies are found and there is no reasonable written and signed documentation of efforts being made to correct them, on a continuous basis, you are a sitting duck! With multiple improvement policies in place there is a MUCH better chance you will be informed of required changes and given a chance to comply verses being fined the new minimum $50,000 (up to $250,000) or charged with fraud. Solutions: You can never be 100% compliant, so it is even more critical you do all you can. Due to the complexity and changes relative to HIPAA compliance, we recommend you get assistance. In our opinion it is now too risky to guess and a bad idea to go into denial… that worked in the past, but it is exactly what the HIPAA regulators are now saying our profession has Texas Journal of Chiropractic
Get help! There are seminars, there is license renewal and there are resources. Make sure the information is up to date and complete. It is TOO RISKY to just figure it out on your own and hope you have the bases covered in today’s environment and it does NOT take a full time c o m p l i a n c e o f fi c e r t o accomplish this. A staff person can easily add the majority of the ongoing needed activity to their job description. There a few good choices. As the doctor, clinic owner, compliance officer or office manager you have access to the information within the office needed to: Assist professionals who can come on site and put your program together for you. For many clinics this is preferable as it saves many hours of staff and doctor time that can be used for practice development activities and patient care. Or Follow direction from a complete training series and for all practical purposes ‘Do it yourself’. This is less expensive and can be done at your own pace. 14
TCA Members obtain your CE hours online at www.ChiroCredit .com/tca and 25% will go to support the TCA.
Or Competently identify the areas in which you are deficient and get only the training you need to improve your weak areas. This is helpful for clinics that truly know all the requirements and what is current, but still need help in one or two areas. It can be a big task to get a comprehensive program in place, but once established it should only take three or four hours per quarter of the year to keep it current. You can find information relative to options at www.hipaacomplianceservice s.com One thing we will offer to TCA members is a free review to a s c e r t a i n y o u r H I PA A compliance score. We will leave this offer in place until we are unable to handle the volume. What is a good starting place? Schedule a time to get your free HIPAA Compliance Score at: www. www.chirotexas.org
The 2012 TCA Convention saw the unveiling of a new Chiropractic Development Initiative. The CDI saw not only the unveiling of the new initiative, but also the unveiling of a new feature film documentary Medical Inc. Tens of thousands of dollars were raised and pledged during the unveiling.
Many doctors, schools, organizations, family members, and others donated or pledged funds for the defense and development of the chiropractic profession from assault in Texas. CLICK HERE TO DONATE. Contributions to the CDI resulted in smiling faces all around.
New TCA Board Members were sworn into office
TCA staff member Amy Archer reports office status to the board of directors
Dr. John Nash presented information for Recycled Baseball Items for military oversees
hipaacomplianceservices. com , while they last.
What if everything you know about your health was bought and paid for?
Click on a-la-carte on the home page. This will take you to explanations of the major components of a compliance system and help you determine your individual needs.
Medical Inc. is a theatrical documentary exposing the modern medical monopoly. Learn more about the movie at this link: Medical Inc.
Ask to be put on a free HIPAA update list by requesting it at the website contact page. Be safe, stay in practice, heal the world. Ty Talcott D.C. is the C.E.O. of HIPAA Compliance Services. He has been consulting, relative to developing chiropractic business practices for many years and is now assisting in protecting the profession from regulatory risk. Martha McKinney is C.O.O. of HIPAA Compliance Services. She has been assisting chiropractors relative to their business development for nearly a decade and has a background rich in claims review, auditing, Medicare and HIPAA compliance as well as being a feasibility expert relative to integration of physical medicine into hospital settings. You can follow them on Facebook, Twitter, LinkedIn or check out their blog at www.hipaacomplianceservices.com
Medical Inc. The Movie www.chirotexas.org
The movie producer presented excerpts from the movie at the TCA Convention and received a standing ovation, and received hugs from the audience for “finally presenting our story in a truthful way.” Says the Medical Inc. producer: “It was great to be with all of you at the TCA’s 2012 Annual Convention, it was an honor to share a little about the film Medical Inc. which will be released later this summer. Texas has been good to us and this project, a measurable percentage of the footage we have shot comes from the great state of Texas. We are excited to share this film with the world, and all the incredible things that chiropractic is doing in your great state.” “As was mentioned when Jeff Hays spoke, we have set up www.supportchiromovie.com as a destination to provide your support to the film and claim your own signed copy of the DVD among other great rewards. This has also been a powerful tool to easily share and spread the word for the project with everyone that is passionate or is affected by 16
this message, so please pass it on.” “We would love for you to join us and stand up in support of this effort.” “We cannot wait for everyone to see what we have here, we are committed to blow everyone away with a film worthy of your support. Movie trailers represent a collection of a handful of the 80 plus interviews shot so far that our editing team put together.” “Pease consider supporting us by purchasing a copy for yourself, or 5 copies for $100; for those that really want to share the film and feel they can get 100 copies out, please consider stepping up at $1000 and make a huge difference.” Thank you all! The Medical Inc. Team
National Certification for Chiropractic Assistants Dynamic Chiropractic reports that at “the Federation of Chiropractic Licensing Board’s (FCLB) 86th Annual Education Congress in San Antonio, Texas this year … the FCLB was announcing an important new educational initiative – a
Texas Journal of Chiropractic
national certification program for chiropractic assistants …” “The program is designed for CAs who provide or assist patients with their physical therapy. It will certify that they are adequately trained and award them the title “Certified Clinical Chiropractic Assistant” (CCCA) or “triple CA.” “According to Donna Liewer, FCLB president, the organization decided to take action after hearing that a number of major insurance carriers were deliberating whether they would continue to reimburse chiropractors for services provided by unregistered assistants. Insurance carriers answer to underwriters or accreditors, who demand they require anyone touching a patient to be credentialed.” “The FCLB suggested a program of certification or registration rather than full licensure, which would have required that each state open their regulations to the legislative process and possibly take years to accomplish. If that had happened, doctors would have been faced with the dilemma of providing therapy without an assistant, providing therapy without insurance reimbursement, or eliminating the provision of therapy altogether.”
postgraduate departments, experts from the field and regulators from states with existing programs. It is also drafting sample language to help states create their regulations.” “The NBCE has the expertise and credentials to satisfy accreditors. Its online test will be ready this fall, and in the meantime, a number of online education providers are gearing up to deliver the training. The training and exam will consist of four primary subjects: foundational knowledge, patient safety procedures, documentation, and boundaries / ethics.”
Smart Training Addresses Needs of HB 300
“The FCLB didn’t create the CCCA program on its own; it enlisted the help of college
Texas health care providers must comply with a new health care privacy law that requires an update to policies and procedures, Notice of Privacy Practices, and employee training and the deadline will soon be upon us–September 2012. TCA is in the process of providing access to such training at a discount. More information will be made available shortly, but here are some of the things that you need to know about HB 300. Texas House Bill 300 (HB 300) mandates new patient privacy protections and
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harsher penalties for privacy violations related to electronic health records (EHR). The requirements of the Texas law are more stringent than those of its federal counterpart, the Health Insurance Portability and Accountability Act (“HIPAA”). Under the Texas law health care entities must provide customized employee training regarding the maintenance and protection of electronic protected health information (PHI). Covered entities are required to tailor the employee training to reflect the nature of the covered entity’s operations and each employee’s scope of employment as they relate to the maintenance and protection of PHI. New employees must complete the training within 60 days of hire and all employees must complete training at least once every two years. Covered entities must maintain training attendance records for all employees. T h e Te x a s l a w r e q u i r e s covered entities to provide patients with electronic copies of their EHR within fifteen days of the patient’s written request for the records. This provision of the Texas law reduces the time frame a covered entity has to produce EHR following a patient’s request from thirty days under HIPAA. www.chirotexas.org
Convention saw new officers interesting seminars, new vendors and lots of gratitude for the soon to be released movie Medical Inc.
www.chirotexas.org
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Texas Journal of Chiropractic
Dr. Tyce Hergert was named Young Chiropractor of the year.
Dr. Jeff Brown Received both the President’s Award and the Director’s Award -->
Dr. Curtis McCubbin Presents the Keeler Committee’s donation to the CDI
Good Food, Good Fellowship, Good times were the order of the day
Dr. John Nash received the Keeler Award
The law charges the Texas Health and Human Services Commission with establishing a standard format for releasing patient EHR that is consistent with federal laws.
marks and you don’t need “www.” either. Just type journal.chirotexas.org into your web browser and you will be at the new Texas Journal of Chiropractic, Online.
The new law contains severe civil penalties for violations of the law. Penalties can range from $5,000 up to $1.5 million per year for unlawful disclosure of a patient’s PHI. These penalties are in addition to the similar penalties that can be assessed by HHS under HITECH, so a covered entity could be facing fines up to $3 million per year for the same violations under state and federal law.
Not only is this new format easier to access, but it is easier and more powerful. Currently we are syndicating news from a dozen different sources, publishing multiple news stories per day. Check journal.chirotexas.org for the latest in current events of interest to the chiropractic profession.
The law is effective September 1, 2012. Texas health care entities should be aware of the new law and its requirements, which are more expansive than HIPAA or HITECH.
Journal.chirotexas .org T h e Te x a s C h i r o p r a c t i c Association implemented an updated, more streamlined and easier to access online news Journal. T h e Te x a s J o u r n a l o f Chiropractic can now be reached by going to “journal.chirotexas.org.” You don’t need the quotation www.chirotexas.org
Here you will find articles from the New York Times, the ACA, the AMA, MedPageToday, and Health and Wellness features from multiple s o u r c e s . We w i l l a d d additional sources as they become available. Each day there will be numerous new posts from the various sources of interest to the chiropractic profession in Texas. Stop here first and you’ll be able to catch up on the health and professional news you need. There are a dozen different categories of news from which you may choose. The latest postings are always on the front page, easy to see. If you want to check out some of the older postings, just check out the categories: • Association news (news from Texas and national chiropractic 20
associations, the AMA, and other associations); •
Notable News (stories to take note of);
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News (other news);
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Legislative (state political news and information);
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Federal Health Reform;
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Federal and
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State Government news;
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Chiropractic College News;
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Clinical news;
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Opinions editorials;
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Health & Wellness (news for everybody, n o t j u s t s c i e n t i fi c professionals); and
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Business News.
and
In upcoming months TCA will also be publishing a new association website based on similar technology so watch for regular changes in the coming months, this is but the first step!
Texas Journal of Chiropractic
Doing the Right Thing the Wrong Way Can Cost You By Dr. R. A. FOXWORTH, D.C., FICC, MCSP
Doing the Right Thing the Wrong Way Can Cost You? Yes, I know. Sounds strange doesn’t it? Strange as it sounds, it is far too familiar to those of us who work with doctors on a daily basis to help improve their documentation, billing coding and collections. We see examples of doing the right thing the wrong way every day in chiropractic clinics across the nation. It happens when doctors attempt to do the right thing in helping patients with no insurance or limited benefits by “tweaking” their documentation and coding to result in an overall lesser charge for the patient. Be honest. Have you ever had a patient that required more than a routine workup but you used a lower level exam code because you knew they had no insurance coverage? Perhaps a 99202 instead of a 99203? No big deal right? WRONG! Or, as long as we are being honest, have you had a patient that you adjusted full spine, 4-5 levels, and you only charged a 98940 for 1-2 levels? No big deal right? WRONG! Texas Journal of Chiropractic
Ok, let’s try one more. How about this scenario? Have you ever had a Medicare patient that required a detailed workup and x-rays and you charged a lower level exam code or just billed for 2 x-rays when you actually performed 4, because you know Medicare doesn’t cover your exams or x-rays? No big deal right? WRONG! All of these are examples of down coding your services in an attempt to strike a balance between what insurance coverage may allow and what you feel your cash or underinsured patients can afford. We all know if you don’t perform a service you should not bill for it…it is called fraud. However, few may be aware that if you DON’T report what you did and DON’T charge for services you would normally bill to insurance because you are seeing a cash patient, there is also the potential for fraud because of a dual standard of care and a potential dual fee schedule. Not to mention, down coding or failure to bill Medicare patients can be considered an inducement and subject to serious fines and penalties according to the Office of Inspector General and CMS. The bottom line is that down coding can be perceived as illegal and inappropriate just as up coding is when it is used to allow you to bill differently based on whether 21
the patient is insured or a cash patient. It is “gaming” the system pure and simple. It is doing the right thing to help the patient, but it is being done the wrong way and it can cost you. What drives doctors to down coding or not charging for all their services? It’s really quite simple. There is the need to maximize reimbursements by billing your UCR fees or contract rates to insurance companies, but you haven’t found a good way to make care as affordable as you would like for your cash and underinsured patients. So the only tool you have is to “tweak” the documentation, coding or billing to allow you to do what you would like to do. It really is that simple, but it can REALLY be very costly if you are audited! So how can you document as you should, bill as you should and code properly for maximum reimbursement when there is insurance available and still be able to help the cash patients? You MUST join and encourage your patients to join a cash discount program. It really is one of the most logical, legal, and ethical ways to allow you to accept a lower fee than your normal UCR clinic fees. It allows you do what you are attempting to do now…help the cash or underinsured. But, with a network contract, you can do it without “tweaking” your www.chirotexas.org
documentation, coding and billing and you avoid running afoul of dual fee schedules or illegal inducements. So, do the right thing! Document properly. Code properly. Bill properly. And, consider joining one of the cash discount plans that allow you to “contract” with cash and underinsured patients. The contract model is not new. The contract model is what allows you to contract with multiple insurance companies for different rates for the same codes without it being considered a “dual fee schedule”. Cash discount plans simply provide you the protection of a “contract” and allow you to document, code and bill properly and still pass on some savings to your cash and underinsured patients. If you are documenting properly, coding properly and billing properly, good for you! Just make sure you don’t do the right thing the wrong way by trying to use a “bookkeeping reduction” or Time of Service discount that can be open to interpretation as to what is a “reasonable” discount. Far too many clinics use these tactics or strategies improperly in trying to help cash and underinsured patients.
hesitate to join these to save money! A good cash discount plan solves so many of the potential problems for you and really helps the patient…the RIGHT WAY! THE MAIN THING IS…. Doing NOTHING is not an option! Dr. Foxworth is a certified Medical Compliance Specialist and President of ChiroHealthUSA. A practicing Chiropractor, he remains “in the trenches” facing challenges with billing, coding, documentation and compliance. Dr. Foxworth is a 1984 Honors Graduate, (Cum Laude), of Cleveland Chiropractic College in Kansas City, MO. He served as Staff Chiropractor for the G.V. Sonny Montgomery VA Medical Center for 4 years and is a member of the American Chiropractic Association and a 3 term past-president of the Mississippi Chiropractic Association. He was voted by his peers as Chiropractor of the Year for several years and is currently a Fellow of the International College of Chiropractic. He was appointed to the Mississippi State Board of Health by Governor Kirk Fordice and again by Governor Ronnie Musgrove and served 12 years, two of them as Chairman. Dr. Foxworth can be contacted through w w w. c h i r o h e a l t h u s a . c o m , info@chirohealthusa.com, and 1-888-719-9990
The court began its session much as it always does. At 10 a.m. sharp, the marshal’s familiar cry of “Oyez! Oyez! Oyez!” rang out as the nine justices entered through heavy scarlet drapes and took their seats at the tall mahogany bench. The looks on their faces gave nothing away. As he took a seat, Chief Justice Roberts smiled slightly in the direction of the justices’ guest seats, where his wife, Jane, was sitting. As he and other justices read statements, it became obvious that Roberts, appointed by Republican President George W. Bush in 2005, had been the crucial vote upholding Obama’s law. Roberts showed he had taken control over a divided bench. He highlighted flaws in the administration’s arguments and stressed the majority was not commenting on the wisdom of the law. Rather, he said, if it could be upheld, the court must uphold it. He said it was not the job of the judiciary “to save” the
Most all patients are familiar with “buying clubs” like Sam’s Club and networks. Experience shows they don’t www.chirotexas.org
Supreme Court Upholds Obama’s Healthcare Law
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nation from policy choices made by elected legislators.
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As he read excerpts from the momentous decision Thursday, Roberts seemed to downplay the drama of the morning. His voice was steady and even. He kept to his script. There were few rhetorical flourishes. He occasionally looked out at the spectators. Among them was Justice John Paul Stevens, a liberal who had served with Roberts until he retired two years ago at the age of 90.
ACA President’s Report–June/July
Following the usual decorum in the white-marble and crimson-draped room, the nearly 300 people listening to the chief justice gave no audible response. Roberts then named the justices who had joined him in various parts of the decision, and those who had not. All told, it took about 20 minutes.
The Chiropractic Summit began in 2007. It was created based on an idea by then ACA Chairman Dr. Lewis Bazakos. Since its inception, the Summit has met 15 times and has grown from 13 members to more than 40. The purpose of the Summit is to work toward five goals on behalf of the chiropractic profession.
Romney and the Republicans had hoped the Supreme Court would gut the law. Deprived of that outcome, they can now continue pressing the attack on Obama on the campaign trail, but their hopes for a rollback or repeal will hang on legislation, unlikely before the elections, and on the voting public, whose views are mixed. “What the court did today was say that Obamacare does not violate the Constitution,” Romney said. “What they did not do is say that Obamacare is good law, or good policy.” Texas Journal of Chiropractic
The following is a compilation of the President’s Report from ACA President, Keith Overland D.C. Chiropractic Summit, Sports Chiropractic; National Health Reform; Give our Veterans a Hand Chiropractic Summit
Those goals are: •
Parity for chiropractic physicians in national health care reform and Medicare reform initiatives
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Increased practice satisfaction and selfesteem for doctors of chiropractic (DCs)
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Collaboration and grassroots mobilization across the profession
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Anti-discrimination/fair reimbursement 23
Public relations: “telling the chiropractic story” and promoting the brand while building cultural authority
The Summit’s steering committee is made up of ACA, ACC, COCSA and ICA. We discuss the best ways for the Summit to continue to help the profession achieve its goals. There is very high agreement within the profession on all five goals, and the committee believes that the Summit can and should cross organizational boundaries to help achieve them. It is my opinion that the Summit has the leverage to do something important for the profession, and that the profession is begging for something important to be done! ACA Considers its Agenda T h e A C A’s B o a r d o f Governors met recently for its midyear meeting. As one would expect, the agenda was jam-packed with issues ranging from budgets to planning. ACA Chairman Dr. Michael Simone led the meeting over a day and a half. Some of the top areas discussed were: •
All legislative initiatives
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Third-party payer insurance issues
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Next steps regarding the Medicare demonstration project www.chirotexas.org
More Convention fun!
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R i g h t - s i z i n g A C A’ s physical office space
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Development of a planning meeting to discuss ACA’s 10-year plan
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M e m b e r s h i p d e v e l o p m e n t opportunities
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Contemporary communications vehicles
that we were beginning to lay the foundation of a bridge to the future. Additionally, there were three moments that I will remember for quite some time: • •
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Updating ACA’s policy on DCs as c o n s e r v a t i v e physicians
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ACA 50th anniversary celebration
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Policies regarding intraand interprofessional relationships
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A p p r o v a l o f t h e 2012-2013 budget, which now goes to the House of Delegate for consideration
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Detailed plans for online, video web collaboration for ACA meetings
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Class action litigation that ACA is involved in
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ACA’s online store and corporate partnerships
At the end of the meetings there was an air of excitement, a palpable sense of opportunity and a feeling www.chirotexas.org
A tribute to our past C h a i r m a n D r. B o b Mastronardi Passing a budget with a surplus A realization that we have seen successes from across the full spectrum of our efforts thanks to the incredibly hard work of a staff of 35 and a volunteer pool of almost 300
To see a recap of ACA’s hard work from last year, please take a look at the recently released 2011 Annual Report online. Sports Chiropractic Dr. Spencer Baron has been a leader in sports chiropractic for many years, and those of us at the 2012 National Chiropractic Legislative Conference had the opportunity to hear him speak in-person. Dr. Baron recently shared some very cool statistics with me about DC’s who work with professional sports teams: •
In the National Football League, 97 percent of teams have worked with DCs (in other words, 31 of 32 teams have a DC referral) 26
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In Major League Baseball, 88 percent of teams work with DCs (28 of 32 teams have DCs)
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In the National Hockey League, approximately 50 percent of teams, or more, work with DCs
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In the National Basketball Association, approximately 60 percent of teams, or more, work with DCs
National Health Reform Regardless of what happens in the months leading up to the November elections, please be aware that ACA will need your help more than ever. ACA and its Chiropractic Summit partners are preparing for any and all eventualities in the Health Reform decision. From our perspective this is not a “red” or “blue” issue; this is an issue about patient choice and patient rights. We cannot stand for the continuation of a health delivery system that has been failing for decades. We have example after example of the poor polices third-party payers and political medicine have made when they are given too much control. It is now time for patients to take the reins of their own health care, so that they are able to make well-informed health care decisions based Texas Journal of Chiropractic
on the best evidence regarding cost effectiveness, safety and patient satisfaction. It’s time to tear down the artificial barriers that prevent patients from choosing a DC. TCA Gavel Club Yet it seems a level playing field for health care providers is just not what political medicine wants. Here is a paragraph from a policy adopted by the American Medical Association’s (AMA) House of Delegates just a few weeks ago: “Our AMA will work to repeal the new Public Health Service Act Section 2706, so called provider ‘Non-Discrimination in Health Care,’ as enacted in PPACA, through active direct and grassroots lobbying of and formal AMA written communications and/or comment letters to the Secretary of Health and Human Services and Congressional leaders and the chairs and ranking members of the House Ways and Means and Energy and Commerce and Senate Finance Committees.” Remember, the National Association of Chiropractic Attorneys called Section 2706 one of the most important pieces of legislation for the profession and its patients in the last 50 years. I’ve always wondered what some within organized medicine are so afraid of, and this week I was reminded of a study by Liberty Mutual’s Center for Disability Research that I think answers the question. It found that workers Texas Journal of Chiropractic
with disabling low-back pain who are treated by physical therapists or MDs may have a harder time permanently returning to work than those treated by DCs or those who receive no treatment at all. Chiropractic physicians clearly offer a better option for patients. Our care is safer, more cost effective, offers high patient satisfaction, and research now shows we prevent reoccurrence in workers’ injuries. Please take time in the next few weeks to make an appointment with congressional candidates in your area. Invite them to have coffee. Go to a fundraiser. Let them know you represent hundreds if not thousands of patients. Talk to them about the facts ACA has shared with y o u f o r m o n t h s n o w, particularly the cost effectiveness studies. Explain that it is time for provider discrimination to come to an end and that patients must be given equal access to all appropriate, evidence-based providers. Our economy, our health care system and most of all our patients deserve no less. This past weekend, many within ACA’s leadership were on the road again. ACA Chairman Dr. Michael Simone attended a meeting hosted by the Arizona Association of Chiropractic. Vice President D r. A n t h o n y H a m m w a s recognized with a presidential award at National University of Health Sciences’ H o m e c o m i n g e v e n t . D r. 27
Richard Bruns and ACA Immediate Past President Dr. Rick McMichael attended a board meeting at Logan College of Chiropractic/ University Programs, and I divided my attention between two meetings that were happening simultaneously. First, I Skyped into the California Chiropractic Association’s Board of Directors meeting, and five minutes later I addressed a room full of doctors at a Pennsylvania Chiropractic Association meeting. Additionally, I had the honor of speaking at the Pennsylvania Association’s presidential banquet and at a private meeting of its board of directors. As ACA’s leadership visits associations around the country, we hope to remind both the doctors in attendance and the association’s leadership that ACA is their partner. We can do far more together than we can do alone. Please consider supporting our CHAMP advocacy fund with even a small monthly contribution. In addition, with our pending lawsuits against several insurance giants, the NCLAF legal fund could use your support, as well. Every contribution helps; and there is always a need for every DC to join ACA so that the rest of us are not carrying their weight. Please take the time to talk to your non-member colleagues www.chirotexas.org
TCA Past President’s Luncheon
TCA Executive Officers
TCA Dept. Coordinators
about becoming ACA members. Tell them about ACA’s numerous member benefits. They will be glad they joined. Give Our Veterans a Hand I also want to make you aware of a very interesting program run by the Congress of Chiropractic State Associations (COCSA). It’s called “Healing Hands 4 Heroes.” This endeavor started to help our nation’s military heroes in all branches of service, including active duty, reserve, guard, veterans, retired and family members. It is very exciting. COCSA is a vital organization in the profession. For more than 30 years it has provided invaluable information sharing opportunities for state a s s o c i a t i o n s . C O C S A’ s mission is to provide an open, nonpartisan forum for the advancement of the chiropractic profession through service to member state associations. The American Chiropractic Association (ACA) remains committed to advocating for the rights of patients to choose the provider and treatments they feel are best suited for them, following the Supreme Court’s decision today upholding the constitutionality of the Patient Protection and Affordable Care Act (PPACA). Allowing patients to choose providers who offer less expensive, conservative treatments is one important way to both reduce health care costs and www.chirotexas.org
address the growing primary care shortage in this country. In respect to patient choice, today’s decision means that the provider nondiscrimination provision within PPACA remains intact. This part of the law makes it illegal for health plans and insurers to discriminate against health care providers based solely on their license. For patients, this means they can visit the provider of their choice for the type of treatment they desire, as long as the service is covered by their health plan. Patients are becoming more aware of the downsides of over reliance on prescription drugs and the premature use of surgery for common health conditions such as low-back pain. These treatments also come with high price tags. For example, many patients prefer to utilize doctors of chiropractic (DCs), who offer drug-free, non-surgical options. Further, the services provided by DCs have been proven to be effective and less costly than traditional medical care. Ensuring provider choice can also help the country address the growing shortage of primary care physicians. According to the Association of American Medical Colleges, by 2015 the U.S. will face a shortage of more than 60,000 physicians across primary care, surgical and medical specialties. To meet the needs of the public, every qualified health care provider will have 29
to practice to the fullest extent of his or her scope of practice. Enabling patients to seek primary care services from doctors of chiropractic and other non-MD/DO providers who are qualified to provide these services will help take some of the strain off the health care system. “As our nation continues in its quest to improve the health care system, it will need to look at options outside the status quo,” said ACA President Keith Overland, DC. “Doctors of chiropractic can provide conservative primary care that saves money. ACA will continue to work with legislators to ensure that health reform is implemented in a responsible way that removes artificial barriers to patients’ choices.” The American Chiropractic Association (ACA), based in Arlington, Va., is the largest professional association in the United States representing doctors of chiropractic. ACA promotes the highest standards of patient care and ethics, and supports research that contributes to the health and well-being of millions of chiropractic patients. Visit www.acatoday.org
We invite you to join with the chiropractic professionals of Texas to insure that chiropractic care remains available to all Texans. Texas Journal of Chiropractic
The Association of Chiropractic professionals in Texas
The Texas Chiropractic 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.
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