Texas Journal of Chiropractic November/December 2012
“We hold that the statute does not prohibit a chiropractor from examining parts of the body other than the spine and musculoskeletal system if such an examination will assist in analyzing or evaluating the biomechanical condition of the spine or musculoskeletal system.� --Page 10
In This Issue: 2013 Strategic Plan Legislative Team Update TCA Action Reports Health Care News Original Articles College Reports Important Reminders Volume XXVII, Issue 6
LOOK! 2013 MIDWINTER CONFERENCE IS IN LUBBOCK!
The Texas Chiropractic Association represents chiropractic professionals throughout the state. TCA serves to protect chiropractic professionals, their patients, and the right for Texans to choose chiropractic as one of their health care options. First formed in 1916, this historic association has existed for nearly 100 years representing the interests of Texans who desire safe and effective health care from chiropractic professionals. ABOUT OUR COVER The winter Holidays are upon us and so is the Texas legislative session. Enjoy this peaceful and quiet scene before the chaos and hectic season sets upon us. Soon it will be time for New Year’s Resolutions. Fortunately TCA has been planning their upcoming year, and beyond, for months now. Read more in this issue.
POLICIES Annual subscription to the Texas Journal of Chiropractic is included in TCA membership dues. The digital Texas Journal of Chiropractic is regularly published 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.
Mid Winter Conference
FAX512.477.9296 REGISTER ONLINEwww.chirotexas.org MAIL1122 Colorado St. Ste. 307, Aus n, TX 78701
Registra on Applica on February 22-24, 2013
Please type or print clearly. Please use one form per doctor.
Doctor’s Name ___________________________________________________ License # ________________ Spouse/Guest’s name ________________________________ CA Name _____________________________ Mailing Address _____________________________________ City/State/Zip _________________________ Phone ______________________ Fax ______________________ email _____________________________ Registra on includes 4 TBCE required hours of Con nuing Educa on, con nental breakfast and refreshment breaks. Early Registra on—by January 31
Late & On-Site Registra on—a er January 31
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Texas Chiroprac c Associa on Membership Applica on
Mail: 1122 Colorado Street, Suite 307, Aus n, Texas 78701 Fax: 512.477.9296 Email: info@chirotexas.org More Info: 512.477.9292 Online: www.chirotexas.org *** Please Print *** *** Please Print ***
Date: __________________ Male Female
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Please designate which is your primary address by checking the box next to it.
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By signing below, I agree to abide by the bylaws of TCA, strive to a end associa on conven ons, take part in district mee ngs, and promptly inform the associa on of changes in above informa on.
Signature: _______________________________________________________________________________________________ Date: ___________________________________
Regular -- $44 monthly / $132 quarterly / $528 annually Spouse -- $24 monthly / $72 quarterly / $288 annually Re red/Disabled -- $60 annually Out of State (with TX License) -- $60 annually Associate Educator -- $60 annually Student - Free New Licensee -- Free un l next annual billing cycle* 2nd Year Licensee -- $11 monthly / $33 quarterly /$132 annually 3rd Year Licensee -- $22 monthly / $66 quarterly / $264 annually
MEMBER DIRECTORY Please designate which way you would like to receive your member directory:
___ Hard Copy ___ Electronically (on www.chirotexas.org)
NOTE: Dues payments and various fund contribu ons may or may not be tax deduc ble as ordinary and necessary business expenses. Only a licensed Cer fied Public Accountant can advise you. Personal and Corporate checks are acceptable. PAYMENTS AND CONTRIBUTIONS ARE NOT DEDUCTIBLE AS CHARITABLE EXPENSES. To the extent that TCA engages in lobbying, a por on of dues is NOT deduc ble as an ordinary and necessary business expense. The deduc ble por on of dues is 48% TCA PAC Contribu ons are NOT deduc ble and cannot be made with corporate checks other *Some New Licensees may receive extra months depending on license date than from P.C.s.
————————————————————————————–- PAYMENT ————————————————————————————
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AUTHORIZATION AGREEMENT FOR PREARRANGED PAYMENTS (DEBITS) I (We) authorize the Texas Chiropractic Association, hereinafter called Company, to initiate debit entries to my credit card or bank account indicated below for $________ once [ Automatically charge my account, check one: per month per quarter per year ] AUTHORIZED SIGNATURE: ________________________________________________________________ PRINT NAME ON CREDIT CARD: ____________________________________________________________ CREDIT CARD NUMBER: ______________________________________________________________________ EXPIRES: ______________________ BILLING ADDRESS: ______________________________________________________________________________________________________________ CITY: _____________________________________ STATE: _________ ZIP: _______________ PHONE: __________________________________________ OR BANK NAME: __________________________________________________ CITY: _____________________________________________ STATE: ________ BANK TRANSIT / ABA NO. : ______________________________________ ACCOUNT NUMBER: _______________________________________________
THIS AUTHORITY MAY BE TERMINATED UPON THIRTY DAYS’ WRITTEN NOTIFICATION OF ITS TERMINATION FROM ME (OR EITHER OF US) TO TCA. A customer has the right to stop payment of a debit entry by notification to BANK or CREDIT CARD prior to the charging account. If an erroneous debit entry is initiated by Company to a customer’s account, customer shall have the right to have the amount of such entry credited to such statement of account or a written notice pertaining to such entry, the customer shall have sent to BANK or CREDIT CARD a written notice identifying such entry, state in that such entry was in error and requesting BANK or CREDIT CARD the amount thereof to such account.
Texas Journal of Chiropractic Volume XXVII, Issue 6
Inside
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 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. Thomas Hollingsworth D.C.
November/December 2012
Where do we Go From Here? 3 TCA Legislative Report 5 TCA Makes Formal Request of Medicaid 7 TCA Insurance Relations Reports: 8 TCA Reports 8 Congratulations TBCE! 10 ACA Presses HHS on Non-Discrimination 11 Meet our Affiliate Members 11 Do You Dread New Medicare Patients? 12 Customer Service for Chiropractic Business Success 13 Footlevelers Continues to Support COCSA’s Mission 15 ACA Vision for the Future 15 510 Sick and 36 Dead--Fungal Meningitis 17 Reassessing Flu Shots 20 Groupon-like Marketing Raises Questions 22 HHS Proposes Rules on Key Parts of ACA 22 Novitas and Trailblazer Switch 23 College News 24-31 IMPORTANT REMINDERS 31
Policies
Helping Chiropractors Help People
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
The team spent time determining the organization’s core ideology. Core ideology describes an organization’s consistent identity regardless of changes related to its environment. Core ideology consists of two elements: core purpose--the organization’s reason for being; and core values--essential and enduring principles that guide the behavior of an organization.
Where Do We Go From Here? 2013 and Beyond The traditional time for reflection on the year past and upon the upcoming new year is upon us. The Texas Chiropractic Association, for some months, has been considering such plans and is putting the finishing touches on its strategic plan.
TCA’s Core Purpose On October 5 and 6, 2012, a strategic planning group consisting of the board and senior staff of the Texas Chiropractic Association (TCA) met to update its long-range strategic direction. Bud Crouch, a principal consultant of Tecker International, LLC and president of Innovations Plus, led the group through the planning process.
The core purpose of the Texas Chiropractic Association, our reason for being, is to help chiropractors help people. TCA’s Core Values We believe in:
The purpose for creating the strategic planning document is to define a clear strategic direction for the TCA and to determine a consensus of what will constitute success in the organization’s future. The strategic plan seeks to answer two fundamental strategic questions: Why will the TCA exist in the future? Thus defining its reason for being and its core purpose; and where is the TCA going? Thus determining its future direction and goals. The strategic direction represents a compass that will be used to guide and focus TCA’s future strategic decision-making and ongoing operational work. The team determined what the organization is not doing today, but must engage in to be successful in the future. This strategic plan is not about “business as usual,” but rather about the change that is necessary to stay relevant.
Representation for ALL chiropractors;
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The patient’s right to access chiropractic care;
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Open communication with our members;
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Taking a team approach;
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Enthusiasm and passion for the profession;
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Constantly striving to be better;
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Being visionary for the future;
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Integrity.
These strategic beliefs and visions will serve to guide the actions and plans of the TCA in the coming years.
One of the challenges that TCA faces is the fact that there is more that it COULD do than it has the resources to accomplish. The temptation to try do everything can lead an organization to attempt to be all things to all people and thus become effective to fewer people. Planning strategically is about identifying a limited number of goals that TCA must undertake to move successfully into the future. www.chirotexas.org
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It’s “in the B.A.G.” The envisioned future conveys a concrete yet unrealized vision for the organization. The compelling catalyst for achieving that vision is termed a “Big Audacious Goal” that, when accomplished, results in the desired envisioned future. 3
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What is that envisioned future? One in which the chiropractor’s profession will:
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Have increased unity concerning their future.
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Be better equipped;
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Be better represented;
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Have greater finical security;
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Be a significant player in providing positive healthcare in the State of Texas;
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Have greater tangible membership benefits;
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Be fully staffed with professionals to help chiropractors to help people;
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Have a fully functional, state of the art business office;
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The envisioned future is also one where the profession’s state association will:
Enjoy wider visibility and recognition; Will improve the health of people in Texas; and
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B e n e fi t f r o m s i g n i fi c a n t fi n a n c i a l reserves;
to accomplish them, each with an indicator of achievement that the goal has been obtained.
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Have more successful business partnerships;
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Benefit from increased recognition and advocacy clout.
TCA members may obtain a copy of the strategic plan via e-mail by contacting their State Director or the TCA office. A summary of the Strategic plan has been placed on the TCA website at www.chirotexas.org
So what is the strategic plan’s B.A.G.? What is the overriding objective that helps us to accomplish all the above? That eighty percent of all chiropractors in Texas are TCA members.
TCA Legislative Report
The strategic plan then focuses on the specific details that the TCA will seek to achieve over the next five years in the area of finances, membership, communication, value, legislation, staffing, education and other areas. These details are what the leadership and the volunteer organization will make use of to plan and execute the activities of the TCA.
The 83rd Legislature convenes on January 8th in regular session for 140 days. During that compressed time the House and Senate will conduct the state’s business. Each session of the Legislature develops its own unique identity and personality based upon the unique membership and the imponderable chaos of political conditions as they arise during each session.
The strategic plan next considers one to three year goals. The TCA senior leadership has determined that it will pursue the following objectives between now and 2015: •
In the area of serving as an educational resource for our profession--TCA will be the indispensable resource for value, content and professional development.
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In the area of business finances--TCA will have the financial stability to carry out its core purpose.
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In the area of advocacy for the chiropractic profession--TCA will be the proactive and sought after authority for the policies regarding chiropractic.
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New Legislative Members Galore The most significant defining factor is the new legislative members. In the Texas House almost one-third of its 150 members will be sworn in for the first time. Another twenty-five or so will be sworn for their second term--almost half of all House members. The loss of experience in working the legislative process and the loss of institutional knowledge in complex and specialized subjects can lead to sharp changes in policy decided by majorities made up of the least experienced members. Some well known and trusted committee chairs have retired or been forcibly retired by voters; others have advanced in seniority and are now in line to chair new and more powerful committees. The potential for rocky times in the House will be the subject of focused study by its senior members and by those entities like TCA seeking legislative action during this session. These personnel changes (in both legislative members and legislative staff) also create both a tremendous challenge and opportunity for
In the area of infrastructure--the TCA will work to reshape its infrastructure to support its goals.
The planning group then turned its attention to determining how these goals could be attained, and developed nearly twenty different strategies www.chirotexas.org
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TCA members: we have a lot of educating to do in a very short window of time. Our TCA Legislative Luncheons at the downtown Austin Club are one significant step to get ahead of the session rush.
school funding from last session. All these possibilities will require politically difficult votes long before the new budget is presented for consideration—long before legislators take up controversial issues like school vouchers; reregulating state university tuition; doing away with, or doubling-down on the controversial STARRS public schools standardized testing. We almost forgot to mention that the state is running out of water, we may have a shortage of electric power this summer, and although the
The thirty-one member Texas Senate also has five new members, each of whom will have to get used to different rules, people, and processes. Senate political fights, though hardfought, are typically more subtle than the pitched rhetorical brawls which occasionally rattle the House chamber. That is due to a Senate rule which requires that two-thirds of Senators agree to place a bill on the Established in 1934 by Dr. Clyde Keeler, The Texas Chiropractic calendar before it can be Association’s award designating the Chiropractor of the year, The considered (though by custom Keeler Plaque, is Texas Chiropractic’s most prestigious award. that can be changed with a simple majority vote). Nominations for the Keeler Plaque should be sent to: Either way, in honor of the Dr. Curtis McCubbin incoming freshman classes in Secretary, Keeler Plaque Committee both the House and in the P. O. Box 272 Senate, this session is brought Hunt, Tx 78024 to you by the word “change” and the number 181.
Call for Keeler Award Nominations
Immediate Budget Challenges For a moment put yourself in the shoes of a newly elected House member for whom the first order of business will be voting on a supplemental appropriations bill to spend roughly $5.3 billion to fund Medicaid through the remaining five months of the current fiscal year. But wait, there’s more; they will also have to pony up tax dollars for the huge increase in Medicaid caseloads which went unaddressed last session. In addition, some in the Legislature want to revisit the $4-5 billion cuts to public Texas Journal of Chiropractic
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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economy is in better shape than 2011, state revenue never exceeds the amount sought by determined petitioners.
TCA Makes Formal Request of Medicaid
TCA Strategy The TCA has made “a formal request that chiropractors be permitted to provide care for Medicaid recipients up to the level of their entire scope of practice, as long as the service is already covered by Medicaid in Texas.”
Your Legislative Committee, TCA Board of Directors and professional Legislative team intend to file reasonable bills to recover the rights of our chiropractors to provide health care to our patients with fewer restrictions. We have developed a list of eleven legislative proposals that we will be seeking in this session. The strategy is to overturn the outrageous restrictions of the past by being aggressive on numerous legislative fronts. In addition to supporting TCA’s long-range strategic plan our legislation will force the opponents of choice healthcare to defend their opposition to nonM.D. and D.O. health care providers. Our bills will also highlight the severe shortage of health care providers in Texas and show how Chiropractic can help alleviate that shortage while offering cost-effective treatment of willing patients. We are fighting for the right of our patients to receive health care from providers of their own choosing. We are fighting to use the professional medical training of Chiropractors to the full extent of that training and for the benefit of all Texans. We are fighting to reduce the costs of patient care, reduce over-reliance on heavily abused powerful prescription medications and questionable surgical interventions. We are fighting for the right to provide the proven therapies and strengths of our profession to Texas’ willing patients, the legislative process and win reasonable outcomes for Chiropractors, their families, employees, and the people of Texas.
Says the letter: “Per the Texas Administrative Code, Title 1, Part 15, Chapter 354, Subchapter A, Division 4 Rule § 354.1052, reimbursable chiropractic services are limited to ‘manual
manipulation of the spine, by use of hands only, to correct a subluxation.’ However, Article 4512(b) of the Texas Chiropractic Act defines the practice scope for chiropractic in Texas. Within that scope chiropractors are permitted to do many more services that Medicaid already covers.” “We feel our profession has the training and education to provide many more services beyond manipulation thereby creating a vast underutilized resource for Medicaid clients. … Also, because doctors of chiropractic practice in every corner of Texas, they can be marshaled to
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address gaps in those areas where access to health care is sparse.”
TCA Reports…
Read the full letter at this link: Medicaid Letter
The Texas Chiropractic Association has been very active on many fronts during the the past year and some of our desires, plans and actions are starting to pay off. BUDGET
TCA Insurance Relations Committee Reports: Claims to be Reprocessed
The 2013 TCA Budget has been prepared and presented to TCA’s Senior Leadership. Internal Affairs Coordinator, Jeff Brown, D.C., stressed that the budget is a work in progress and subject to updating as required to meet the needs of the environment in which we find ourselves. The b u d g e t c o m m i t t e e , D r. Brown reports, spent a significant number of hours in developing the budget for 2013 and a sound budget based upon “evidence based figures” has been submitted.
T h e Te x a s C h i r o p r a c t i c Association Insurance Relations Committee has spent a great deal of time investigating complaints regarding recent Aetna denials of manual therapy (CPT code 97140) when billed in conjunction with spinal manipulation, we have been able to verify the following. Aetna says that beginning September 1, 2012, due to a coding edit update, they began denying all manual therapy when billed in c o n j u n c t i o n w i t h C M T. Beginning 10-28-12, Aetna Click to was to reprocess all those denied claims. Aetna is saying to not send back in for re-processing as they have made this a “project” and will work all denied claims from their end. We will also be on the watch for Aetna’s December newsletter it seems that they are planning another implementation of this flawed methodology beginning in March. The ACA and TCA, as well as numerous other states are working on this problem.
The new budget hinges upon a moderate growth in membership and all Texas Doctors of Chiropractic are encouraged to hold active membership. Dues income is the primary means by contribute which this state’s profession f u n d s i t s a c t i v i t i e s . Following the significant expenditures that various lawsuits and appeals have necessitated, the association has been working hard to insure that its financial house is on solid footing. The 2013 budget helps us to achieve that objective. Kudos to Dr. Brown, Amy Archer, and the rest of the budget committee for their diligent and vital work for the association! MEMBERSHIP DEVELOPMENT TCA Membership Committee Chair, Elizabeth Evans, D.C., has initiated plans to help insure that as many of Texas’ chiropractors as possible
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are given the opportunity to support the state association of their profession. Dr. Evans and the Membership Committee are currently contacting those who are not actively supporting the state professional association.
soon after their selection. Max Vige, D.C., current chair of the Executive Director Search Committee, reports that over 30 resumes have been received for consideration and the work of the committee has proceeded at a rapid pace. Final interviews are to be conducted early in December and it is hoped that a new ED may be selected before the end of the year.
The membership committee will also be working with Student TCA organizations on the college campuses for assistance with membership development.
INSURANCE WEBINAR
NEW WEBSITE ON THE WAY
United Health Care and Optum recently announced a product that they call “Navigator.” It appears that this product would required a referral from an M.D., or D.O. in order for an insured to be treated by a chiropractor. Todd Whitehead, D.C., Chair of the TCA Insurance Committee, led a number of TCA members and senior state leaders during a conference call to learn more about this product and to express the profession’s opinion regarding such referral policies.
It has long been desired that the TCA offer a website that is functional, attractive, and informative. Our websites developed over the past years have been primarily voluntary efforts developed as a stopgap measure until more professional development could be obtained. We are nearing completion on our new site, seeking to develop a more simple, more elegantly functional website that will bring TCA new capabilities for the coming year.
These are but some of the myriad activities and work being conducted by the TCA to help chiropractors help patients. We hope that you will join with us to make chiropractic in Texas the best represented chiropractic profession in the nation.
FUNDRAISING FOR THE PROFESSION
As a result of the various lawsuits, TCA has spent a significant amount of its resources to defend our profession’s ability and capability to diagnose. The Texas Medical Association has appealed this capability to the Texas Supreme Court–an appeal to which only the TCA has been named a party. Therefore TCA has initiated fundraising activities that are ongoing; Established over half a century ago, this award is for EVERYONE IS ENCOURAGED TO the purpose of recognizing doctors who have shown CLICK HERE AND DONATE TO THE outstanding dedication and who have made longFUNDRAISING PROJECT. Thank lasting contributions to the profession and their you!
Call for Nominations for Young Chiropractor of the Year
EXECUTIVE DIRECTOR SEARCH
community, and who are under 40 years of age at the time of the award’s receipt. Send nominations to 2010 recipient:
Since June of 2011, the TCA has been without an executive director. Executive director search committees have selected individuals to serve as the TCA Executive Director, but for various reasons, the selected candidates were shortly discharged www.chirotexas.org
Dr. Tyce Hergert, D.C. 1500 W. Southlake Blvd #120 Southlake TX 76092 or via email at www.chirocaresouthlake.com
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musculoskeletal system, there is no language in the Chiropractic Act that authorizes a chiropractor to ‘analyze, examine or evaluate’ the brain, eyes or inner ears. The TMA maintains that chiropractors are not permitted to analyze, examine, or evaluate the eyes or inner ear and therefore may not perform VONT. We do not agree that the statute so limits the scope of chiropractic. Rather, the statute permits chiropractors to use objective or subjective means to analyze and evaluate the biomechanical condition of the spine and musculoskeletal system. … This means that so long as the objective or subjective means used are capable of revealing a significant fact about the biomechanical condition of the musculoskeletal system or spine, the test itself need not necessarily be a direct examination of the musculoskeletal system or spine.”
We hold that the statute does not prohibit a chiropractor from examining parts of the body other than the spine and musculoskeletal system if such an examination will assist in analyzing or evaluating the biomechanical condition of the spine or musculoskeletal system.”
Congratulations TBCE!
“We hold that the statute does not prohibit a chiropractor from examining parts of the body other than the spine and musculoskeletal system if such an examination will assist in analyzing or evaluating the biomechanical condition of the spine or musculoskeletal system.”
Chiropractic “wins one” in TMA v TBCE (VONT) Lawsuit The Texas Third Court of Appeals on November 21, 2012, reversed the summary judgement against the TBCE in the TMA v TBCE (VONT case) and ordered the case back to the trial court to proceed.
“We believe it would be inappropriate and contrary to the legislature’s intent to give deference to the Board’s interpretation of the statutes governing the two disciplines. … (‘As neither statute establishes a clear line of demarcation between the professions, we believe it would be unreasonable and contrary to the legislature’s intent to give t o t a l d e f e r e n c e t o e i t h e r a g e n c y ’s interpretation of the statutes to the extent of any overlap.’).”
Says the court: “The Texas Medical Association (“TMA”) sued the Texas Board of Chiropractic Examiners (“the Board”) and its executive director seeking a declaration that portions of the Board’s administrative rule defining the scope of chiropractic practice were invalid. … The rule provisions at issue purport to authorize certain of the Board’s licensees to perform ‘Technological Instrumented Vestibular-OcularNystagmus Testing’.”
“We therefore reverse the trial court’s judgment and remand the cause to that court for further proceedings.”
“The district court rendered judgment invalidating those portions of the Board’s administrative rule. We will reverse the summary judgment and remand the cause to the trial court,” the appeals court decided. “The TMA argues that because Texas law limits the practice of chiropractic to the spine and the
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The TMA lawsuits continue…
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benefit covered through an exchange health plan. “Discrimination against providers is also discrimination against patients,” the letter continues. “Discrimination against the services provided by doctors of chiropractic and other providers unduly and unlawfully restricts the patient’s ability to select the provider, and the service, of his or her choice.”
ACA Presses HHS on NonDiscrimination Enforcement The American Chiropractic Association (ACA) in an October 19 letter to HHS Secretary Kathleen Sebelius raises serious concerns regarding the Department’s implementation of a key provider non-discrimination provision of the Patient Protection and Affordable Care Act (PPACA) of Federal Health Reform.
Further, ACA requests that HHS communicate to states that adherence to Section 2706 is vital and implement a process to evaluate each state’s proposed benchmark plan to determine whether it is in compliance. The association will formulate future action based on the extent to which HHS addresses its concerns.
The association’s concerns center on HHS guidelines allowing states to choose their own essential health benefits standard—known as a “benchmark” plan—from among 10 existing plans in each state that will be made available within the newly created insurance marketplaces (“exchanges”) required under PPACA to be established by 2014. Essentially, this process will determine what specific benefits are provided under health insurance plans marketed via the exchanges in each state.
To read the ACA letter to HHS, click here.
Meet our Affiliate Members-ChiroHealthUSA
In the letter to Sebelius, ACA President Dr. Keith Overland expresses concern that states will not only pick plans that are less than robust but, more importantly for chiropractic patients, that some states may submit benchmarks that are inconsistent with Section 2706, PPACA’s provider non-discrimination provision, and exclude the services of chiropractic physicians.
ChiroHealthUSA is Discount Medical Plan Organization (DMPO) with a network of over 1300 doctors who are concerned about patients having access to affordable healthcare. ChiroHealthUSA allows them to offer legal discounts to their uninsured, underinsured and partially insured patients.
“We have reason to believe that several states have taken just such an action, having allowed little to no input from the chiropractic community during their deliberations,” the letter states.
Every day we see more patients who have no insurance, minimal coverage of 6 to 10 visits maximum per annum, or limited coverage like Medicare which only covers three CMT codes. Our patient base is more financially responsible for their care today than they have been since the 1960s. Many doctors are responding to their patient's needs by lowering their fee schedule overall, and losing money they could legitimately be charging to insurance companies, when insurance coverage is available. Conversely, and in response to these changes in insurance, a segment of doctors
Section 2706 prevents health plans from arbitrarily excluding the participation and coverage of entire categories of providers based solely on their licensure. The law enables patients to receive care from any provider who is licensed in a state to provide a specific www.chirotexas.org
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doctors getting compliant and patients benefiting from these legal network-based discounts. There's never a charge for the doctor to join ChiroHealthUSA. Doctors select their own discounts and they stay in charge with a 30-day opt out clause! Find out more about joining ChiroHealthUSA this week. Register for a free informational webinar held e a c h T u e s d a y b y going to www.chirohealthusa.com. Like so many of your colleagues, you'll be glad you did!
Do You Dread New Medicare Patients? By Dr. R. A. Foxworth, FICC, MCS-P I don't know about you, but I LOVE new patients! Sure, there's more work involved with starting a new relationship: going through initial intake, examination process, clinical decision-making, formulating diagnoses and written treatment plans, explaining findings and clinical conclusions to the patient (including their financial responsibility), then finally getting agreement to begin care.
have kept their fees high, to maximize any insurance reimbursement. Other doctors have limited their practice and only see PI and Workers Comp.
Becoming a ChiroHealthUSA Provider is a WinWin-Win situation. Doctors get peace of mind and audit-proof their discount policies, the patients that are uninsured and underinsured or partially insured have a more affordable way to continue their treatment in their office, and chiropractic is benefited on a national and local level.
We know new patients are the lifeblood of practice; but if patients’ focus, and their managed care insurance companies’ focus, is on pain relief and not wellness. It’s challenging. Now compound that by seeing how this directly affects new Medicare patients! Generally, Medicare patients are on some type of fixed income. Medicare only covers three CMT codes reimbursable for medically necessary care rendered by chiropractor. So the new patient visit is 100% the patient's financial responsibility when Medicare is the primary insurance.
As a member of ChiroHealthUSA, doctors will be glad to know that every card that is sold in their practice is supporting chiropractic. ChiroHealthUSA donates a portion of EVERY card sale to the Foundation for Chiropractic Progress, The Congress of Chiropractic State Associations and participating State Associations, TCA included. So there are benefits on the local and national level for chiropractic, as a direct result of Texas Journal of Chiropractic
When a new patient calls, have a clear answer to the question, "How much does it cost to see the doctor?" especially when Medicare is the primary insurance. Being unclear about fees or giving a broad or vague range of fees makes it difficult for a
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Medicare patient to commit and schedule that appointment.
Customer Service for Chiropractic Business Success
Here's a simple solution: become a provider with ChiroHealthUSA, a Discount Medical Plan Organization (DMPO). As a provider you can set a capped Initial Visit Fee that is all-inclusive for the initial visit services provided. Your scripting becomes simpler. When asked, "How much will it cost?" instead of answering, "Our regular fees may range from $175-$350 on an initial visit; it depends on what the doctor decides needs to be done," try this: "We offer a program that limits your first visit to only $100."
By: Drew Stevens PhD The most important but overlooked issue in business is customer service. Today, patient-topatient influences are stronger than ever. With the proliferation of the Internet and instant connectivity, patients relate instant information about chiropractors and their offices. It is not necessary to react to every patient issue but it is vital to indulge in a culture of service.
You’ll see the difference the first day! Find out more about how ChiroHealthUSA can, not only keep you compliant, but also make practice easier, profitable and more fun.
With over 25 years of research and consultancy in the field, I have found that success for the chiropractor is achieved with a focus on three functional areas 1) Mindset 2) People and 3) Differentiation.
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 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 C h a i r m a n . Yo u c a n c o n t a c t D r. F o x w o r t h a t 1-888-719-9990, info@chirohealthusa.com or visiting the ChiroHealthUSA website at www.chirohealthusa.com
Mindset During my collegiate business studies, I discovered a quote that personifies the achievement of every business. Peter Drucker stated, “Every organization is in business for one reason- the customer [patient]”. All activities and internal functions rely on acquiring and retaining clients. This imperative concept is needed to ensure that chiropractors focus on the area of acquiring patients. Simply put, chiropractors require a laser like focus on marketing and service. It also presupposes that those hired will also focus on these business attributes. Second, chiropractors also need to understand that upon graduation they are entrepreneurs. Doctors become involved in a myriad of tactical issues that can alter focus and create stress. Doctors therefore need to be confident about their achievements, and, they must continually maintain staff confidence even during volatile times. This also includes operating the business using prudent risk. Removal from the comfort zone is difficult for business owners.
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People
marketing and advertising costs while also retaining current patients.
Customer service simply comes down to proper communication and implication to patients. When doctors and staff communicate poorly service fails. While conducting research for chiropractic practices, three functional areas help and hinder doctors.
Property - Individuals always judge books by their covers and patients are no different. On a recent appointment with a supplier, I could not find a spot to park my car. All employees were in visitor spots. On another visit, I entered the main lobby of a potential client to what seemed like a hurricane. These images leave a certain perception of company operations. Simply put: pictures say a thousand words.
People - There is nothing more prevalent to business then internal employees: they are the frontline to the organization. Failure to exemplify a patient culture only diminishes a firm’s ability to communicate and collaborate with prospects. Working for a chiropractor many years ago, I was greeted by a receptionist that could have passed for an Undertaker. I do not suggest that receptionist require effervescence however, empathy works better for customer care. Service culture needs to run throughout the practice and not just reception. Everyone from the CA to the PT needs to be empathetic to patient needs. More importantly, people know people. Doctors need take full advantage of referrals and testimonials. Patients are always enamored in hearing of other patient cures. Such stories become more beneficial than any four-color brochure.
The reception area must be tidy, organized and exemplary of the service you provide. Smiling staff and signage drawing attention to the practice’s location. Staff should dress professionally and preferably have nametags. It took five trips to my current chiropractor (Yes I do use one) before I even knew the name of his receptionist! Service Suggestions: • • •
Patients are the most important people. Patients are not dependent on us. Patients are not an interruption of our practice.
Differentiation Finally, ensure you spend time and get to know your patients and their families. Individuals do business with those they know and trust. When chiropractors are rushing from treatment room to treatment room this illustrates inward focus.
The deterrent to practice growth is a lack of focus on simple things. While working with chiropractors I typically ask them to identify their value proposition. I also inquire if patients can repeat it.
Processes – Patients and prospects are enamored by increased communication. The more you tell them, the more comfortable they become with information. Remember they are investing in your sage advice on health. Communicate the rationale for paperwork, procedural issues, signatures, etc. Ensure the phones are answered promptly and with rapt professionalism.
The rationale is if patients understand the value provided they repeat it, thus becoming marketing avatars. The largest compliment received by a doctor is the referral and testimony of current patients informing others. However, customer service must be part of everyday living stemming from holding doors during shopping excursions, smiling when meeting others in public, and general posture and attitude.
Finally, when patients are serviced appropriately they inform others of their positive experience. Such feedback assists with decreasing Texas Journal of Chiropractic
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donating $22,500 on Friday, November 9th at the COCSA Convention in Atlanta, Ga. Foot Levelers has supported COCSA for the last 20 years because they believe in COCSA’s mission: To provide advancement of the chiropractic profession through service to member State Chiropractic Associations.
be in everything you do. I know of one chiropractic associate that is so shy, some take him as being aloof. Hence their portion of the practice produces negative results. Ensure inclusion in everything you do. The cacophony of competition is too strong to avoid the power of customer service. With many practices and many patients having the power to influence other patients, service is the marketing differentiator.
The $22,500 donation was made in honor of the 48 state associations that participate in Foot Levelers’ Speakers Grant Program. The program supports state organizations by providing a topnotch speaker for their conventions at no charge. Annually, Foot Levelers donates $1,500 to the state association as well as $500 to COCSA in the name of each state association that is a participant of the Speakers Grant Program.
Ironically, many chiropractors look at how many patients they see per week. Arn’t you curious how many patients you don’t see because of your customer service? ©2012. Drew Stevens PhD, all rights reserved. Drew Stevens transforms struggling chiropractors into wealthy chiropractors. For more information visit www.stevensconsultinggroup.com
“COCSA is deeply grateful for the continued friendship and support of Foot Levelers,” said Dr. Kate Rufolo, President of COCSA. “Each year we receive a substantial check from Foot Levelers due to our state members taking advantage of a wonderful program to provide excellence in education to their doctors in the field. This gracious donation allows COCSA to continue to work to provide value to our state members and be the voice of the State Associations.”
Foot Levelers Continues to Support COCSA’s Mission
ACA: Vision for the Future By Keith Overland, DC Our visions for the future, while expressed differently, essentially are focused on the necessity of society to have the unencumbered freedom to choose a health care provider. We also are very focused on a future in which conservative, natural health care options, such as chiropractic care, would be a first choice for patients. ACA volunteer leaders and staff are now developing the specific vision, themes, goals, strategies and road map that will successfully take ACA into the future. What is
Dr. Kate Rufolo-Dreher, President of COCSA and Kent Greenawalt, CEO of Foot Levelers Foot Levelers supports the Congress of Chiropractic State Associations (COCSA) by www.chirotexas.org
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clear is that, m o v i n g forward, our health care system will be different than it is today.
help him keep these important provisions in the bill. Second, insurance exchanges are currently being formed around the country. While some states are waiting for the federal government to take on this task, others are moving full steam ahead with implementation. An exchange is a group of qualified health plans that meet the state and federal requirements to offer the minimal essential benefits package to small businesses and the under or uninsured. Benchmark health plans are being chosen as we speak.
Republicans, who voted over 30 times to repeal the P a t i e n t Protection and Affordable Care Act (PPACA), have promised to continue their work dismantling it in favor of a more free-marketbased interstate system. Democrats will attempt to keep the key provisions that have already been implemented and build upon the new medical models forming throughout the country.
Fortunately, many of these plans are based on one that is already in operation in a state and in many cases have coverage for services provided by a doctor of chiropractic. Yet, as one would expect, some plans are looking at ways to remove chiropractic care from coverage, while maintaining the services of other provider groups.
Our role will be to quickly assess the direction of the new Congress and to develop a strategic plan to help continue our battle to offer the public a health care system that no longer tolerates provider discrimination. As 2014 comes closer and section 2706 of the PPACA, the provider anti-discrimination section, moves towards implementation, we will have our work cut out for us. AMA has made it a top legislative priority to eliminate 2706. is is the section the National Association of Chiropractic Attorneys called the most important piece of legislation in 50 years. AMA still wields significant clout in Washington and we will have to work with every friendly legislator to keep it intact.
Another set of inappropriate activities that has continued almost unimpeded is the abusive activities of certain managed care organizations. The ACA, in partnership with several states, has filed a class action lawsuit against American Specialty Health Networks (ASHN). The outcome will not be known for some time, but ACA could not sit idly by while our doctors and their patients are being treated so unfairly. As you can see, there are many issues that are taking the full attention and resources of your association. above are just a few of the many that are dealt with on a daily basis. Our ACA mission states that we must preserve and protect our patients’ rights to seek the services of a doctor of chiropractic.
There are two other trends that appear to be imminent. First, the wellness sections of the health care bill seem to be the well in which legislators dip their hands to redistribute funds from health care to other more lean parts of governmental operations. This is legislative language that Iowa’s Senator Tom Harkin, a champion of healthy lifestyle promotion, has worked hard to create and preserve. He has asked us, as doctors who believe so strongly in the concepts of wellness and prevention, to Texas Journal of Chiropractic
No other organization has the resources to take on this obligation. While I am certain that not every member is happy with every initiative or action ACA takes, I believe that we all do agree that when we look at those critical needs facing our profession, tough decisions will need to be made and the big picture must always be kept in the forefront of our minds. I am reminded of a quote from a dear departed friend who said, 16
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“Nothing cannot be done if we raise our voice as one.�
relating to the cleanliness of the prescription department, the dispensing of medications, the compounding of medications, and record keeping." The department said the company had been notified of the violations previously but had not corrected them. The FDA said that the Massachusetts company at the heart of the outbreak had "several health and safety deficiencies related to the practice of pharmacy," US Senators requested documents from the FDA, NECC, and Massachusetts health officials in their investigation, and received 10,000 pages summarizing the near decade-long relationship between NECC and regulators. The company itself found several cases of bacteria and mold growing in rooms meant to produce sterile products but apparently did not correct the situation. The company shipped about 17,000 vials of preservative-free methylprednisolone acetate in three separate lots to pain clinics in 23 states, where it was mainly injected into the spine of patients with chronic back pain.
Fungal Meningitis Assault 510 Sick, 36 Dead The Outcome The fungal meningitis outbreak continues with more compounding pharmacies coming under fire, as the number of reported cases hits 510. Massachusetts health officials said they had found "significant issues" at a company that prepares the injectables and "called into question the company's compliance with nationally accepted pharmacy standards and Massachusetts regulations." One company, which makes drugs for about 40 patients, surrendered its license voluntarily and is asking prescribing doctors to request their patients to return any medications they still have. That company had set up a separate space at their site to give intravenous medications without having a license to do so – something that is contrary to regulations.
The drug has been shown to be contaminated with the black mold Exserohilum rostratum, which has also been isolated from many fungal meningitis patients. The Massachusetts Board of Pharmacy has permanently lifted the company's license to operate in the state, as well as those of the company's three principal pharmacists. The director of the board that regulates pharmacies in Massachusetts has been fired for ignoring a complaint about the company implicated in the continuing fungal meningitis outbreak. He took no action when Colorado health officials complained that the New England Compounding Center (NECC) was acting like a drug manufacturer. The Problem
Florida health officials have suspended the license of a compounding pharmacy after a routine inspection found a number of violations of the state's rules governing compounding pharmacies. The health department said in a statement that it yanked the license of another compounder after an inspection revealed violations of "a number of statutes and rules www.chirotexas.org
The Massachusetts company that made the injectable steroid is licensed in Massachusetts as a compounding pharmacy and allowed to make drugs on a patient-specific basis after receiving a valid prescription. Instead, the 17
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Colorado health department said in July 2012, it was distributing drugs to hospitals there without having prescriptions in advance.
of the ongoing fungal meningitis outbreak that has killed 36 people. FDA Commissioner Margaret Hamburg, MD, received more harsh questions during a congressional hearing about why her agency didn't do more to stop the New England Compounding Center before it shipped more than 17,000 vials of tainted methylprednisolone acetate that has sickened 510 and killed 36 since late September.
Since the start of the current outbreak, both the FDA and the Massachusetts health department have also said the company was acting more like a drug maker than a compounding pharmacy, shipping more than 17,000 vials of the steroid to pain clinics in 23 states without advance prescriptions. "The thousands of U.S. compounding pharmacies are not registered with the FDA; they are not subject to federal record keeping and reporting rules for drug manufacturers; and, through litigation, the FDA can be blocked for many months from visiting them," The problem stems from a 2002 Supreme Court ruling striking down a section of the Food, Drug, and Cosmetic Act that codified the agency's role in p o l i c i n g compounding pharmacies.
State or Federal Oversight?
The New E n g l a n d Journal of Medicine has editorialized that compounding pharmacies can play a "valuable role" in providing specialized products for patients with special needs. The best way to balance the need for the "designer therapeutics" with safety, they argued, is to give the FDA broader powers, since current state-based oversight is "clearly inadequate to protect the public health." "States lack the resources to supervise what has become a national industry with interstate activity," they argued.
The FDA said that in the 1997 F D A Modernization Act, Congress exempted compounders from the agency's purview, and efforts to regulate them have been blocked by various federal circuit courts.
Hamburg said the FDA's authority over compounding pharmacies is "limited, unclear, and contested." While compounding pharmacies are regulated by state boards of pharmacies, manufacturing is overseen by the FDA, and the line separating the two has been blurred by court cases rejecting the a g e n c y ' s actions, she said.
Hamburg reiterated her call for a tiered approach to regulating compounding pharmacies, separating them into "traditional" and "nontraditional." Traditional compounders, who generally operate under the oneprescription-one-drug paradigm, will still be under the oversight of state boards of pharmacies. Nontraditional compounders would register with the FDA and adhere to other requirements typically mandated for manufacturers.
United States Senators from both political parties said they plan to craft legislation to give the FDA authority over compounding pharmacies the agency says is needed in light Texas Journal of Chiropractic
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"There were a number of authorities and mechanisms for both federal and state regulators to address this issue, but bureaucratic inertia appears to be what allowed a bad actor to repeatedly risk public health," the congressional report concluded. A Solution? Consumer watchdog Public Citizen has said the Centers for Medicare and Medicaid Services (CMS) is required by law to deny Medicare reimbursement for any drug that is not "reasonable and necessary" and that the agency generally considers drugs that haven't received FDA approval -- which would include many compounded formulations -- not to have met that standard.
CMS could have issued a national coverage determination to exclude or limit coverage for specific classes of compounded drugs. "CMS demonstrated poor judgment by not using this authority, particularly since CMS obviously recognized the dangers posed to Medicare beneficiaries by compounded drugs," the letter stated.
Yet despite those regulations, CMS nonetheless provided reimbursement to centers such as the New England Compounding Center (NECC), allowing large-scale compounding pharmacies to flourish.
The agency used this authority in 2007 when all four regional durable medical equipment contractors issued local coverage decisions denying coverage for compounded inhalation drugs administered with nebulizer devices. The reason given was that such drugs weren't tested for safety or efficacy.
"CMS, through its inconsistent Medicare drug reimbursement policies concerning compounded drugs and coverage decisions allowing routine coverage for such drugs, appears to have created inadvertent financial incentives for inappropriate use of compounded drugs."
Public Citizen said that rationale is applicable to compounded drugs given to Medicare patients. The group points out a few areas of concern, including:
Public Citizen wrote in a letter Monday to Health and Human Services (HHS) Secretary Kathleen Sebelius. In the letter, the watchdog asks for HHS' Office of Inspector General to launch an investigation of CMS' reimbursement policies and regulatory decisions. CMS has stated in guidance documents that Medicare doesn't cover compounded drugs in violation of the premarket approval and manufacturing requirements of the Food, Drug, and Cosmetic Act (FDCA). "Drugs manufactured by compounding pharmacies -as opposed to registered drug manufacturers -typically do not meet these FDCA requirements," Public Citizen wrote. www.chirotexas.org
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CMS guidance on compounded drugs is ambiguous and conflicting, stating at first compounded drugs made in violation of the FDCA are excluded from coverage. The agency still ordered carriers to reimburse for compounded drugs unless the FDA and CMS take specific action to stop payment.
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CMS appears to have no mechanism to implement this guidance since it has "no regular form of coordination with the FDA" to allow CMS to identify when the FDA has deemed that a compounded Texas Journal of Chiropractic
drug was produced in violation of the FDCA. •
source of care is more important than who it was that provided these services. … Studies comparing the quality of care provided by physicians and nurse practitioners have found that clinical outcomes are similar." “Organized medicine,” including the American Medical Association, assert that encouraging patients to see NPs rather than primary care physicians may put patients' health at risk, but don’t often cite their evidence.
CMS hasn't issued a national coverage determination excluding coverage on any class of compounded drug, leaving the determination up to local carriers.
Like CMS, the FDA could have eliminated the widespread, large-scale production of compounded drugs if it had properly used its authority, Public Citizen said.
The American Academy of Family Physicians (AAFP) denounced primary care practices run by NPs, saying such practices do not provide a quality of care equal to that of physician-led practices. The AAFP says they support more "patient-centered medical homes" in which a medical doctor leads a team of allied health professionals -- including nurse practitioners -as the way to provide optimal care.
Debate on Independent Nurse Practitioners Continues State legislatures will continue to debate the role advanced-practice nurses should play in the delivery of primary care. Physician groups continue to push for greater oversight of their work. According to data from the National Conference of State Legislatures, about fifty of 245 bills recently filed at the state level relating to changing scopes of practice have dealt in some way with the freedom with which nurses -including nurse practitioners (NPs) -- can operate.
Some of today's primary care work can involve routine care rather than treatment of complex diseases. To help with such routine care, some states have turned to NPs. Such moves are consistent with 2010 recommendations from the Institute of Medicine, which urged states to remove barriers against independently practicing nurses. Health reform has tried to spur the use of NPs by authorizing funding for nurse-led clinics. The Affordable Care Act also provided $30 million to cover educational expenses to train 600 NPs.
Some states are turning to NPs as a way to fill the void physician shortages leave in primary care. Many physician groups have declared themselves in opposition to this practice. Eighteen states and the District of Columbia allow NPs to diagnose and treat patients and prescribe drugs without a physician's involvement, while thirty-two states require some sort of involvement in those areas.
Reassessing Flu Shots It’s that time of year again and public health officials are urging everyone over 6 months of age to get a flu shot. Many businesses are providing on-site flu shots, and some hospitals have told staff members that they have to wear masks if they do not get the vaccine. By 2020, United States health leaders want 80 percent of the population to get yearly shots.
A review of twenty-six studies published since 2000 that found that health status, treatment practices, and prescribing behavior were consistent between NPs and physicians. "There is a growing body of research demonstrating that patients perceive that receiving primary care and having a usual Texas Journal of Chiropractic
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They also discovered 30 inaccuracies in the statement on influenza vaccines put forth by the expert panel that develops vaccine recommendations, all of which favor the vaccine. CDC officials acknowledge that the vaccines do not work as well in the elderly population as they do in younger healthy adults. They say the effectiveness of the flu shots, which are reformulated every year in an attempt to match the strains most likely to be circulating that season, varies depending on the population being inoculated and the year.
For vaccine manufacturers, it’s a bonanza: Influenza shots — given every year, unlike many other vaccines — are a multibillion-dollar global business. But are they worth the public investment?
“Does it work as well as the measles vaccine? No, and it’s not likely to. But the vaccine works,” says the chief of epidemiology and prevention in the CDC’s influenza division. The new report from the Center for Infectious Disease Research and Policy is not the first to point out the shortcomings of influenza vaccines. The Cochrane Collaboration, an international network of experts that evaluates medical research, concluded in a 2010 review that the vaccines decrease symptoms in healthy adults under 65 and save people about a halfday of work on average, but that they do not affect the number of people hospitalized and have minimal impact in seasons when vaccines and viruses are mismatched. (When the vaccine matches the circulating viruses, 33 adults need to be vaccinated to avoid one set of influenza symptoms; when there is only a partial match, 100 people must be vaccinated for the same effect.) It was also concluded that the vaccines appear to have no effect on hospital admissions, transmission or rates of complications. A separate Cochrane review on vaccines for the elderly determined the evidence was so scant and of such poor quality that it could not provide guidance.
The Center for Infectious Disease Research and Policy at the University of Minnesota released a report saying that influenza vaccinations provide only modest protection for healthy young and middle-age adults, and little if any protection for those 65 and older, who are most likely to succumb to the illness or its complications. Moreover, the report’s authors concluded, federal vaccination recommendations, which have expanded in recent years, are based on inadequate evidence and poorly executed studies. “We have overpromoted and overhyped this vaccine,” said the director of the Center for Infectious Disease Research and Policy, as well as its Center of Excellence for Influenza Research and Surveillance. “It does not protect as promoted. It’s all a sales job: it’s all public relations.” “I say, ‘Use this vaccine,’ ” he said. “The safety profile is actually quite good. But we have oversold it. Use it — but just know it’s not going to work nearly as well as everyone says.”
Another Cochrane review found no evidence that vaccinating health care workers who work with the elderly has any effect on influenza or pneumonia deaths.
Authors discovered a recurring error in influenza vaccine studies that led to an exaggeration of the vaccine’s effectiveness. www.chirotexas.org
“Not having evidence doesn’t prove it doesn’t work; we just don’t know,” said a Cochrane 21
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Collaboration coordinator for the University of Calgary in Alberta. Initially developed for soldiers and approved in 1945, the flu vaccine was approved for civilian use a year later. In 1960, the surgeon general, Leroy E. Burney recommended vaccinating three high-risk groups: pregnant women, the chronically ill and people 65 and over.
In simple terms, these programs may be deemed illegal for health care providers due to direct payment or kickback for a referral to the referring party. Even the most novice health care provider should be aware that they may not directly pay someone for a referral; ultimately these programs may be doing just that. However, if the service were not being paid by specific referral(s), but by charging a flat fee for marketing, with the fee paid being the same regardless of the number of referrals, it would not violate any of the anti-kickback laws.
Another option for those who want to reduce their risk of influenza and flulike infections may be simply this: Wash your hands more often. There is good evidence this works.
It is the provider's responsibility to ensure they are working within legal constraints, so I recommend you inquire with any group you engage with to provide this type of service as to how they have addressed the issue.
Groupon-like Marketing Raises Questions
Regarding how it would be billed to insurance: First and foremost, the amount billed to any insurance on this type of deal must be at the amount paid by the patient, not your regular rate. Patient and insurance are equal, and their insurance for the same service must be billed at that amount.
Many questions arise surrounding the use of “Gorupon� style of marketing. Using this type of marketing protocol creates some dilemmas for the health care provider. Its legality for health providers, in addition to how it may be billed for insurance claims are just some of the questions raised. Any chiropractor who wishes to engage in the services or use of Groupon or similar Internet daily deals should invest in some investigation by their legal counsel regarding the specific issue of illegal kickbacks these offers may violate.
HHS Proposes Rules on Key Parts of ACA The Obama administration released a set of proposed Affordable Care Act (ACA) rules that outline, among other things, starting the guaranteed coverage of adults with preexisting conditions in 2014. Under one of the rules issued by the Department of Health and Human Services (HHS), insurance companies would only be allowed to vary premiums based on age, tobacco use, family size, and geography. Health insurers would be barred from denying coverage or charging higher premiums because of past or current health problems, gender, occupation, and employer size or industry.
With the proliferation of Internet health care discount programs one must consider the federal anti-kickback law (42 U.S.C. 1320a-7b) t h a t p r o h i b i t s t h e o ff e r o r r e c e i p t o f remuneration in return for referrals for or recommending purchase of supplies and services reimbursable under federal health care programs. The referral service or discount safe harbors (42 C.F.R. §1001.952) issued under this statute may not extend to most types of Internet discount programs.
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Other proposed rules outline standards and policies for coverage of essential health benefits and for employer-based wellness programs. All the rules would take effect Jan. 1, 2014.
for a bronze plan, 70% for a silver plan, 80% for a gold plan, and 90% for a platinum plan. "These AVs, called 'metal levels,' will assist consumers in comparing and selecting health plans by allowing a potential enrollee to compare the relative payment generosity of available plans," HHS said. "Taken together, EHB and AV will significantly increase consumers' ability to compare and make an informed choice about health plans."
"The implementation of these proposed rules will ensure that every American, for the first time, will have access to affordable health insurance coverage notwithstanding any health problems they may have," HHS said in one rule. The rules also mandate that insurers maintain separate statewide risk pools for the individual and small-employer markets, unless a state wants to combine the two. Premiums and rate changes would be based on the health risk of the entire pool. "This provision prevents insurers from using separate insurance pools within markets to get around the market reforms and to charge people with greater health problems higher premiums by increasing their premiums at higher rates than other, healthier risk pools," HHS said in a release.
The last proposed rule sets up standards for "health-contingent wellness programs" -- those that require individuals to meet a specific standard related to their health to obtain a reward -- to ensure individuals are protected from unfair practices that could reduce benefits based on their health.
The proposed rule includes provisions for enrollment in catastrophic plans -- plans with lower premiums and high deductibles. It also reaffirms existing protections that individuals can't be dropped from coverage or not allowed to renew because they become sick or have a preexisting condition.
Novitas and TrailBlazer Switch
A second proposed rule outlines health insurer standards in regard to essential health benefits (EHB), the 10 core items and services must be offered in all health plans. Specifically, it requires that EHBs be based on a state-specific benchmark plan, including the largest smallgroup health plan in the state.
Effective November 19, 2012, Novitas Solutions, Inc. became the Medicare Administrative Contractor for Jurisdiction H. The TrailBlazer Part B toll-free numbers and IVR will no longer be in service after 4 p.m. CT Nov. 18, 2012. Novitas will observe a “dark day� on November 19, 2012, to complete cutover transition activities and will offer a single tollfree customer service line to be effective November 20, 2012. The TrailBlazer J4 Medicare Administrative Contractor (MAC) Web site will no longer be available after 4 p.m. CT Nov 18, 2012.
The rule also outlines how HHS will calculate specific actuarial values (AVs) for all health plans. AV is calculated as the percentage of total average cost for covered benefits that a plan will cover. For example, if a plan has an AV of 70%, on average, a consumer would be responsible for 30% of the costs of all covered benefits. Plans will meet specific values: 60% www.chirotexas.org
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Providers must contact Novitas for all Medicare questions and information from November 19, 2012 and forward.
Other speakers included Parker University President Dr. Fabrizio Mancini, Olympic chiropractor Dr. Mindy Mar, Vice-Chairman of the Parker Board of Trustees Dr. Mike Flynn, American Chiropractic Association East Texas Delegate and Chairman of the Parker Board of Trustees Dr. Cynthia Vaughn, Cleveland Chiropractic College Vice President Dr. John Nab, among others.
Novitas Solutions: •
Toll-Free Customer Service – (855) 252-8782 (effective November 20, 2012).
•
We b s i t e – h t t p s : / / w w w. n o v i t a s solutions.com.
During the conference, SACA held elections for its national officer positions and appointed Parker student Don White as the SACA National Chair.
Parker University Hosts SACA Leadership Conference
The first SACA leadership conference was held in October of 2004 at National University in Lombard, Illinois. The focus of the conferences is leadership in professional and personal relationships. They also provide students with the opportunity to interact and learn from leaders in the chiropractic field.
Parker University hosted the 9th annual Student American Chiropractic Association (SACA) Leadership Conference the weekend of October 5. Students from every chiropractic campus were invited and approximately 100 students from 13 campuses attended, including Cleveland Chiropractic College, Logan College o f C h i r o p r a c t i c , N e w Yo r k C o l l e g e o f Chiropractic, Southern California University of Health Sciences, and more.
SACA provides student members with scholarship opportunities, the ability to participate in the annual National Chiropractic Legislative Conference, and access to educational programs and webinars.
James Gardner, current president of the Parker SACA chapter, said students who attended the conference learned about the leadership potential they possess and the ability to develop into future leaders of the profession.
Palmer College of Chiropractic Expands DoD / VA Internship Affiliations
“By being involved with SACA, you can meet new people, and network with doctors that can lead to amazing opportunities in the future,” he said. “You will also play a key role in shaping the future of the chiropractic profession.”
With the recent announcement of an academic affiliation with the Martinsburg VA Medical Center in Martinsburg, W.V., Palmer College of Chiropractic's Department of Defense/Veterans Affairs (DoD/VA) Chiropractic Internship Program has grown to include 14 facilities.
The keynote speaker for this year’s conference was Thurl Bailey, former Utah Jazz basketball player. Since retiring from the NBA, Bailey has become a renowned professional speaker and community advocate. The 1983 NCAA national champion encouraged attendees to persevere, develop peak performance and leadership, and discover the opportunity in change. Texas Journal of Chiropractic
The staff chiropractor at Martinsburg is Shawn Neff, DC, a 2003 graduate of Palmer's 24
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Davenport campus, and the first intern in the program is expected to begin later this year.
TCC Students Present Research at National Conferences
Palmer's DoD/VA Chiropractic Internship Program provides senior-level interns from all three Palmer campuses with an opportunity to work alongside a staff doctor of chiropractic located in a Department of Defense military treatment facility or a Veterans Affairs medical center. The intern gains valuable insight into how the DC works with health professionals from other disciplines to benefit patients. Interns provide chiropractic care and, depending on the location, may also rotate among other departments, observing procedures and interacting with medical interns or residents.
Texas Chiropractic College students Joseph Urrea, Gabrielle Williams and Kelley Humphries represented the College, their research teams and the chiropractic profession on Nov. 8, presenting research posters at two national research conferences. Urrea and Williams both had posters accepted for the National Center for Human Performance Annual Meeting’s student research competition, with Urrea taking third in the competition. Humphries presented at the annual Biomedical Research Conference for Minority Students in San Jose, Calif. In August, Humphries also presented the findings of a spring 2012 r e s e a r c h s t u d y, T h o r a c o l u m b a r s p i n a l manipulation impact on exercise performance, at the ACA Sports Council Symposium in Arizona. She won first place and $3,000 for the college. This is the first year for TCC to compete in these research poster competitions.
Facilities with which Palmer College has a memorandum of understanding or academic affiliation include seven under the Veterans Health Administration and seven in the Department of Defense. These facilities are located throughout the United States in 11 different states.
Logan College President George Goodman to Retire in 2013
Additionally, TCC was awarded a $10,350 grant from NCMIC in August to help increase student research efforts on campus. Faculty and research leaders Dr. John Ward and Dr. Jesse Coats will be using part of the award to fund six $1,100 student research development grants.
Logan College of Chiropractic/University Programs President George Goodman, D.C. announced today that he will retire as President by March 31, 2013.
“As a faculty member and researcher, it’s very exciting to have our students actively engaged in the research process here at TCC,” said Dr. Ward. “I’m proud of the work Joseph, Gabby, Kelley and many of their classmates continue to further the chiropractic profession.”
Dr. Goodman has led Logan for two decades and is responsible for growing enrollment, expanding programs and establishing an endowment and investment base of more than $25 million.
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Urrea presented on Relationship between orthopedic hip screening tests and peak force production in unilateral isometric and dynamic movements (Joseph Urrea, Robert Burdsall, Robert Byrne, Tim Lee, Brett Ramey, Jamil Vohra, Amber Watson, Barry Wiese, William Amonette). In this project, asymptomatic participants engaged in four different orthopedic 25
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tests (Thomas test, Ober’s test, Trendelenburg test, and Gillet’s test) which measured hip function. After this, the participants engaged in isometric squats and other exercises to see how well the orthopedic test findings correlated with actual physical performance.
community, reviewed patient cases and shared their knowledge of medications commonly prescribed to patients with back and neck pain,” said Jack Koford, assistant professor and director of the Experiential Education School of Pharmacy. ”For some of the pharmacy students it was their first experience with chiropractic.”
Williams presented on Short-term impact of chiropractic spinal manipulation on cardiovascular physiology (John Ward, Jesse Coats, Ken Tyer, Gabbrielle Williams, Shauna Weigand, Danielle Cockburn). This study measured how spinal manipulation impacted blood pressure, EKGs, pulse oximetry, and other cardiovascular attributes. The first part of this two-part study received final approval for publication by the Journal of Manipulative and Physiological Theraputics in September and should be published soon. The second part just received final approval for publication by Clinical Chiropractic.
This collaboration provided both health professions, which are taught at D’Youville, a chance to collaborate in the review of patient cases in an environment conducive to learning about each other’s profession. “Both the Department of Chiropractic and the School of Pharmacy recognize the importance of interdisciplinary collaboration to foster improved communication and an understanding of other’s profession,” said Lisa DeMarco, assistant professor in the chiropractic department. “We believe this will improve patient outcomes while administering evidence based quality care.”
In San Jose, Calif., Humphries presented on Systematic review of the use of complementary and alternative medicine by Non-Hispanic Blacks (John Ward, Kelley Humphries, Michael Ramcharan, Caroline Webb). This project is currently under review for publication consideration.
On schedule is another rotation for the spring semester where the chiropractic students will participate in the pharmacy rotations in the community.
TCC Announces New Board of Regent Members
Pharmacy and Chiropractic Students Collaborate
At their October retreat, the Texas Chiropractic College Board of Regents added Barbara M. Hanson, Ph.D. of San Jacinto College and William Theodore “Ted” Cummings, Ph.D. of the University of Houston–Clear Lake to their ranks.
In a unique student collaboration, D’Youville pharmacy students spent a week with the college’s chiropractic students during their clinical rotations. The pharmacy students had the opportunity to ‘shadow’ the chiropractic interns at their clinic on Main Street in Buffalo where they treat members of the local community. They were also at the College Campus Clinic and Buffalo Spine and Sports Institute in Williamsville, N.Y.
The pair joins Paul Raymond, D.C., a July 2012 appointee, as the newest members of TCC’s governing body. Dr. Hanson is the vice president for learning at San Jacinto College Central and was recently selected by a national review panel as one of only 24 community college leaders to attend the prestigious Executive Leadership Institute
“Pharmacy students observed chiropractic treatments being provided to members of the Texas Journal of Chiropractic
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sponsored by the League for Innovation in the Community College. She joined San Jacinto College in September 2009, bringing with her more than 25 years of experience, including 17 years in community college administration. She has served in such roles as chief academic officer, executive director for strategic program development, dean of instruction, division chair for modern languages, and has been a full-time faculty member teaching English as a Second Language and German. Dr. Hanson holds a doctorate in educational leadership, with a specialization in language and culture, from Northern Arizona University; a Master of Arts in English as a Second Language from the University of Arizona; a Master of Arts in German and German Literature from the University of Arizona; and a Bachelor of Arts in German and Music from the University of Arizona.
medicine. He is responsible for patient care and management, including nutritional assessments, impairment evaluations, and interpretation of functional capacity evaluations. He earned his Bachelor of Science degree in biomedical science from Texas A&M in 1994 and holds an American Academy of Disability Evaluating Physicians Designated Doctor certification. He is currently working on a second degree in nutrition.
Parker University Holds Homecoming Event Celebrating 30 Years Parker University held Parker Homecoming 2012 on its campus in Dallas, Texas, on October 26 – 28. Doctors of chiropractic and massage therapists attended customized education tracks while earning continuing education credits. Classes covered numerous topics, including combining nutrition and chiropractic, multiple causes of vertebral subluxation and disease, decompression, Medicare, treating sports injuries, the neurology of stress, orthopedic testing for upper extremity injuries, and much more.
The dean of the school of business at UH–Clear Lake since 1998, Dr. Cummings has been active on various organizations. He is a member of Bay Area Houston Economic Partnership, having served on the Board of Directors for two terms, and is also a member of Bay Area Houston Transportation Partnership. Since 1998 he has been a member of Space Center Rotary Club. Before coming to Texas, Dr. Cummings was interim dean and professor of marketing in the College of Business at the University of Nevada, Las Vegas. During his 18year tenure, he also served as associate director and senior research associate of the Center for Business and Economic Research, associate and assistant dean and department chair as well as principal investigator to several major grants with the Department of Energy. Dr. Cummings earned his doctorate in business administration from Arizona State University; a master’s of business administration from Western Illinois University; and a Bachelor of Science in Business from Indiana University.
The homecoming gathering marked the university’s 30 year anniversary and was comprised of numerous events, luncheons, and get-togethers including the annual Oktoberfest celebration where attendees reconnected with old friends, classmates, professors, and mentors. Along with the festivities, the Parker Alumni Association held an Alumni Awards Luncheon as well as 5, 20, and 25 year class reunions. Saturday’s all-day Philosophy Fest provided attendees the opportunity to refine and develop a stronger understanding of the chiropractic philosophy. Some of the professions’ greatest minds presented including Dr. Arno Burnier, Dr. Jay Morgan, Dr. Francis Murphy, Dr. Shawn
A 2001 graduate of Texas Chiropractic College, Dr. Raymond is a partner in the multidisciplinary, Injury Center of Houston, working closely with other doctors of chiropractic, medical doctors and a doctor of podiatric www.chirotexas.org
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Powers, Dr. Liam Schubel, Dr. Tracy Wilson, and more.
Medical Center, Walter Reed Military Medical Center and the Uniformed Services University of Health Services.
“There are so many people that have a need for what we do, but not an awareness of it,” said Dr. Shawn Powers.
B o t h fi n a l i s t s a r e a c t i v e c h i r o p r a c t i c practitioners, with extensive academic teaching experience and broad community service. Each finalist has research and publication credits, and an extensive array of professional presentations.
Speakers presented inspiring and motivating messages as well as provided tips on how to become leaders, how to communicate effectively with patients, and how to create awareness of chiropractic and its benefits.
The finalists were recommended by a boardapproved nine-member search committee selected from the board of trustees. The national search resulted in a total of 36 applicants for the presidency of the university.
“Imagine a world where every man, woman, and child is checked for cerebral subluxations and is adjusted from birth,” said Dr. Liam Schubel. “All I’m asking is for each of us to step up and take over by leading.”
"This recommendation is the culmination of hours and hours of reviewing applications and interviews," said Dr. Lassiter, search committee chair and member of the Parker University board of trustees. "The committee felt that these two candidates best fit the presidential profile that was approved by the board of trustees before the search began."
In addition, chiropractic, massage therapy, and other health and wellness exhibitors presented cutting-edge products and technologies. Parker University held additional homecoming festivities throughout the week including a 30th anniversary party, a student fitness competition, a pumpkin carving contest, and a scholarship dinner recognizing scholarship recipients and donors.
Sherman College of Chiropractic Announces New President
Parker University Announces Two Finalists for President
Sherman College of Chiropractic has named Edwin Cordero, DC, as the college's fifth president, effective Jan. 1, 2013.
The presidential search committee, headed by Dr. Wright L. Lassiter, Jr., has recommended two finalists in the search for the presidency of Parker University. The new president will replace Dr. Fabrizio Mancini, who has retired after serving as president for just under 14 years.
Peter Kevorkian, DC, chair of the Sherman Board of Trustees, made the announcement on campus Tuesday, Nov. 13. Dr. Kevorkian says the trustees look forward to working with Dr. Cordero as he continues to advance the college's mission of preparing students to become doctors of chiropractic through education, research and service.
The finalists, who both offer extensive experience in higher education and in the chiropractic profession, are Dr. Brian J. McAulay, executive vice president and provost of Life University; and Dr. William Morgan, clinical department head at the National Naval Texas Journal of Chiropractic
"I firmly believe the college has found in Dr. Cordero an outstanding leader who possesses 28
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not only vision and passion, but also an individual who has demonstrated over the years his commitment to the chiropractic profession and the vitalistic tenets upon which the profession was built," Kevorkian said. "I am confident that Dr. Cordero will lead the college and its students to face the contemporary demands and health care needs of the public while holding steadfast to the traditional values upon which Sherman College was founded. We look forward to all we will accomplish under Dr. Cordero's leadership and guidance." Dr. Cordero, a 1993 graduate of Life University's College of Chiropractic, is a practicing chiropractor in Boynton Beach, Fla. He frequently speaks at chiropractic associations, conferences and other organizations around the world with the goal of inspiring and motivating chiropractors and students to make a positive impact in their communities and the world. The Florida Chiropractic Society named him Chiropractor of the Year in 2011.
Cordero, Dr. Joe Donofrio, and Dr. Shawn Powers. Schwartzbauer continued to serve as the college's leader while the board conducted its search; his contract at Sherman ends on Dec. 31, 2012. Kevorkian said the board is grateful for Dr. Schwartzbauer's leadership of the college. "So much has been accomplished during the past five years thanks to Dr. Schwartzbauer's vision and his faithful service to the Sherman College. The Board of Trustees sincerely appreciates the dedication, time and talent he generously shared with the college during his tenure."
Transition Time at Northwestern With impending leadership changes at Parker University and National University of Health Sciences grabbing the recent headlines, many in the profession may not be aware that Northwestern Health Sciences University is currently searching for a new president.
Fluent in Spanish, Dr. Cordero practiced in Puerto Rico for a year before establishing his current private practice in Florida in 1995. He is dedicated to serving the chiropractic profession and has participated in humanitarian chiropractic mission trips; he served as chiropractor for the Costa Rican team in the Central American Olympic Games for eight years.
While the university declined to provide any details regarding his departure (including that he had left), it is clear that Dr. Mark Zeigler is no longer president, as evidenced by the university's acknowledgement that Dr. Michael Wiles, provost and vice president of academic affairs, is serving as interim president – a position he has held since April 2012.
Dr. Cordero says he is honored to serve as Sherman College's next leader. "My vision as president is to lead Sherman College in becoming the preeminent chiropractic school in the U.S. and the world, and to strengthen its cultural legacy of outstanding academics, chiropractic philosophy, excellent faculty, technique and research," he said.
According to Northwestern officials, a search firm has been selected by the university's search committee (consisting of board members, faculty, staff and students) to guide the process of identifying the next president. The application process will be announced once core competencies for the position have been determined.
Sherman College's search for the next president began in May after Dr. Jon Schwartzbauer announced he would be stepping down. After reviewing 20 applications and conducting preliminary interviews, the board narrowed the field to three candidates and released those names in October – Dr. www.chirotexas.org
In addition to providing the above information, Northwestern stated the following when responding to our request for information 29
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regarding the leadership transition at the university: "Rising enrollment numbers enable the university to be selective in identifying and attracting a new president. As a leader in chiropractic education, Northwestern continues to make significant contributions to chiropractic clinical research; and advocates for chiropractic and other CAM professions through its Center f o r H e a l t h c a r e I n n o v a t i o n a n d P o l i c y. Additionally, forthcoming revisions to the University mission and vision statement will reflect new growth opportunities. These initiatives, along with expanding programs, are key areas of focus for a new president."
Progress board of directors. As of press time, it is unknown what circumstances prompted his departure from Northwestern. However, we do know his next professional pursuit: vice president of education for Foot Levelers Inc., a position he assumed Oct. 8.
Palmer College Develops Clear Identity for DCs There is growing value and acceptance for conservative approaches to health care. Unfortunately, too many people are not aware of what chiropractic can do to improve their health. At least some of the public's poor understanding of chiropractic stems from the lack of a clear identity for the profession and description of what chiropractors do.
Dr. Zeigler was inaugurated as Northwestern's fifth president on Feb. 2, 2007, replacing Dr. Alfred Traina. A 1980 NWHSU graduate, Dr. Zeigler originally practiced in Sturgis, S.D., and held several professional and governmental leadership positions prior to being named president, including president of the South Dakota Chiropractic Association (1994-1996) and mayor of Sturgis (2001-2004). He was also a member of the Foundation for Chiropractic
Texas Journal of Chiropractic
More than three years ago, Palmer College of Chiropractic Board of Trustees Chairman,
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Trevor Ireland, DC, decided to begin a project designed to increase clarity and unity in chiropractic's public messages, hoping to promote better understanding of chiropractic, leading to greater utilization and better health through chiropractic care.
Be prepared to document your attendance at these required Medicare hours, and MAKE S U R E Y O U H AV E R E C E I V E D Y O U R REQUIRED MEDICARE HOURS BEFORE THE END OF 2012 OR YOU WILL NOT "BE ALLOWED TO RENEW [YOUR] CHIROPRACTIC LICENSE AT ANY TIME DURING CALENDAR YEAR 2013."
The Palmer Identity Statement for chiropractors is: The primary care professional for spinal health and well-being. It is supported by a number of documents, all of which are available on the Palmer Web site.
PQRS
The Palmer Board of Trustees unanimously approved the Palmer Identity Statement, Chiropractic Pillars, Mission, Vision, Values, Philosophy Statement and Practice Paradigm in June 2012. The benefits of widespread acceptance of the Palmer Identity Statement by a majority of chiropractors are far-reaching.
The Centers for Medicare and Medicaid Services (CMS) has ruled that providers not successfully/satisfactorily participating in PQRS by the 2013 reporting period (Jan. 1 - Dec. 31, 2013), will have their Medicare reimbursement decreased by 1.5 percent beginning in 2015, and 2 percent in 2016. Therefore, the 2012 reporting period is the last opportunity providers have to voluntarily participate in PQRS and learn how to report successfully/satisfactorily while their Medicare reimbursement is not subject to penalties. In 2013 your performance in reporting PQRS measures will determine what penalty will be imposed upon you in 2015 in the form of reductions in your fees.
With chiropractic firmly established as the thirdlargest form of health care in the U.S., behind medical doctors and dentists, Palmer's identity efforts are intended to preserve that core identity while building greater collaboration within the national health care system. The language approved by the board reinforces that direction by providing not only an identity, but also a description of what chiropractors do.
ANOTHER REMINDER!
The PQRS, or Physician Quality Reporting System, is an important new addition to "the reform of healthcare." Created in March 2007, PQRS originally established a financial incentive for eligible healthcare professionals to participate in a voluntary quality reporting program. For 2012, there are 208 quality measures and 22 measures groups in the PQRS, which can be reported to CMS.
Don't forget that TBCE Rule 73.3, (b)(2)(A)(iii) states: "...all chiropractic licensees must complete at least eight hours of continuing education in coding and documentation for Medicare claims during either calendar year 2011 or 2012. ... No licensee who was initially licensed in Texas prior to September 1, 2012, shall be allowed to renew his or her chiropractic license at any time during calendar year 2013 unless he or she has completed the required eight hours of continuing education in coding and documentation for Medicare claims during either calendar year 2011 or 2012. " www.chirotexas.org
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“We do not agree that the statute so limits the scope of chiropractic. Rather, the statute permits chiropractors to use objective or subjective means to analyze and evaluate the biomechanical condition of the spine and musculoskeletal system. … This means that so long as the objective or subjective means used are capable of revealing a significant fact about the biomechanical condition of the musculoskeletal system or spine, the test itself need not necessarily be a direct examination of the musculoskeletal system or spine.” “We hold that the statute does not prohibit a chiropractor from examining parts of the body other than the spine and musculoskeletal system if such an examination will assist in analyzing or evaluating the biomechanical condition of the spine or musculoskeletal system.” Congratulations TBCE! --Page 10
Texas Chiropractic Association www.chirotexas.org 1122 Colorado, Suite 307 Austin, TX 78701 Phone: 512 477 9292 Fax: 512 477 9296 E-mail: info@chirotexas.org