November 1, 2013
TEXAS JOURNAL OF CHIROPRACTIC The Texas Medical Association is again seeking to use Texas courts to change the scope of chiropractic practice in Texas. Seeking to limit chiropractic to musculoskeletal only, to remove the neurological component of the subluxation complex, and again going after “diagnosis.”
The latest attack by "offensive medicine" poses a danger to the chiropractic profession and threatens to either eliminate the profession altogether or to relegate it to nondiagnostic technician status.
There They Go Again! Texas Medical Association Sues to Change Chiropractic "Offensive Medicine" is at it AGAIN! By: Chris G. Dalrymple D.C., F.I.C.C.
The Texas Medical Association (TMA) is once again seeking to control others for the benefit of organized medicine. The latest attack by "offensive medicine" poses a danger to the chiropractic profession and threatens to either eliminate the profession altogether or to relegate it to non-diagnostic technician status. The TMA has amended their previous lawsuit (the one limiting the use of VONT) to once again question the right of the chiropractic profession to exist. TMA wants to limit the chiropractic profession to muscles and bones of the spine ONLY. They want to prohibit any association between chiropractic and the nervous system – they want to prohibit "improving the subluxation complex" because it is "a theory unsupported by evidenced-base research." They are asking that the definition of "musculoskeletal system" and "subluxation complex" as Continued page 2
Texas Chiropractic Association
TEXAS JOURNAL OF CHIROPRACTIC November 1, 2013
Texas Chiropractic Association
TMA claims that the subluxation complex does not exist and that the nervous system is “unrelated to a determination of the biomechanics of the spine or musculoskeletal system.”
conceptually used within the chiropractic profession for more than a century be deleted for reasons of their own choosing.
chiropractors to diagnose diseases by using the word “diagnosis” in its rules—“diagnosis” is a medical term referring to a medical diagnosis, which is the practice of medicine…."
Says the TMA in their lawsuit "regardless of the level of education or training … those who practice medicine must take the same examination that is required of all others doing the same thing, regardless of the system employed–they must be licensed by the Texas Medical Board." Thus the TMA would have all of health care be under the controlling authority of one governmental regulatory entity. While it may sound reasonable to proclaim the concept "if you want to practice medicine, get a medical license", the TMA, however, goes on to claim that the treatment of "medical conditions" is the "practice of medicine.
A declaratory judgement is the legal determination of a court as to the legal position of litigants in cases where there is doubt as to their position in law. It is a form of legally binding preventative adjudication. Thus, it seems, that the TMA is asking the judge to just legally determine that the cited TBCE rules be voided because the TMA's assertions are correct.
The problem is that to them quite literally EVERYTHING is a "medical condition," and EVERYTHING is the "practice of medicine," and they want to be in charge of EVERYTHING. The TMA again claims that the TBCE rule “unlawfully authorizes chiropractors to diagnose diseases by using the word 'diagnosis' in its rules," and "it unlawfully authorizes chiropractors to practice medicine in violation of the Texas Medical Practice Act." Below are direct quotes from the TMA's latest challenge to the chiropractic profession. See for yourself. WHAT TMA WANTS “This suit is a substantive challenge, by declaratory judgment, to the validity of …. the rule [that] unlawfully authorizes
The amended lawsuit is specifically asking for a declaratory judgement that the TBCE Rules 75.17 (c)(3) (C); (b)(5); and (b)(9) are invalid for the reasons asserted by the TMA, and they seek an order that they be declared invalid. These rules are published on the State of Texas web pages and are as follows: 75.17 (c)(3)(C) –This section has already been removed from TBCE rules. 75.17 (b)(5) – The definition of musculoskeletal system as "the system of muscles and tendons and ligaments and bones and joints and associated tissues and nerves that move the body and maintain its form." 75.17 (b)(9) – The definition of subluxation complex as "a neuromusculoskeletal condition that involves an aberrant relationship between two adjacent articular structures that may have functional or pathological sequelae, causing an alteration in the biomechanical and/or neuro-physiological reflections of these Continued page 3
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Texas Chiropractic Association
articular structures, their proximal structures, and/or other body systems that may be directly or indirectly affected by them." The trouble is the TMA's assertions are outrageous, incorrect, or just plain wrong. TMA's OUTRAGEOUS CLAIMS The lawsuit makes outrageous claims. A few of these are: "There is no accepted definition of biomechanics that includes the function of the brain, eyes, and inner ear." Really? Function of the listed body parts are NOT included in biomechanics – “the study of the structure and function of biological systems"? "Neither the brain, the eyes, nor any part of the ears is a part of the musculoskeletal system or spine of the human body."
Really? NOT knowing the functional ability of the nervous system – the central focus of the spine and the controlling factor of biomechanics – is acceptable to the TMA? "Subluxation complex is … a chiropractic theory unsupported by any evidence-based research." So, it's not the evidence, it's the "evidence-based research" that is the determining criteria for the TMA? Scientific studies that are published in chiropractic literature – AND IN MEDICAL LITERATURE – aren't "evidenced-based"? But then the TMA hasn't presented any evidence-based research demonstrating that "chiropractic theory is unsupported by ANY evidence-based research."
Really? There are no muscles in the eyes and no bones in "any part of the ears?" The brain has NO control over the coordinated movement of ALL muscles? Really? "The eyes and ears are not part of the spine or musculoskeletal system of the human body." The musculoskeletal system is defined by one source as "the human musculoskeletal system (also known as the locomotor system) is an organ system that gives ... the ability to move using the muscular and skeletal systems." So the eyes do not move and nothing in the ears move? Really? "In terms of anatomy, there is no health care definition that makes the nervous system a part of either the muscular system or the skeletal system." Really? I guess Gray's Anatomy is incorrect when it states "the NERVOUS SYSTEM is the most complicated and highly organized of the various systems which make up the human body. It is the mechanism concerned with the correlation and integration of various bodily processes and the reactions and adjustments of the organism to its environment." Nerves play no part in the function of the muscusloskeletal system or in biomechanics? "The nervous system is unrelated to a determination of the biomechanical condition of the spine or musculoskeletal system." Continued page 6
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Texas Chiropractic Association
Texas SpineCare Network
Medicare, Medicaid or an employer-sponsored health plan. To ignore this reality places all but the few totally private-pay practices at serious financial risk. Most health plans have A "Seat at the Table" for historically attempted to save Chiropractic money on chiropractic care by By Kevin E. Cichocki D.C. limiting annual visits and dollar Participating in managed care benefit limits. But because of the cost concerns and pressures placed networks has been historically on payers by competition and the been a point of concern for Affordable Care Act, more and doctors of chiropractic. Losing more of them are pushing beyond control of a patient’s course of these limits and are adopting a treatment to a nameless, faceless entity at the other end of an 1-800 utilization management approach that saves money through the telephone number or website reduction of physician-requested address, flies in the face of visits and services. everything we are taught as doctors. What's a profession to do? Do we passively sit on the sidelines Submitting to seemingly and allow the Texas landscape arbitrary decisions made by an insurer, or its delegated agent, that continue to migrate towards more difficult and arbitrary utilization result in denial of treatment that our profession considers within the management rules and control, or do we take matters into our own best interests of our patients is a frustrating proposition for even the hands and work to control our own destiny? TCA has elected an most patient and cooperative approach that offers us a seat at chiropractic doctor. Yet, the table and an opportunity to insurance and associated utilization management programs enter into a constructive dialogue with the Texas payer-community. are a fact of life for most For far too long, we have been chiropractic practices today. In a state like Texas, well over unable to initiate or sustain a 70% of patients are covered by
cooperative relationship with these folks. TCA’s affiliation with Palladian Health promises to change the conversation from chiropractic limitations to one that features chiropractic and spinal manipulation as the key to reducing unnecessary surgeries and injections. TCA is sponsoring the development of a membership-based statewide chiropractic network which will be self-governed by a panel of TCA members. The Texas SpineCare Netorksm, (TSN), will be featured in Palladian’s Coordinated Spine Caresm program (CSC), which uses data mining, population health management techniques and indisputable science to reduce the migration of back pain patients to anesthesiologists, physiatrists and spine surgeons. With a new standing as a positive factor in reducing surgeries and injections (which services comprise the vast majority of the 10-15% of total health plan spending attributable to back pain) we will now have a unique opportunity to join the conversation as a solution, rather than being seen as the problem. By performing their claims-based, Continued next page
Dear TCA, Regarding the Texas SpineCare Network If we could get "enlightened physicians" on board with what we are trying to do, it would make a huge effect on peoples' health and the future of chiropractic.
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I think this sounds like a good idea, and I think what will enhance the effectiveness of your new approach is testimonials from
patients who have been remarkably helped by chiropractic–myself included. I have a bad back from years of river-rafting - but am kept MOBILE and HEALTHY with my regular chiropractic adjustments and nutritional
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TEXAS JOURNAL OF CHIROPRACTIC November 1, 2013
Texas Chiropractic Association SpineCare Network from pg. 4
data-driven analysis of historical health plan spending, Palladian will be able to support the contention that priorauthorization is best applied to the migration of back pain patients to allopathic specialists rather than to effective chiropractic care. Many patients who have historically migrated up the complexity curve will now be channeled to conservative care, primarily spinal manipulation performed by doctors of chiropractic, increasing payer patient flow and practice revenue.
What's a profession to do? Passively sit on the sidelines or do we take matters into our own hands?
outlier practice patterns for resolution. Most importantly, this TSN will be supported by a information will be Palladian-supplied set of data used in combination collection and reporting tools, with measurable which will allow for gathering reductions in overall patient self-reported condition back pain spending to information and diagnosis/ prove the value of treatment plans created by chiropractic as safe and participating chiropractic cost-effective care. physicians. This information will Participation in TSN will be be used by all parties – TSN, available to all qualified TCA primary care allopathic physicians, members who apply and meet the health plan and our individual network credentialing member participants – to track requirements. There are no patient progress, measure member costs related to functional recovery and to identify application/membership, ongoing
supplements (I am 61). My daughter is a nurse and has almost all of her nurse friends on chiropractic, massage and supplements - with which they have had GREAT results after trying "physical therapy" first and getting no true results. Also, I have worked for orthopedic surgeons in the past (I am retired now) and frankly would not
participation or claim submission. There will be a small percentage of per-claim reimbursement withheld for distribution to those chiropractic physicians who meet the quality and overall performance standards set by the TSN Governing Board. TCA and Palladian will not share in the distribution of these funds; contracting health plans will be responsible for paying for access to CSC and TSN services on a per-member per-month basis. The network itself will not be built until we are ready to deliver payer clients to our members, and each member will have the ability to elect participating on a payer-specific basis. The TCA/Palladian collaboration offers Texas chiropractors a way to create a measure of control over our own destiny and a guaranteed chair at the table during these important decisions. In the imperfect world in which we practice, isn’t it better to have that seat than to wait for the payers to announce another takeit-or-leave it arrangement?
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go to one unless I had a broken leg, or a condition that my chiropractor was unable to correct and required surgery - believe me, that would be my last resort. Even then I would still try to find a way to avoid the surgery. Unfortunately, it is all about the $$$ these doctors make from very expensive, invasive back surgeries which change the normal Continued page 16
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Texas Chiropractic Association
“Bought” Movie in Preproduction Movie Producer Jeff Hays reports that "Bought the movie has come a long way. We’ve been in preproduction and started interviews and filming. And once again, we get our breath taken away by what we’re capturing." "We’ll spend just $600,000 to make this film. Pharmaceutical companies will spend $4 Billion this year to advertise to you, your family, your children, your doctor." "We’re filming stories of the ruined lives of people who did nothing more than trust in their doctors, their government, and their well-intentioned friends. We intend to shine a bright light into some very dark corners. We’re going to bring more evidence, more credibility, and more promotion to these subjects than any film has ever attempted." "We just launched the new Indiegogo campaign to fund the rest of the production of the film. We’ve enlisted some great sponsors who’ve stepped up in a huge way and donated some fantastic reward items to help make Bought a reality. Go ahead and click here to see for yourself. Offensive Medicine from page 3
WHAT TMA CLAIMS The TMA states that "'practicing medicine' means the diagnosis, treatment or offer to treat a mental or physical disease or disorder or a physical deformity or injury by any system or method, or the attempt to effect cures of those conditions, by a person who: (A) publicly professes to be a physician or surgeon; or (B) directly or indirectly charges money or other compensation for those services." This is straight out of the Medical Practice Act. A closer reading of the above sentence demonstrates that the "performance of medicine" is 1) the diagnosis of, and 2) the offer to treat for that diagnosis, by 3) any system or method by
4) a person who publicly professes to be a physician or surgeon, or 5) who charges a compensation. The phrase "a mental or physical disease or disorder or a physical deformity or injury" is a descriptor of the object of treatment, IT DESCRIBES A CONDITION TREATED MEDICALLY, NOT THE DEFINITION OF THE TERM "MEDICAL CONDITION." TMA claims that "improving the subluxation complex" should be removed because it is "a theory unsupported by evidenced-base research." The term “subluxation complex” is supported: a complex is "an intricate or complicated association or assemblage of related things." A subluxation is an "incomplete or partial dislocation, as of a bone in a joint." A dislocation is "displacement of a body part, especially the Continued page 11
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Texas Chiropractic Association
Still Don't Believe Organized Medicine Wants CONTROL of Health Care? The American College of Physicians (ACP) took a nuanced position on the role advanced nurse practitioners play in clinical care teams in a position paper. The college believes patients should have immediate access to a physician who oversees but care teams should be organized and managed in a way that best meets patients' interests. Nurse practitioners "cannot substitute" for doctors, but patients should be matched with the member of the care team most qualified and available at the time.
The internal medicine group tipped its hat toward … other health professionals … But later, the paper placed doctors at the top of the team's pecking order, saying, "Advanced practice registered nurses and physician assistants cannot substitute for or replace the skills and expertise of physicians.”
The internal medicine group tipped its hat toward nurses, physician assistants, pharmacists, social workers, and other health professionals, saying responsibilities in a The position paper comes at a time team must assure that patients receive the when ACP says the current model of healthcare delivery must change to meet the care they need at any given time. But later, the paper placed doctors at the top of the coming demands of patients. To do so, the healthcare system therefore must shift from a team's pecking order, saying, "Advanced practice registered nurses and physician individual-clinician model to that of teamassistants cannot substitute for or replace the based care, the paper stated.The paper marks ACP's entry into the scope-of-practice skills and expertise of physicians within their discipline, but when they practice to the top controversy. of their licenses, they can provide Continued page 10
From the Internet
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Texas Chiropractic Association
Dr. Harper defined Environment as: “The totality of influences acting upon the organism both internal and external.” Internal is intracellular and external is extracellular matrix according to Harper. Dr. Harper defines the line itself between Environment and Resistance as the nervous system in the chiropractic formula. Epigenetics struggles with this and in some of the literature even calls it Innate. Most of the Epigenetic scientists drop the idea at this point.
Epigenetics and Chiropractic By Tim McCullough, D.C., D.A.B.C.I., A.P.C.
Dr. William Harper wrote in Anything Can Cause Anything, “We might define health as controlled irritation of the nervous system that leads to adaptation, that is, some environmental demand starts the process that causes Innate to direct the impulses which control function for adaptation.[1] Andy Feinberg, MD, MPH, professor of molecular medicine and director for Epigenetics at Hopkins’ Institute for Basic Biomedical Sciences found reversible tagging of methylation patterns of genes respond to changes in the environment controlling the output of the genes. Epigenetic scientists including Dr. Feinberg have determined that environment of the cell is the controlling factor of cellular response determining health and disease.[2]
Dr. Harper’s book was an explanation of chiropractic theory as promulgated by DD Palmer. The essence of Dr. Harper’s treatise resulted in a formula for chiropractic theory. It is important to remember Dr. Palmer was searching for the universal formula for disease when he “developed” chiropractic. Here is the formula for the chiropractic theory: Environment Disease = –––––––––– = Health Resistance When you study this formula in its entirety you will understand that this new science of Epigenetics isn’t new at all. In fact, you will see that epigenetics explains what Drs. Harper and Palmer were
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TEXAS JOURNAL OF CHIROPRACTIC November 1, 2013
Texas Chiropractic Association Epigenetics from pg. 8
communicating about health and disease starting in 1895 and expanded during the 1960s. Dr. Harper called chiropractic the science of Existence. This is no simple concept and requires serious study of every branch of science. There is a critical bit of information here that if you missed this you would miss the entire concept of this formula. Dr. Harper defined Environment as: “The totality of influences acting upon the organism both internal and external.” Internal is intracellular and external is extracellular matrix according to Harper. [3]
Dr. Harper goes further asking the same questions Dr. Feinberg and thousands of scientists are asking today about epigenetic control of the cell. He writes: “If we could answer the following questions for every system, organ, and cell in the body, there would be no questions that we could not answer.” “What is the gross reaction of the organism to changes in the environment?” “What is the analysis of the simpler reaction of which the gross reaction is composed?” “What is the assignment of each cell, its part in every reaction, and how is it controlled normally?” Dr. Harper answered these questions in 1964 minus current knowledge such as does the attachment of the DNMT3A epigenome to the Cp6/DNA cause the gene to express a certain disease or condition? Dr. Harper said, “This knowledge would explain how and why every symptom or abnormal function occurs. This is diagnosis. This concept is peculiar to chiropractic. Let us use it, even if it means discarding ideologies that have no basis in fact.” [4] Chiropractic theory adds another layer to the current theory of epigenetic control of the cell. Chiropractic theory states that this expression of the cell is coordinated through the nervous system. In fact, Dr. Harper defines the line itself between Environment and Resistance as the nervous system in the Continued page 15
The Kentucky Board of Chiropractic Examiners, now backed by the state, has claimed that physicians who review chiropractic medical records are violating state law prohibiting nonchiropractors from performing peer review of The Litigation Center of the AMA and State patient care given by chiropractors. Medical Societies is standing up for physicians’ “A licensed physician’s scope of practice is the ability to provide expert review of medical records most broad and complex of all the health carewithout undue interference in a Kentucky appeals related professions, due in large part to the highly case. competitive and extensive medical education and Last week the AMA Litigation Center and the training required as a condition of licensure,” the Kentucky Medical Association (KMA) filed a friend- brief states. “Providing expert opinions and of-the-court brief supporting a lower court’s ruling testimony is a facet of the practice of medicine for that upheld physicians’ right to provide expert many physicians, and it is an important service to medical review in auto insurance cases that included their patients and the community at large.” chiropractic treatment.
Kentucky Case Questions M.D. Review of Chiropractic Cases
via AMA Wire - Kentucky case questions physicians’ right to review medical records.
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Texas Chiropractic Association Control of Health Care from pg. 7
complementary and unique approaches, as well as additional skills in the service of patients and families." And the policy paper later states patients deserve access to a personal physician who "has leadership responsibilities for a team of health professionals. "Leaders of the American Association of Nurse Practitioners disputed many of the ACP's principles. "These needs and the patient's preferences should determine which provider leads a healthcare team. Team leadership should not be defined by a particular professional nor by a regulatory or licensing body." The American Medical Association and American Academy of Family Physicians have more clearly asserted that physicians should led care teams, while other bodies, like the Institute of Medicine and the National Committee for Quality Assurance, have stated they're fine with nonphysician leadership. The scope-of-practice controversy failure to resolve this issue hinders the development of dynamic clinical-care teams, particularly in states where nurse practitioners can practice autonomously."
The Institute of Medicine and the National Committee for Quality Assurance, have stated they're fine with nonphysician leadership. The scope-of-practicecontroversy hinders the development of dynamic clinical-care teams. ACP said exceptions to the physician-asleader model should be made for communities with physician shortages, although in such cases, doctors should still have a "virtual presence on clinical-care teams." "Given the breadth of primary care, licensure and regulation cannot restrain nonphysician primary caregivers from offering primary care services that they are not qualified to provide." "Only professionalism will keep such caregivers operating within their sphere of competence -- as is the case for all clinicians, including primary care physicians." The paper also suggested that training of students and residents should involve team-based care -- a method of instruction not currently done -and that states should review their licensure laws. Via: ACP Hedges in Debate on Scope of Practice.
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Texas Chiropractic Association
TCA recently held their annual Leadership Conference where they learned: There is a better way. The old adage, “Form follows function” certainly applies. Organizations are systems. Organizations that fail to understand the interaction among these three elements – outcomes, performance, and structure -- will diminish their effectiveness.
“Offensive Medicine” from pg.. 6
temporary displacement of a bone from its normal position." Thus a subluxation complex is "an incomplete or partial temporary displacement of a bone from its normal position in an intricate or complicated association or assemblage of related things."
and maintain its form,’) which implies that anything that affects movement of the body or maintenance of its form would be included in the musculoskeletal system …."
The word "related" means "associated; connected"; therefore the brain, the muscles of the eye, the bones in the ear, ARE related via the nervous system and thus may be a component of a subluxation complex. They MAY be (and have been) improved by the practice of chiropractic. This is the concept promoted by the chiropractic profession for nearly 120 years.
That defining “subluxation complex” as a “neuromusculoskeletal condition ... exceeds the scope of authority conferred on chiropractors by the Chiropractic Act." That "the use of the term “diagnosis,” the definition of “musculoskeletal system,” the definition of “subluxation complex” .... unlawfully authorizes chiropractors to practice medicine."
TMA ALSO CLAIMS The definition of musculoskeletal system used by That "the privilege of practicing medicine and chiropractors "improperly defines an anatomical the value of the medical license held by term by a functional context (‘that move the body Continued page 12
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TEXAS JOURNAL OF CHIROPRACTIC November 1, 2013
Texas Chiropractic Association “Offensive Medicine” from pg.. 11
physicians are diminished because chiropractors are not licensed to practice medicine." If taken out of context this statement could be interpreted to mean that the physician's medical license is devalued because DCs are not licensed to "practice medicine."
"A chiropractor’s scope of practice is limited to the spine and 'musculoskeletal system' of the human body and the use of procedures to improve the subluxation complex." "TBCE’s addition of 'nerves' to the definition of musculoskeletal system improperly expands the definition beyond the limits of the scope of practice.”
Alas this is NOT what TMA intended, but it does demonstrate that things taken out of context can be misconstrued to a meaning opposite of its original intention.
More Quotes From TMA
biomechanical condition is limited to the spine and musculoskeletal system, which does not That "the authority of a chiropractor to 'analyze, examine or evaluate' and treat a patient include the … nervous system." is limited to the biomechanical condition of that "The Scope of Practice Rule unlawfully patient’s spine or the biomechanical condition of exceeds TBCE’s statutory authority because [it] that patient’s musculoskeletal system, and to authorize[s] chiropractors to perform critical perform procedures intended to improve the diagnostic tests and engage in activities that subluxation complex." exceed the analysis, examination, and evaluation “There is universal accord that ‘biomechanics’ means simply the application of mechanical principles to living bodies …. There is no accepted definition of 'musculoskeletal system' that includes 'nerves.' …. The nervous system is a different body system. And, as noted above, a chiropractor’s analysis, examination, evaluation and treatment of a person’s
of the biomechanical condition of the spine and musculoskeletal system of the human body and are unrelated to procedures designed to 'improve' the subluxation complex." "It takes years of medical training and education in the intricacies of the audio vestibular system in order to perform, read and interpret ENGs and VNGs Continued page 13
S 944 and HR 921 Recently the ACA's U.S. Department of Veteran's Affairs (VA) expansion bill was included in a VA omnibus bill (S. 944) that passed out of the Senate VA committee. There is also a companion bill in the U.S. House of representatives, H.R. 921, which needs additional co-sponsors. Many members will cosponsor a bill if a constituent asks them to. Please take the time to reach out today and ask your elected officials to co-sponsor H.R. 921.
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Texas Chiropractic Association “Offensive Medicine” from pg. 12
[Electronystagmography (ENG) and Videonystagmography (VNG)], reach a correct diagnosis and treat patients effectively. Indeed, the purpose of ENGs and VNGs is to make a medical diagnosis, which chiropractors are not licensed to do."
authority to “analyze, examine, or evaluate.” By comparison, the practice of medicine is defined specifically to include the “diagnosis” of medical conditions …."
of systems. There is a skeletal system (comprised of bones) and a muscular system (comprised of skeletal, e.g. striated, muscle). There also is a nervous system, a cardiovascular system, a "The legislature did not lymphatic system and a gastroauthorize chiropractors to intestinal system, among diagnose medical conditions, as others. Each of these systems is "Furthermore, disorders shown by its deliberate on par with the other systems. affecting the biomechanical exclusion of the word from the The term “musculoskeletal” condition of the spine and definition of the practice of commonly is used in health musculoskeletal system of the chiropractic." care because the function of the human body do not cause "A chiropractor’s scope of muscles is to move the bones, vestibular system pathology. practice is limited to the spine thereby making it convenient to Thus, Vestibular-Ocularand 'musculoskeletal system' of describe the two systems Nystagmus testing does not fall the human body and the use of together. There is no known within the statutory practice of procedures to improve the similar combined use of chiropractic. Therefore, subluxation complex." “nervous system” with either TBCE’s rule authorizing the muscular system or the "TBCE’s addition of chiropractors to perform skeletal system. 'nerves' to the definition of Vestibular-Ocular-Nystagmus musculoskeletal system testing exceeds the statutory In terms of anatomy, there improperly expands the authority of TBCE and is void." is no health care definition that definition beyond the limits of makes the nervous system a "Chiropractors have no the scope of practice part of either the muscular statutory authority to make authorized by the Chiropractic system or the skeletal system. diagnoses; instead, the Act. Specifically, the human The addition of the term statutory definition of body is composed of a number “nerves” to the definition was chiropractic limits their Continued page 17
IPAs May Help Small Practices Enhance Care Small and mid-size practices may be able to implement advanced care management programs by participating in independent practice associations (IPA) according to a new study. The study looked at the extent to which IPAs made it possible for smaller practices to share resources to improve patient care. On average, the practices that participated in one of these organizations—nearly a quarter of the survey respondents—provided nearly three times as many care-management processes for patients with
chronic conditions as did the practices that did not participate in an IPA. The authors concluded that these organizations may be a "viable organizational alternative" to hospital employment "during an era of major changes in how health care is delivered and paid for." via AMA Wire - Study: IPAs may help small practices enhance care.
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Texas Chiropractic Association
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Texas Chiropractic Association Epigenetics from pg.. 9
chiropractic formula.[5] Epigenetics struggles with this and in some of the literature even calls it Innate. Most of the Epigenetic scientists drop the idea at this point for the fear of being associated with the untouchable idea of including theology in science. Epigenetics is the expression of the genes in response to the internal and external environment of the cell. This expression can be short term or long term, abnormal or normal but it is in response to changes in the cell environment. This is a new concept in medicine and is taking the scientific world by storm, and yet this is right out of Dr. Harper’s book explaining DD Palmer's principles. It is becoming clear that the gene itself plays only a partial role in health and disease and isn’t the controlling factor as current epigenetic theory holds. It is the epigenetic control of the gene that determines the expression of the gene. Cellular biologist and epigenetic geneticists understand that methylation of the gene is a key to epigenetic control; this control is a result of the cell responding to a changing environment of the body–either macro, micro, internal or external. Dr. Harper elucidated bacterial, viral, chemical, physical, electrical, psychic factors that are responsible for abnormal cellular environments and that the nervous system reflects those changes physically in the body and the spine. He also postulated that the nervous system ultimately controls the reaction of the body to the abnormal cellular and extracellular environment and treatment of the nervous system is vitally important. He didn’t know about epigenomes, histones, and methylation of genes and other new discoveries that control the cell’s reaction to its environment but I would imagine he would be very excited to read the new research. Today we know about endocrine disruptors, receptor disruptors, genetically altered foods and micro dose chemicals and drugs that change cellular environment causing and abnormal expression of
the genes and cause disease. Chiropractic theory states, any physical, chemical, psychic factor that causes irritation of the nervous system is functional pathology. A recent study in Clinical Pharmacology stated, “It is becoming clear that all complex diseases are the result of gene-environment interactions and that epigenetic modification of gene function during critical periods in development plays a critical role in the etiology of disease.”[6] Dr. Harper, using DD Palmer's ideas, theorized that neurological reflections from an altered cellular environment and the reaction of the cells to this abnormal environmental stress resulted in the chiropractic subluxation complex. He even defined the nervous system as the mediator in his formula for disease and health. In light of this new information Dr. Harper might say that any stress– chemical, structural, and electrical–can result in the changing of the cellular environment. This may result in epigenetic control alterations in the expression of the genes which in turn are reflected through the nervous system and may manifest in a biomechanical alteration of the body. The scientific world has arrived in 2013 where chiropractic started in 1895. Today’s modern theory of disease is "Chiropractic 101" right out of Dr. David Harpers textbook explaining DD Palmer's theory of chiropractic. [1] Anything Can Cause Anything, Harper, William, 1997, Texas Chiropractic College, page 20 [2] Science News, How Bees Decide What to Do, Sept. 16, 2012, page 1. [3] Harper, page, 27, 30. [4] Ibid, page 26 [5] Ibid, page29 [6] Clinical Pharmacology and Toxicology, 102 (2) (2008), pp. 76-81.
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TEXAS JOURNAL OF CHIROPRACTIC November 1, 2013
Texas Chiropractic Association “Dear TCA” from pg.. 5
anatomical position of the spine and weaken the level above and below it, thus often necessitating future surgery. Please continue to fight for a redefinition of the scope of chiropractic. So many people are clueless regarding the other aspects of their health that chiropractors can help them with - NUTRITION, DETOX, HEALTHY DIET, etc. A friend of mine's son-in-law just recently graduated from medical school, and she asked him "Did you have ANY training in nutrition?" He said "About 6 months, and it was an elective so those who chose NOT to take this class were absolutely allowed to skip it." This is sad since the body needs proper nutrition and cleansing of all of the toxins from our environment to avoid life-threatening diseases such as auto-immune disorders (Cancer, MS, Rheumatoid arthritis, lupus, etc.). I speak from experience– I am an 18 year cancer survivor. I give first credit to my faith in the Lord, and secondly to my diet and nutritional supplements. As we know, our food is processed (sometimes it travels 1500 miles to the grocery store and in that time loses valuable nutrients). And the farmers don't rotate crops as they did 50-100 years ago, to make sure the nutrient content stays high. Most foods are now GMO's (genetically altered), and the effects of eating that type of food are long-lasting, especially high fructose corn syrup which many people, who are allergic to yeast and gluten are also sensitive to. This can cause diseases of all sorts, as it forever changes the normal bowel flora unless cleansing and nutritional supplementation are used to help restore things to their natural balance.
My opinion is just that of one loyal patient. I would literally not be mobile or healthy without chiropractic. I am one who has tried to pass on the "good news" of chiropractic to as many as I can. My daughter, as I said, also passes the word on and has helped many. One of the nurses she used to work with was afraid of chiropractic originally, but was having horrible pain in her back and legs. One week-end she COULD NOT walk, and eventually called my daughter, saying "What is the phone number of your chiropractor? I cannot walk and I must be able to for work, etc." After a few adjustments she was not only walking but feeling GREAT. Now she goes for regular care every 3-4 weeks. I have a fine heritage of chiropractic, with both of my grandparents on my mom's side graduating from the original Palmer Chiropractic College in Davenort, Iowa (probably around 1916). So, I guess they were some of the first pioneers in the field. Of course, I am so proud of them and their "Heritage of Health" which they passed on to my mom, my children, and now we're passing it on to my grandchildren and as many other people as will listen to the message – those who have not been negatively influenced by false popular–medicine statements.
God bless you in your quest to get the knowledge of chiropractic as the first and the last form of treatment for acute and chronic back pain. We have at least one "informed" physician in the hospital where my daughter works who refers his back patients to a chiropractor rather than an orthopedic surgeon for help! If we could get more I apologize for going "on and on' about this, but "enlightened physicians" on board with what we are somehow we have to get the message out there that trying to do, it would make a huge effect on peoples' American people do NOT need more drugs, surgery, health and the future of chiropractic. injections etc. to get well; these only promote God bless you in all you do! sickness (with all the side effects of same) and Sincerely, eventually lead to death. We need to get at least one pharmaceutical company or some other successful Erin Perdue company who is willing to invest in America's health future on board with promoting WELLNESS and helping TCA to get the word out!
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TEXAS JOURNAL OF CHIROPRACTIC November 1, 2013
Texas Chiropractic Association “Offensive Medicine” from pg.. 13
done by TBCE to expand unlawfully chiropractors’ scope of practice into the field of neurology, something the statute does not authorize them to do. Further, the nervous system is unrelated to a determination of the biomechanical condition of the spine or musculoskeletal system. Lastly, by combining these terms with the phrase, 'that move the body and maintain its form,' (a functional component), the language implies that any body system could 'affect' movement and therefore be within the scope of chiropractic. Accordingly, the definition of musculoskeletal system exceeds and is in conflict with TBCE’s statutory authority and is, therefore, void." "The Chiropractic Act authorizes chiropractors to treat the subluxation complex. … The Act does not define subluxation complex. The language of the statute, when read as a whole, does not support using the authorization to perform procedures to “improve” the subluxation complex to expand on the limited authority of chiropractors to analyze, examine and evaluate the biomechanical condition of the spine and musculoskeletal system." “Subluxation complex” is neither a medical term nor a known pathological entity. It is a chiropractic theory unsupported by any evidence-based research. In fact, in 2010, the General Chiropractic Council (TBCE’s counterpart in the United Kingdom) issued a guidance on the use of the term due to the fact that, 'it is not supported by any clinical research evidence.' According to TBCE’s own expert,
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subluxation complex as a theory of disease no longer is taught in any chiropractic schools in Texas. Even though the statute uses the undefined term 'subluxation complex' in describing what a chiropractor can treat, TBCE cannot define the term to include things that exceed the scope of practice set forth in the statute, including calling it a 'neuromusculoskeletal condition,' and 'neurophysiological' and claiming that it extends to 'other body systems that may be directly or indirectly affected by them.' The definition of subluxation complex exceeds and is in conflict with the Chiropractic Act and is, therefore, invalid and void." "TMA asks for the following relief: A. A declaratory judgment that 22 TEX. ADMIN. CODE § 75.17(c)(3)(C), § 75.17(b)(5), and § 75.17(b)(9) are invalid for the reasons stated above; and, B. An order invalidating 22 TEX. ADMIN. CODE § 75.17(c)(3)(C), § 75.17(b)(5); and § 75.17(b)(9)."
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TEXAS JOURNAL OF CHIROPRACTIC November 1, 2013
Texas Chiropractic Association
Organized Medicine Introduces 300 State Legislative Bills To Discourage Trade
legislative session in most states, dozens of legislative victories made possible by collaborations between the AMA and state and medical specialty associations will be driving the future of health care across the country." "Included among these successes are the following legislative actions: Florida passed a broad medical liability reform Once again Organized medicine makes no secret bill that will transform the state’s practice landscape of their desire to maintain an effective monopoly by by requiring fairness in the use of medical expert decreasing barriers to their own practitioners while at the same time raising them for others. In fact they witnesses. are crowing that organized medicine introduced 300 Georgia adopted a bill to clarify that federal state legislative bills to discourage trade. These standards and guidelines designed to enhance access include nearly 300 bills introduced "to eliminate team- to high-quality care cannot be used to invent new based models of care" and those which, in their minds, legal actions against physicians. The law is based on were designed to "expand the scope of practice for nonan AMA model bill. physician professionals." Texas adopted legislation that will regulate rental Other legislation pursued by "organized networks and require these payers to obtain medicine" will require health care professionals to express agreement from physicians to pay clearly and honestly disclose their level of training, discounted rates for the services they provide. education and licensing to patients. Will this Four states enacted laws based on the AMA’s necessitate us having to put on our business cards “Truth in Advertising” model bill, which requires "Dr. John Doe D.C., XXX undergraduate hours, 2500+ health care professionals to clearly and honestly Doctorate Hours, XXX hours of clinic supervision, over 500 disclose their level of training, education and of continuing education, and 30+ years of active practice?" licensing to patients. Of course specialists and diplomates would have to Fourteen states passed laws aimed at reducing have a name badge the size of a 3-by-5 inch index physicians’ cost and time burdens of prior card. Why not just make all health professionals authorization processes. wear lab coats that emblazon their credentials like Also during the 2013 legislative session, nearly sponsors logos on NASCAR jumpsuits? 300 bills were introduced to eliminate teamThe American Medical Association appears based models of care or dangerously expand satisfied at their exertion of control over other the scope of practice for non-physician people's lives for the betterment of their own. professionals. Scores of these bills were defeated They report that "with the conclusion of the 2013 by the joint efforts of organized medicine, even as others still are under consideration." "No matter where physicians live, however small Call 512-477-9292 or large their state, they can count on the power of organized medicine to fight for a legislative environment that advances quality care and supports the needs of physicians and their patients." Via: State legislative sessions bring big successes for physicians, patients
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Offering discounts the wrong way is like getting into a boxing match with all the odds against you. CMS/Medicare is targeting violators and insurance companies are enforcing provider agreements; they are hiring and training heavyweight auditors, and are far better prepared than ever before. Offering discounts or free services could be considered inducements if not done properly, and with fines of up to $10,000 per occurrence, many practices are just one audit away from being K.O.’d. But offering discounts to your cash and underinsured patients can be legal if done the RIGHT way! Over 2,100 doctors are doing it... Are you? If you’re not sure, give us a call and let’s review it together. Over 140,000 patients appreciate their doctors for keeping health care affordable for their families; join ChiroHealthUSA and yours will too! And if that’s not enough, ChiroHealthUSA is also proven to help converting shopper calls into new patients, and can help transition patients from insurance to cash, as well as offering options for HIGH deductibles plans and affordable family plans. Don’t risk it; contact us now and start practicing with peace of mind!
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TEXAS JOURNAL OF CHIROPRACTIC November 1, 2013
Texas Chiropractic Association
Chiropractic Advocacy Report – State and National Teamwork One of the American Chiropractic Association's (ACA) newest programs, the State Affiliation program, is picking up steam and seeing many successes, the ACA reports. The goal of the program is to increase communication and collaboration between the state chiropractic organizations and the ACA. Participants say it is meeting, and exceeding, that goal. The idea for the State Affiliation program came about several years ago when chiropractic leadership realized that chiropractic national, state, and local level advocacy associations needed a way to be able to work together and to assist each other. "Several other health care professions have one dues program that encompasses the national, state and local levels and allows the different levels to work together and assist each other," explains Rick McMichael, DC, chairman of the State Affiliation Committee. “We realized that our profession doesn’t have the infrastructure necessary for such a program, but we wanted to begin moving in the direction of working together and assisting each other more frequently. That’s how the State Affiliation program was born,” he says. It’s important for the national organization to be aware of the happenings in each state and vice versa. The ACA's State Affiliation program places an approved state representative into the ACA’s House of Delegates as a voting member, and in turn, allows ACA to place an approved representative on the state organization’s governing body. “This allows us all to understand the goals and objectives and issues on each other’s plates,” says Dr. McMichael. “Now, when state issues are addressed, the national perspective can be heard, and when national issues are brought up, the state perspectives will be voiced.”
Michael Martin, DC, is currently serving as ACA’s state organization representative (SOR) from Texas. “ACA has resources and information that the Texas Chiropractic Association (TCA) doesn’t. It’s my job to get TCA to make good use of those resources and to ensure that the communication between the two organizations is as seamless as possible,” Dr. Martin explains. “At the same time, TCA has the organization and infrastructure of members working on the state level that could be useful to the ACA.” There are numerous examples of the successful collaboration between ACA and TCA. Recently, TCA was involved in a lawsuit with the Texas Medical Association (TMA), and the state wanted to send press releases to generate public support for its cause. Dr. Martin was able to connect TCA’s public relations chairman with ACA’s public relations manager. Within an hour, TCA’s press release was sent to more than 600 outlets. In another instance ACA’s PR manager was able to run media training for the TCA executives at a time when they were dealing with difficult interviews from a newspaper questioning the role of DCs in the treatment of obesity. The training greatly helped the executives feel comfortable handling aggressive interviews, and this put us (TCA) in a position where we could do much better work for the profession,” notes Dr. Martin. “My job is to create those connections between TCA and ACA, and I’ve seen how effective the collaboration can be,” says Dr. Martin. “The amount of cooperation and collaboration we’ve accomplished in such a short time has been truly energizing for TCA,” he reports. “We’ve achieved a sense of higher purpose and more enthusiasm about Continued pg. 24
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TEXAS JOURNAL OF CHIROPRACTIC November 1, 2013
Texas Chiropractic Association
Giving Good Phone By Dr. R. A. Foxworth, FICC, MCS-P As I travel around the country and talk to chiropractors, I’ve seen that more and more office are offering online scheduling to their patients—and I think that’s great. Anything that encourages return visits and doesn’t take up valuable front desk time is undeniably an asset. It concerns me, however, that as more patient interactions move to cyberspace, the art of just plain talking to people is becoming lost. And nowhere is that art more crucial than in handling the shopper call. Established patients may be happy to schedule appointments online, but novice chiropractic patients, for the most part, are not. They’ve got questions, and so, for these people, the phone remains the first point of contact. And if that first phone call doesn’t go well, odds are good that a potential new patient will move on to someone else.
Hire the right people. Each staff member needs more than just the relevant clerical or clinical skills. They must also be able to contribute to a positive and supportive team environment. An easily irritated, unmotivated front desk CA, for example, can almost single-handedly destroy a practice—whereas a likeable and motivated CA can help it thrive. Educate front desk staff. When DCs don't take the time to explain policies and procedures and even the basics of chiropractic to their staff, those staff members won’t be able to answer questions coherently when they answer the phone. Every practice should have a written manual to which any staff member can refer, and staff education should be part of every regular team meeting.
Any business’s office environment, including a chiropractic practice, is a reflection of its internal practices. When an office is disorganized, chaotic, inconsistent or overwhelmed, that’s exactly what comes across to potential patients. Think about it: how would you feel if you called to find out about chiropractic fees, whether or not the office accepts your insurance and the specifics of care and found yourself talking to someone who sounds distracted, confused, irritated or clueless? Yeah, I’d probably get off the phone as soon as possible, too. Bottom line: creating a sustainable relationship of trust between chiropractor and patient begins with that first phone interaction. But that trust is fragile and easily broken by behaviors perceived as confusing or untrustworthy. This might include anything from being unclear or unable to explain policies and procedures to offering complicated (and illegal) dualfree schedules and impulsive, inconsistent time-ofservice discounts in excess of the 5-15% reduction recommended by the OIG. So how can DCs help create that atmosphere of trust from the very first phone call? Here are some of our recommendations:
Compose written scripts for the most frequently asked questions. Front desk staff know what these questions are— they hear them every day—but don’t always have a clear, concise answer at hand, especially when they’re multi-tasking by answering phones, scheduling appointments, handling billing, etc. Doctors, however, can make all the difference by creating "Q&A scripts" so that every team member is ready for "shopper" conversions. Reduce the patient’s perceived risk. All patients—but especially those who are uninsured, under-insured, or partially insured—are afraid of what care might cost, and fees can be complicated to explain. With managed care and regulated fee schedules, it’s imperative to have a straightforward script explaining how first visit finances are handled. Continued next page
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TEXAS JOURNAL OF CHIROPRACTIC November 1, 2013
Texas Chiropractic Association
Offer new patients affordable options. Here’s where having a legal discount program comes in. By becoming a provider of a Discount Medical Plan Organization (DMPO) like ChiroHealthUSA, DCs can offer affordable capped fees for first visits. It’s easy for even someone new to chiropractic to understand—and it makes it easier for even the most nervous shopper to make that first appointment. We know that even as we all navigate increasingly complex waters, it’s important that we not forget the basics of patient interaction and kindness. Let us help you with our free Tuesday informational webinars at www.chirohealthusa.com. (We give good phone AND good webinar!) 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 Chairman. You can contact Dr. Foxworth at 1-888-719-9990, info@chirohealthusa.com or visiting the ChiroHealthUSA website at www.chirohealthusa.com
White Rock Lake Weekly– Letter to the Editor The White Rock Lake Weekly contained a letter to the editor that favorably reported on chiropractic. “You gotta straighten me out,” I pleaded with my chiropractor. There aren’t many men, or women for that matter, whose hands I would relax my head into, breathe deeply for, and allow to twist my head quickly from side to side. But my chiropractor is definitely one of them. I trust him with my life, literally. I learned years ago that the
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cracking you hear when popping knuckles or any other joint is not bone cracking; it’s nitrogen bubbles being released into your body. My friend, the oriental medicine doctor, turned me on to chiropractic adjustments back then and I’ve loved them ever since. Years later, I’ve come to realize that I not only love to get adjusted, I need to get adjusted. Blame it on the horrible office chair I promise myself I’ll replace each week and never do. Or my overall bad posture. But if I go too long between adjustments, my body begins to show unmistakable signs of weakness. I start gritting my teeth at night or get headaches. Some people used to say chiropractors are not “real doctors” and I would be the first to correct them. They are real doctors. They may not be “medical” doctors but chiropractors go through years of intensive training and are licensed and governed by the State. Done by hand – that’s what chiropractic means, after all. It comes from the Greek words cheir (hand) and praktos (done). I sure hope my chiropractor takes good care of his hands. Because I would surely go back to my crooked ways without them. via White Rock Lake Weekly - LETTER F.
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TEXAS JOURNAL OF CHIROPRACTIC November 1, 2013
Texas Chiropractic Association Advocacy Report from pg.. 20
the profession’s ability to make a difference and to grow,” he continued. Both Dr. McMichael and Dr. Martin are excited about the future of the State Affiliation program. “We’ve always had quality organizations doing good quality work, but now we have quality organizations working together doing good quality work. We’re seeing in real time that we can make a difference,” says Dr. Martin. So far, seven states are participating in the State Affiliation program, and Dr. McMichael notes that the program will continue to grow and improve.
THE NEXT TEXAS JOURNAL OF CHIROPRACTIC WILL BE PUBLISHED IN FEBRUARY 2014
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February 22, 2014 TCA Midwinter Conference Holiday Inn Park Plaza Lubbock, Texas