The Missouri Chiropractor - August 2007

The views and opinions expressed are not necessarily representative of those held by this web site, the MSCA, its staff, officers or contractors.

President's Report

by Edward A. Hengel, DC,  MSCA President

The Grass is Always Greener...

... or so it may appear.  You have all heard that particular saying, right?  "The grass is always greener on the other side of the fence."  Well, when that may appear to be the case, try fertilizing your side of the fence.  When we are faced with day-to-day challenges in our chiropractic practices, we try to be problem solvers.  Whether we are dealing with the health concerns of our patients, a staffing issue or tax strategies, we look for answers in order that we may move forward with each individual hurdle that we have before us. 

As a profession, how do we move forward?  The Missouri State Chiropractors Association is the vehicle with which we can, and have, continued to gain ground for the benefit of our patients and the DCs in our great state.  Our approach has been multifaceted in nature.

Our legislative agenda has been successful on both the offensive as well as defensive fronts.  While the passing of HB 121 was an encouraging and bold victory in Jefferson City, it has also given us a "toe-hold" to gain future ground over insurance dilemmas.  With the proper signature on our new practice act, it will allow us to treat our patients in the unencumbered fashion that we have been taught in our various chiropractic institutions.

The Missouri State Board of Chiropractic Examiners has bolstered the efforts of the MSCA by supporting our stance concerning a number of insurance related topics.  This type of teamwork has been most successful in getting the attention of our concerns to the various health carriers in Missouri.  Again this is for the benefit of our patients and practices. 

The formation of the Legal Action Fund has been an instrumental tool with which we recently won a legal battle over a major HMO carrier in Missouri regarding excessive co-payments.  The terms of the settlement call for the refunding of excessive co-payments to our patients and the establishment of a system that ensures no more chiropractic co-payment abuses by the carrier.

While we are still waiting for our case to be heard against UHC/ACN in the southern district of Florida, we, as a profession, can not wait.  We need to continue to build our Legal Action Fund.  In order for our profession to continue to move forward we have to be financially vigilant for any more hurdles.

So, once again, I am going to ask for your financial support.  I want you to join our fight by helping to build the Legal Action Fund with your dollars.  A handful of pro-active volunteers have donated over $200,000 in just a few years.  It is my goal to help encourage you to get the Legal Action Fund up to $1,000,000 dollars as soon as possible.

As our past MSCA President Dr. Mark Howell stated, "If you are not part of the solution, you are part of the problem."  So please, be solution oriented and help fertilize our side of the health care fence.

Executive Directors Report

by Kathleen Wilcoxson, MPA

Is the MSCA Auxiliary in Jeopardy?

One of our dedicated members of the MSCA and PAC for many years, and an active member of both the MSCA and PAC boards, stood up at our last MSCA board meeting and brought to our attention the great value of having an active MSCA Auxiliary and how terrible it would be if we lost its support. He captured our attention when he explained how the organization might be approaching a fragile point.

As with so many organizations, the burden of work falls on a dedicated few individuals who see the value, and are willing to put forth the time, to keep the organization going. Since the Auxiliary was re-established a few years ago, a few outstanding individuals have stepped up and taken a huge role in carrying out the many projects and events undertaken.

This small group of individuals are on hand and help with most of the major events held by the MSCA. It’s not enough to say they help organize the opening reception and children’s activities at our summer convention, or hold a memorial service at our banquet; they work year-round, month to month, to help plan events, raise money for MSCA and PAC, and run their own Student Scholarship Fund.

Please hear this impassioned plea for greater participation in the MSCA Auxiliary. If you are a CA, spouse, supplier, or just a good friend of chiropractic, please take this plea to heart and consider stepping forward. Each person who steps forward will lessen the burden for everyone else. With enough participation, I hope we can ensure a long future for the Auxiliary and the amazing work it does.

Even if you can’t find the time to get involved, please consider sending a $25 annual membership fee. This small amount of money goes a long way to help the Auxiliary help others.

Auxiliary Board 2007 Officers
President: Carol Furjes
Vice President: Virginia Kessinger
Secretary: Joyce Prater
Treasurer: Christina Drumright
Parliamentarian/Historian: Wanda Munson
Scholarship Chairman: Margie Elder
Liaison from the MSCA: Dr. Paul Foster

Governmental Affairs Report

by Mo McCullough, Government Affairs Director

PAC: Best Investment You’ll Make

As you might expect, as a lobbyist I spend a lot of time with other lobbyists. What you might not expect is that many of my colleagues in the Capitol envy me in one very important area. That area is the “client.” They are constantly amazed at how active and responsive chiropractors are in Missouri. They know that when I send out an alert, you respond. They see how successful our legislative day is by the increased energy in the halls of the Capitol. They see DCs at legislative functions and fundraisers across the state. They know the members of the general assembly hear your voices.

While the MSCA may not be considered a large association by many, we are generally acknowledged to be very active and effective. What we lack in numbers, we make up for through our passion for chiropractic and other health care issues. I feel very thankful for the opportunity to fight along side all of you for this great profession. And yes, I must admit, I enjoy being envied.

Now, I am asking you to show the lobbyists, current legislators and new candidates that you’re still out there and ready once again to step up to the plate and strike another blow for chiropractic. I’m asking you to join or re-new your membership to the political action arm of the MSCA, the Political Action Committee (MSCA PAC).

2008 is an election year, and we need to support the re-election efforts of our old friends and begin building new relationships with the legislative leaders of tomorrow. It is imperative for the success of the chiropractic profession in Missouri that we actively participate in this very important aspect of the political process. That is the purpose of the MSCA PAC.

The MSCA PAC needs your help now, and I know I can count on your support because you understand how truly important it is. Please don’t delay, send in your membership application. Do it today! Let’s show everyone we fully intend to continue the fight.

PAC Report

by Phillip Prater, DC
PAC President

Have You Answered the Call?

ATTENTION ALL CHIROPRACTORS IN THE STATE OF MISSOURI, PLEASE TAKE FIVE MINUTES OF YOUR TIME TO READ THIS ARTICLE!

Now that convention is over for 2007, I want to thank all my friends in chiropractic who took the time to take my calls. There are many of you who responded to my calls for donations to support our needs in legislation. YOU KNOW WHO YOU ARE; and many, many thanks. I know that your heart is in chiropractic and the future for chiropractic in the state of Missouri.

Now, on the flip side, there were many doctors who didn’t take my calls. The receptionists took my messages and said the doctors would return my calls, and guess what? The doctors didn’t call back! YOU KNOW WHO YOU ARE!

I would like to think that we, as chiropractors, strive for the same goal which is to serve and promote chiropractic to our patients. The sad situation is that the MSCA and the MSCA PAC helps the cause for all chiropractors, whether they actively support us or not. Wouldn’t it be great if all the doctors would support MSCA and PAC? Just think how much more we could get done for our profession.

As PAC President, this will be my last communication. Thank you my friends.

Feature Article: Managed Care and Chiropractic: Are There Healthcare Solutions?

By Howard Levinson, DC

Chiropractors have been the “Wellness” doctors for over 100 years. Insurers such as United Healthcare, Aetna and WellPoint, Inc. (parent company to Anthem BCBSMo), are moving in the direction of disease prevention too, adopting a “Wellness” model.

Healthcare is becoming more transparent.1 Programs will eventually provide the patient with detailed information about their condition. They will assist the patient in making an informed choice about their doctor, hospital, procedures and treatment. Insurers are becoming more proactive in managing patients suffering from chronic diseases that are accompanied by high morbidity and cost. Insurance companies may offer patients a health coach and various on-line resources to help the patient stay well. These same type programs could be extended to chronic musculoskeletal conditions such as lower back pain. The inclusion of chiropractic care as an integral part of the patient’s healthcare, could result in fewer hospitalizations, complications or surgeries and the reduction in adverse drug reactions. The cost savings for the insurance company could be significant.2 However, this shift towards wellness may not favor chiropractic.

We are known by the claims we submit, our medical records, our costs, and the measurable health benefit we offer the patient. Oftentimes, the only contact a managed care organization (MCO) has with a DC is when a chiropractor is suspected of controversial coding, improper treatment, fraud and/or abuse. Many MCOs utilize chiropractic vendors such as Landmark, ACN, or ASHN to manage their chiropractic networks. Anthem BCBSMO does not currently use a chiropractic vendor and conducts its own evaluations of the chiropractic network.

Chiropractic Audits
Anthem conducts numerous audits of all providers. Studies evaluate MDs, DOs, DPMs, DDSs, pharmacies, ambulance providers, hospitals, nursing facilities and DCs for appropriate coding and treatment. Analyses and audits are done to assure that medically necessary and appropriate care is being provided. A few studies of Missouri DCs include:

Claims data indicating a high frequency of Evaluation and Management (EM) services, above a peer average. Chiropractors who performed EM services 2X over the state average received a request for medical records to document the EM service. 23 doctors, (.02%) in the network received letters. In some cases, the doctors were substituting EM codes for manipulation.

Claims data indicating a high frequency of therapeutic procedures above a peer average. Chiropractors who performed therapeutic procedures 2X over the state average received a request for medical records to document the PT service. 53 doctors, (.05%) in the network received letters. In some cases, the doctors were substituting a PT code for manipulation, or were providing multiple modalities to every patient during every visit.

Claims data indicating a high frequency of 5-region manipulation. Chiropractors who performed a 5 region manipulation 4X over the state average received a request for medical records to document the service. 52 doctors, (.05%) in the network received letters. In some cases, the doctors’ records did not support that a five-region manipulation was provided.

The very small percentage of Missouri DCs who received letters indicates that the majority of our peers practice within the norm. The aberrant claims data does not necessarily indicate that the provider is doing anything inappropriate. A provider with a high frequency of EM, may be functioning as an exam doctor. A provider with numerous PT modalities may be working in a rehabilitation clinic in which their primary service is physical medicine. A doctor’s practice demographic may validate full spine adjusting. The claims data may be considered a symptom of a potential problem, not a final diagnosis.

Medical records would be reviewed to determine if the coding was correct and to confirm the medical necessity of the service. If the coding was correct and the records support the services, no further action is warranted. If the records are inadequate or fail to support the medical necessity for the services, the provider is notified. A multi-faceted approach is used to change the providers’ behavior. The approach involves education, setting clear and specific expectations, establishing a measurable method for identifying change, and providing constructive feedback. Discipline is held as a last resort.3

The provider may be given a grace period and placed in a corrective action plan for a specific time period in which they are to change practice behavior, improve documentation, or correct whatever the issue may have been. Upon completion of the time given for the corrective action, a subsequent data analysis and medical record review would be conducted to assure compliance.
If the provider’s activities, coding and/or documentation do not significantly change, the insurer may take administrative action such as requiring medical records prior to any claims payment. These procedures are typically called pre-payment review or special claims review. On occasion, the insurer may elect to terminate a providers contract according to termination procedures defined in each managed care contract. If the provider’s activity is suspected of violating a civil or criminal fraud/abuse statute, a referral to an investigative unit may be made, where coordination with law enforcement may be conducted. If the investigation determines that claims should not have been paid, the doctor may be required to refund overpayments to the insurer.

An unfortunate dichotomy exists between our profession and the insurance industry. Many chiropractors document well, practice evidence informed chiropractic, and are part of the overall healthcare team for their patients. Yet they continue to suffer declining reimbursements and are not viewed by the MCOs as valued partners in the healthcare system. Many DCs are frustrated and are voicing opinions that they cannot afford to remain ‘in the network’. Managed care organizations may lose experienced and important wellness partners, if more and more chiropractors find the restrictions and reimbursement rates unacceptable.

There is good news that healthcare is changing towards a wellness paradigm. Chiropractors can only hope that patients and insurers will realize, we were there first.

References
Accessed 2/12/07
http://www.insurancetech.com/news/showArticle.jhtml?articleID=191601572
(2) Sarnat, R., Winterstein, J., Clinical and Cost Outcomes of an Integrative Medicine IPA. J Manipulative Physiol Ther 2004; 336-345.
(3) Martin, W., The levers of influence-Positively Influencing Physicians., Physician Executive, Nov.-Dec.1999

Committee Report

by Michael Finley, DC, Membership Committee Chair

Do You Know What You Want?

Simple question. What do you want? As a profession, there is a long list of things that chiropractors “want,” and that’s good. When people “want” something, they will apply energy and focus to achieve it. The problem is there are often a lot of “wants,” and doctors are often unsure how to focus this energy. As a single doctor, it can be extremely difficult to achieve the “wants;” but, as a large group of doctors focusing on a few “wants,” things can change.

Let me give you an example. Two years ago, a meeting was held in my district to ask docs what their main goals were for legislation for our profession. A top three “wants” were chosen. Number one was to update our 30-year-old practice act. The old practice act more or less read “bone on nerve” terminology. The proposed legislation stated a more broad language: “commonly taught in chiropractic college.” The main goal of the legislation was not to be pigeon- holed and defined by outside groups telling us what we can do. It was also cornerstone for future pieces of legislation.
This was not a new “want.” This discussion had been going on for almost 15 years on the MSCA board level. Finally, it was pressed by a group of doctors to address this “want.” The final terminology was agreed and voted on. There were over 20 docs on the board; all but two voted in favor. Even the two who voted against the proposed legislation stated it was better than the old practice act but it did not go far enough.

Two years later, with focus and energy, the new practice act passed; and now, as of July, is waiting for a signature from the governor. It’s simple, doctors agreed as a group to focus and work together to achieve a “want.“

Share with your MSCA representatives your “wants.” Remember, you must “do to get,” so help volunteer to achieve the “want.”

If you are not a member of the MSCA, how can you achieve your “wants?” Simple, join the MSCA. In unity, we can achieve many “wants!”

District Reports

DISTRICT 1 REPORT
By Michael Finley

Please welcome are new president and representatives for District 1.
President
Bill Nolan

Representatives
Rob Arnone
Mark Holland
Quinn James
Jerry Wertel
Ray Weigand

They are ready to help answer your questions or concerns. Go to the website for their e-mail or phone numbers.

Due to the summer break, there are no District 1 meetings at Logan College for August.

Check out mscainfo.com for the latest information.

DISTRICT 2 REPORT
By Gerald W. Witt, D.C.

This month District 2, representing chiropractic physicians in the nine Missouri counties of Benton, Cass, Clay, Henry, Jackson, Johnson, Lafayette, Platte, and Ray, report on District 2 Seminars and the District 2 Christmas Banquet.

We are continuing to work on our 36-hour Continuing Education Seminar scheduled for December 7-9, 2007, at the Holiday Inn Northeast (same location as the last Seminars). Because of the positive response we had at our last seminar on Laser Light technology, we plan to have another speaker address this interesting subject on Friday, December 7. Also, back by popular demand, the “Big Three” will be given on Saturday including “Differential Diagnostic Rounds” in which five or six speakers will be employed to deliver case studies from actual experience. Don’t forget “Acupuncture Sunday” as our speakers are now fresh back from China and have a lot of new information to share. If you have suggestions for improvements to any of our events, please direct those to our President, Dr. Ron Manfredi, who can be reached at 816-358-0035. For enrollment information, please contact Dr. Russ Matthias at 816-228-5113.

Any Vendor wishing to have a booth at our seminars should contact Dr. Jennifer Forbes at 816-741-4104 for an application form and information. Some restrictions will apply, and space is limited.

A Dinner Banquet is planned for Thursday, December 6, 2007. We are planning to provide magical entertainment, dinner music, and dancing. Please put this date on your calendar and plan to attend. Your support and participation is important to our organization. We hope all of our colleagues will plan to attend the 2007 Christmas Banquet.

In 2008, we will be hosting our next 36-hour Continuing Education Seminar scheduled for February 7-10, in 2008. This scheduled event allows Missouri and Kansas doctors to get an early start on their required CE hours.

The next “District 2 Board meeting” will be Thursday, September 6, 2007. Interesting topics like BCBSKC and Medicare will be on the agenda for a member meeting early this fall.

If you wish to attend one of our monthly meetings, they are held on the first Thursday of the month at 7:30 pm in the Truman Room on the first floor of the Ararat Shrine Building located at “exit 65” (I-435 and Eastwood Traffic-way). Go West to 5100 Ararat Drive, Kansas City, Missouri. Visitors are welcome.

DISTRICT 7 REPORT
By: John Dennehy

A meeting was held at TJ's Supper Club in Hannibal on Thursday, July 19, 7:00 pm.  Beth Sankpill, an Occupational Therapist at Hannibal Regional Hospital, was our guest speaker.  Beth is the wife of Dr. Stephen Sankpill. She discussed the treatment of Lymphadema. 

Insurance Matters

By Margaret Freihaut, DC, Insurance Committee Chair

Is An All-Cash Practice the Answer?

As I sit thinking about what is going on around the state and country in the insurance arena, there's nothing new. It is the same old stuff; lowered reimbursements, ways the insurance companies are figuring out how to pay us less for the work we do, discrimination, intimidation, and what will they think of next.

Thank God we have a state organization and national associations that fight for our rights and the rights of our patients. Many of you sit in your office and feel the effects of the many changes that are occurring in our profession, and I hope that it makes you MAD. The reason I hope it makes you mad is that it will take us all working together to make a dent in the many inequities that are affecting chiropractic.

It reminds me of the tragedy of 9/11.  People come out and want to do something when it gets bad enough. Sleeping giants are awakened. How bad does it have to get before you and I are awakened and get active and want to do what we can to make a difference.  Before you judge me and think I am being negative, let me say, I believe there is always a solution to every problem and that there are still ways to be successful; and I, for one, do not want to sit around and wonder what happened and why the profession didn't do more. It certainly will take a multi-prong approach: legislation, litigation and grassroots efforts.  They have not seen what we, the underdog, can do when we are pushed.

I say it will take us all taking the time to send in our complaints to the Division of Insurance and the MSCA Insurance Committee, sending in our MSCA dues, joining the legal action funds in Missouri and nationally, donating to PAC, getting to know our legislators, going to Legislative day, going to meetings occasionally and being part of the solution. Let the insurance committee know when you see any issue in your office so that we can address them as they arise; and teach your staff to document all interactions with insurance carriers because you never know when it may be necessary to prove the problem.

I hear many say I will just go to an all-cash practice.  I say that is great and that we would all be better off without insurance companies telling us how to practice; but, on the other hand, our patients have insurance that they pay for and have a right to use. When you see copays that are more (or almost the same) than the insurance company allows for the services, do they really have coverage for chiropractic? Is it really an all-cash practice if your patient is expecting to be reimbursed by their insurance company? Would they all follow through as much if they didn't get reimbursed as they expected?  We all know the answer to that, they would not.

Anthem Blue Cross Blue Shield has sent out a new fee schedule that went into affect July 1, 2007.  You should have received copies in the mail.

I have gotten several calls from doctors who have been sent correspondence from Healthlink that they will be terminated if they do not pay their administrative fees. 
 
ACA Data Collection 
The American Chiropractic Association has asked all doctors to send them five unsanitized files showing the problems that they have had with United Healthcare and ACN.  They have outlined the procedure in their website because you do have to make sure your patients have consented to their records being sent, and specifically how they will be used.  In the process of working with state regulatory agencies, it has come to the point that they need to show the proof.  Log on to www.acatoday.com to get copies of the forms that would be necessary.
 
The MSCA Legal Action Fund WANTS YOU AND YOU AND YOU..........YOU......YOU.....
If you are a member, THANK YOU.  If you are not a member, join at whatever level you can. We hope you will join as a monthly contributor giving $100 a month, but all contributions are welcome and needed. Many giving a little goes a long way and ads up quickly.  We can reach our goals quicker and be ready when the issue arises that needs immediate action.

Legal Briefs

McGonagle, Spencer, PC, Legal Counsel

Missouri DCs Score Legal Victory

In 2004 and 2005, the Missouri State Chiropractors Association Legal Action Fund was established to help ensure equal access to chiropractic care and to ensure parity of treatment for chiropractic physicians in the managed care arena. Since its inception, numerous legal battles have ensued. Currently, Missouri physicians have filed a cause of action against United Healthcare and ACN which is currently pending with numerous other cases of managed care litigation in the Federal Court in the Southern District of Florida.

Since early 2000 until the present, many Missouri HMOs had stifled access to chiropractic care by reclassifying chiropractic physicians as “specialists” and imposing chiropractic co-payments that are often more than the cost of the chiropractic treatment itself. This practice dissuaded many chiropractic HMO patients from visiting their physician since, although they were insured, they were paying the chiropractic benefits out of their own pockets.

HMOs continue to use this practice to restrict access to chiropractic benefits, even though, in 1998, the state of Missouri passed an insurance regulation that prohibited HMOs from charging a co-payment of 50% or greater than the actual cost of the service provided. As a result of the formation of the Legal Action Fund, our legal counsel has been able to take decisive action against the HMOs that are restricting access to chiropractors through their excessive co-pays by the imposition of huge specialty co-pays.

After a little over a year, our first legal victory has arrived with a major HMO carrier in the state of Missouri settling with Missouri plaintiffs by refunding excessive co-payment amounts to chiropractic patients and by setting a system in place whereby chiropractic HMO patients would not be charged excessive co-pays, thereby allowing them access to the chiropractic care that they deserve and need. It was your Legal Action Fund which permitted this litigation to go forward, and it was your Legal Action Fund that caused this company to stop violating Missouri law. Furthermore, as a consequence of our litigation, the Department of Insurance has now begun to look at these HMO co-pay violations, and has ordered several major HMO insurers to refund excessive HMO co-payments to Missouri chiropractic patients. Without your Legal Action Fund, this would never have happened.

However, the fight still continues, and there are still violators who exist that must be brought to justice. Therefore, if you have any HMO patients that are still being charged excessive chiropractic co-pays and/or prescription co-pays that are at least 50% or greater than the cost of your service, please have them contact legal counsel in order to determine whether or not Missouri law has been violated.

News & Views

GOVERNOR APPOINTS NEW BOARD MEMBERS

The Governor recently appointed two new members to the Missouri State Board of Chiropractic Examiners, Dr. William Madosky from St. Louis, and Paul Nahon (public member) from Springfield.

Missouri State Board of Chiropractic
Examiners
Lee Richardson, DC - President
1734 East 63rd St
Kansas City, MO 64110

Jack Rushin, DC - Secretary
400 S 11th St
Poplar Bluff, MO 63901

Paul Nahon, Public Member
4230 East Turnberry Dr
Springfield, MO 65809

Richard D. "Rick" James, DC
98 "A" Charleston Square
St Peters, MO 63304

William F Madosky, DC
1202 Bellevue
St Louis, MO 63117

Homer R Thompson, DC
2740 East Sunshine
Springfield, MO 65804

CLEVELAND CHIROPRACTIC COLLEGE-KANSAS CITY (CCCKC) STUDENT WINS STUDENT AMERICAN CHIROPRACTIC ASSOCIATION (SACA) ‘IDOL’ CONTEST

Stellar performances in the classroom and the clinic have come to be expected at Cleveland Chiropractic College. The talent of the college’s faculty and students in the realm of chiropractic is well documented. Of course, that’s not to say their aptitude in other areas isn’t as impressive. It’s just usually happening off campus or behind the scenes and not in the context of the educational process, which is Job 1 for all Clevelanders.

This applies to CCCKC student Jimmie Douglass and his command performance in the spotlight during this year’s National Chiropractic Legislative Conference (NCLC) in Washington, D.C. The NCLC wasn’t just a forum for advancing chiropractic’s important legislative agenda, it also served as the site for the national Student American Chiropractic Association (SACA) “SACA Idol” competition. Douglass participated in the event after winning CCCKC’s “Cleveland Idol” contest for the second consecutive year.

Last year at the national level, Douglass placed second and was very excited to have another chance to win it all. Having been there the year before, he had a leg up on the 15 other contestants, one from each chiropractic college. However, that doesn’t mean he wasn’t nervous, though.

Where he fit in was right on top, as he sang his way to first place in the competition with a riveting performance of “End of the Road” by Boyz 2 Men. Douglass’ humble spirit shines through when he talks about being the two-time “Cleveland Idol” and the 2007 “SACA Idol” national champion.

Douglass’ win earned him $2,500, half of which was earmarked for the local SACA chapter. His reign as “SACA Idol” will last through the year. He has also been invited to sing at the Parker Seminars in February 2008.

MCSA Partners:


Bank of America