The Missouri Chiropractor - October 2007

President's Report

by Edward A. Hengel, DC,  MSCA President

Is There a Crisis Yet? Make the Call

For years I have heard the same story. “In order to get a large audience at a district meeting, you need to have a crisis.” This has been said over and over. Apparently it is true. The sad part is that we don’t pay enough attention to our profession to realize we have an ongoing crisis. If we did, every meeting in all seven Missouri districts would be overflowing with DCs.

For the chiropractors who happen to be reading this, it is a call to action. Consider what has transpired since you have been in practice. (You may have 30 plus years under your belt, or you may be wearing the same belt you wore as a student intern ... hopefully not both.) The climate in which we are currently practicing is rapidly and dramatically changing with regards to insurance.
Excuse my comparison between weather and chiropractic; but there are similarities between the two, especially when it comes to a natural disaster and a lack of preparedness. While the fluctuating insurance barometer is man-made, we don’t want to miss obvious indicators as “intentional storm fronts” batter our “sandbagging efforts.” So if we don’t strengthen ourselves professionally as a unified force, we will find ourselves caught like flash flood victims saying, “what happened?”

This is not a doom and gloom proclamation as we have made great gains legislatively as well as in the legal arena. This is a CALL TO ACTION. This is a wake-up call to MSCA members and non-members. We have shown that there is strength in numbers, but it has been an ongoing battle to keep everyone focused and involved. For the sake of our chiropractic profession take it unto yourself to get to your district meetings. Call your association’s officers and representatives to see what you can do.

Help our profession with crisis preparedness in the face of the ongoing onslaught of insurance tactics with financial maneuvering behind each change in the “forecast.”

Executive Directors Report

by Kathleen Wilcoxson, MPA

700th MSCA Member on Horizon

We are nearing a record. As of the deadline for this publication, the Missouri State Chiropractors Association needed 11 memberships to reach a record-breaking 700 members. This will be the largest number of members the MSCA has ever had on record.

I would like to challenge every chiropractor who is not currently a member to fill out an MSCA membership application and help us reach this goal. I will even go one step further. If your application comes in as number 700, we have a new folding canvas chair, with MSCA printed on the back, to send you in recognition of this accomplishment.

If you are wondering why this numbers game is so important, let me give you some reasons why. One of the easiest reasons to understand is our comparison to other associations battling for the attention of our Missouri legislators. When we are tying to pass laws that will benefit the chiropractors in Missouri, we often go head to head with the MDs, DOs and PTs who have close to a dozen lobbyists and represent thousands of members across the state. We are severely outnumbered. And we don’t begin to compare to the insurance lobby.

Hand in hand with our numbers, goes the amount of our budget. As long as we stay outnumbered in membership, we will remain overpowered in budget. This is why we need your membership. The MSCA does a tremendous amount of work with the resources it has; but imagine what it could do with more.
The MSCA is your professional association. It works endlessly to provide you with services that will improve your daily practice by changing laws, helping with insurance concerns, giving legal advice, providing continuing education opportunities, offering practice management information, and much more.

Those who join and take advantage of the many benefits the MSCA has to offer, have a definite advantage in their practice. Those who don’t join, still benefit from all the legislative, legal and insurance work that helps the profession as a whole. So why join? If you benefit anyway, why not just sit back and take advantage of all the progress and achievements of your association?

It’s a matter of pride. MSCA members take pride in contributing to the successes of their profession. Even with less numbers, the MSCA wins battles. Won’t you consider joining today and take pride in giving your profession the added resources to grow and advance your profession?

There are nearly 1,200 chiropractors in Missouri who have not made the decision to support their profession by joining the MSCA. If you have a chiropractor in your community who is not a member, please give them a call. If you happen to be one of the 1,200 who has not stepped up to this calling, it’s not too late. Please, join today. Be the one member who helps us reach our goal – 700 members.

Next year, 1,000!

New PAC Officers Elected

by Paul W. Foster, DC, PAC President

At convention 2007, the PAC board of trustees elected new officers for two-year terms.
 
President Dr. Paul W. Foster
Vice President Dr. Phil Prater
Secretary/Treasurer Dr. Jeff Nagle
 
The MSCA PAC board of trustees are as follows:
District 1 – Dr. Rick James
District 2 – Dr. Paul W. Foster
District 3 – Dr. Phil Prater
District 4 – Dr. Jeff Nagle
District 5 – Dr. Jay Kessinger
District 6 – Dr. Gerald Yurth
District 7 – Dr. Shane Hart
Some of you at convention stated that perhaps there are other things PAC might do, in addition to the raffle tickets, to increase our cash flow. The PAC board of trustees will certainly entertain any suggestions that you may have.  We shall be discussing, in detail, any and all thoughts that will help us step to the next level at our next board meeting which is October 13, 10:30 at The Resort at Port Arrowhead, Lake Ozark. Please come and join us.
 
In closing, I would like to salute and thank our outgoing PAC President Dr. Phil Prater for a job well done.

Feature Article: The Changing Scope Of Practice In Missouri: What It Means in the Field

By Geordie McGonagle, MSCA Legal Counsel

INTRODUCTION
Since its inception the practice and art of chiropractic has changed and expanded to reflect the ever-increasing flood of new research and data that substantiates the efficacy of this particular discipline of the Healing Arts. In 1895, D.D. Palmer announced, “…95% of all diseases are caused by displaced vertebrae, the remainder by subluxations of other joints…”1 Palmer’s original theory was simple: adjusting vertebrae to remove an appearance of nerve energy would allow the body to heal most diseases. With this simple core value, the scope and practice of chiropractic has changed to reflect the times. In July of 1996, the Association of Chiropractic Colleges (ACC), representing 16 North American Chiropractic Colleges, issued a position paper defining subluxation and scope of practice in a less simplistic manner.2 The paper said in part: “…Chiropractic is concerned with the preservation and restoration of health, and focuses particularly on the restoration of health…” In November 2000, the International Chiropractic Association and the American Chiropractic Association endorsed the ACC paradigm and its views on subluxation.

As the scope of chiropractic evolved so did the training and education of the chiropractic physician. In the modern world, chiropractic physicians require extensive training in anatomy and embryology, physiology, pathology, microbiology, diagnosis, neurology, obstetrics and gynecology, orthopedics, x-ray, psychology and psychiatry.3 While the schools evolved, many state laws did not reflect the changing face of chiropractic. Very well-trained chiropractic physicians were matriculating from chiropractic colleges but were being restricted by archaic state statutes from treating patients in accordance with their expansive education. In the summer of 2007, Missouri’s governor signed into law a Practice Act that actually reflects what chiropractic physicians in the state of Missouri are trained to do.

OLD VS. NEW
Prior to the summer of 2007, Missouri’s chiropractic scope of practice restricted treatment to “malpositioned articulations and structures of the body” and solely “towards restoring and maintaining the normal neuromusculoskeletal function and health.”4 This narrow interpretation of the scope of chiropractic did not accurately reflect the current level of education, skills and training of DCs in Missouri. Simply put, the law failed to keep up with science.

The new law was crafted to accurately reflect the modern chiropractic physician and to help encompass future trends and developments in the ever-changing scientific world of chiropractic medicine. The new language states that you may treat “by those methods commonly taught in any chiropractic college or chiropractic program in a university which has been accredited by the Counsel on Chiropractic Education, its successor entity or approved by the Board.”5 This language now ensures that the practice of chiropractic in Missouri can keep pace with future advancements in chiropractic research and education.

THE SCOPE OF PRACTICE IN OTHER STATES
Unfortunately, the trend of state legislatures and courts in recent years has been to narrowly limit the scope of chiropractic. A recent New Jersey decision indicated that extremity adjustment is not within the scope of chiropractic.6 Arkansas limits the scope of chiropractic to the correction of nerve transmission by the adjustment of the articulations of the spinal column which [sic] immediate articulations, including spinal adjustments, spinal manipulations, and spinal mobilizations.7 Arkansas’ scope also explicitly prohibits the puncturing of the skin for the purpose of introducing any substance into the body.8 Compared to Missouri’s new Practice Act, Arkansas is much more restrictive.

California defines the course of chiropractic treatment in terms of manipulations and/or adjustments. It also specifically prohibits chiropractic physicians from delivering a child or practicing obstetrics; using a lithotripter; using ultrasound on a fetus or performing a mammography.9 Again, no such specific restrictions are found in Missouri’s Practice Act.

Oklahoma’s Practice Act, on the other hand, is less restrictive. Defining chiropractic as “…the science and art that teaches health and anatomic relations and disease or abnormality in anatomic disrelation, and includes hygienic, sanitary and therapeutic measures incident thereto in humans. The scope includes those diagnostic treatment services and procedures which have been taught by an accredited chiropractic college and have been approved by the Board of Chiropractic Examiners…”10 The Oklahoma Statute permits chiropractic treatment of animals and does not specifically outlaw surgery or the administration of prescription drugs.

Viewed in a light of practice scopes throughout the country, Missouri’s is clearly one of the most expansive. Not only are chiropractic physicians free to practice by those methods commonly taught in an accredited chiropractic college, they can also practice by those methods approved by the Board. Additionally, while Oklahoma requires approval by the Board of Chiropractic Examiners for services and procedures which have been taught by an accredited chiropractic college, Missouri law has no such restriction.

WHAT DOES THIS MEAN?
Only time will tell what this Practice Act means to chiropractic physicians in Missouri and their patients. However, the possibilities are endless. The introduction of vitamins and nutritional aids via injectables seems plausible. Certainly when viewed in the light of laws already on the books approving certain diagnostic procedures. Chiropractic physicians in Missouri are already allowed to conduct laboratory examinations using blood, urine, fecal and sputum specimens.11 With no prohibition against puncturing the skin for the purpose of introducing any substance into the body, injectables may now fall within the scope of practice. Similarly, the use of IVs may now become a viable option for chiropractic physicians in Missouri. Certainly the ability to treat more diseases by methods commonly taught in the accredited chiropractic college may also become an option for chiropractic physicians and their patients.

The development of aesthetic practices where physicians engage in hypotrocology (hair removal), laser peels, botox and dermabrasion are modalities that have been utilized by chiropractic physicians currently in states with Practice Acts that are much more restrictive than ours and may now be viable in Missouri.

From a managed care perspective, the benefits in the change in the Practice Act may be less noticeable since the relationship between the provider and the Managed Care Organization are contractual in nature. However, chiropractic physicians may now have the ability to utilize a greater number of codes for reimbursement, and reimbursement denial may be more difficult.

The chiropractic physicians in Missouri now have a Practice Act that more accurately reflects what they are trained to do. This would not have been possible but for the tireless work of those such as Mo McCullough, Sam Licklider, Logan and Cleveland College, the Missouri State Board of Chiropractic Examiners and all the DCs across the state who lobbied hard to make this milestone possible.

1 Palmer, D.D. The Chiropractor. Whitefish, MT: Kessinger Publishing Company, 1914.
2 Association of Chiropractic Colleges. A position paper on Chiropractic. J Manipulative physiol there 1996; 19:633-637
3 Information obtained from counsel in Chiropractic Colleges.
4 See R.S.Mo. 331.010 (1939)
5 See House Bill 233.
6 See Bedford v. Riello.
7 See A.S.a. 17-81-102(6)(a)(1971)
8 See A.S.a 17-81-102(6)(a)(1971)
9 CA Code of Regulations 302(2).
10 OK Stat. Amn. 59-161.2(2000)
11 4 C.S.R. 70-2.020: Diagnostic Procedures and Instruments.

There’s Never a Right Way to Do the Wrong Thing

by Kathy Mills Chang

There’s an interesting saying, “If you have integrity, nothing else matters. If you don’t have integrity, nothing else matters.”

What is integrity? The American Heritage Dictionary defines integrity as “steadfast adherence to a strict moral or ethical code.” In a chiropractic practice, success is not measured by the amount of dollars taken in, it is measured by the way in which all team members treat patients, because that is what keeps them coming back and this is what motivates them to refer the practice to their friends and family.

Chiropractic Assistants have a responsibility to maintain the strictest adherence to a specific code of ethics when interacting with patients. CAs exhibit ethical behavior when they:
Assist in protecting a patient’s rights to autonomy, the clinical effects of care, and full disclosure regarding their condition, care options, and related costs.
Maintain any type of confidence placed in them – whether it be the doctor’s, a patient’s or another practice team member.
Fulfill promises that are made
Promote confidentiality of patient information and records.
Place the patient welfare over any personal gain.
Act as a patient advocate in clinical and financial matters
Approach conflict resolution, when needed, with sensitivity, professionalism and a demeanor of responsibility.
Understand the meaning of boundaries and the fact that they may be different for different patients and different for the patient from one visit to the next; the CA’s intent is not what matters here, what matters is the patient’s interpretation.

In addition, CAs function as “eyes and ears” for the chiropractor, listening to waiting area “chatter” and comments from patients that throw up a “red flag” and require that either the CA or doctor address or clarify an issue, policy or viewpoint.

Ethical behavior demands strict honesty – honesty with patients, colleagues, doctors, insurance companies and oneself. It also demands a level of respect – respect for those who uphold different views and beliefs – acting always in the best interest of others and never strictly in one’s own self–interest!

The name of the game here has got to be quality care and service; it’s what chiropractic is all about. Chiropractic team members have to be willing to step up to the plate and talk to the practice doctors about any potential concern, without fear. If an error is made, it must be handled, or the liability to the practice may be more than just losing a job!

A potential area where this has significant and severe ramifications is in billing and insurance. While one billing error may not constitute fraud, a consistent pattern of incorrect billing or constant up-coding will be. There is never a right way to do the wrong thing, which is why honesty, in every aspect of chiropractic practice management, is always the best policy.

Job security in any chiropractic office is predicated on gaining the respect and trust of the doctors, other team members and most importantly, patients. Open and honest communication and actions are vital so that all can reach their full potential – both those on the giving end of chiropractic care and on the receiving end of chiropractic care. Therefore, it behooves all team members to honor their commitment to the practice, to themselves and to those whom they serve.

 

Kathy Mills Chang is celebrating her 25th year in the chiropractic profession and is the founder of her own chiropractic financial consulting firm. She serves as Foot Levelers’ Insurance Advisor, a consultant to several state chiropractic associations, and continues to teach seminars around the country and work with practices one-on-one to help them achieve Financial Ease. Questions can be directed to her at Kathy@kathymillschang.com or visit her website at www.kathymillschang.com.

Convention Highlights

Convention Exhibitors

American Chiropractic Association 800-986-4636
Biotics Research Corporation 800-231-5777
Brandt Cellars International (BCI) 217-415-0966
Brown's Medical Imaging 800-701-9729
Cleveland Chiropractic College 800-467-2252
Dr. Dennis Baker 636-671-5440
Elsevier / Mosby / Saunders 314-963-9537
Foot Levelers, Inc. 800/553-4860
Gammon Equipment 800-972-0086
Gateway X-Ray 636-978-9220
Gibson Mgt. 800-468-3606
Griffith Equipment, Inc. 800-727-2312
HoffMoor Ventures, LLC 517-393-6742
IntelliBed / Advanced Comfort Technologies 314-479-1741
JR Consulting 952-474-3426
Lansberg Medical Equip. 800-325-9298
Med-Advantage, LLC 636-519-0640
Metagenics, Inc. 800-522-6382
Midwest Microcurrent 314-799-4052
NCMIC Insurance Company 800-321-7015
Neuromechanical Innovations 480-785-8448
Nexagen USA / The Weightloss Patch 501-691-0890
ODEN Enterprises 573-392-6621
OUM Chiropractor Program 800-423-1504
Performance Health 800-246-3733
Phillips Chiropractic Tables 877-426-6111
Precision Biometrics 800-969-6961
PRP Wine International, Inc. 816-965-9501
Select Comfort 314-567-4658
Spectracell Laboratories 816-200-3995
Standard Process, Inc. 314-753-6004
The Great Plains Laboratory 913-341-8949
The Key Company 800- 678-6138
The Limu Company 417-214-0692
Universal X-Ray 417-848-3058
V-JUV 800-729-8922
VBR, Inc. 636-575-0658
Whole Food Farmacy 636-233-4162
Wyldewood Cellars Winery 316-554-9463
Xymogen/NuMedica 918-665-1151

 

Thank You
Wanda Munson
The Key Company

Let’s join together to give The Key Company, Wanda Munson and Ted Winzlick, our sincere appreciation for helping make the 2007 MSCA Summer Convention a huge success. Wanda sponsored a delicious Opening Reception at Tan-Tar-A Resort in Osage Beach.

2007 MSCA Summer Convention
Thank You
Speakers

Dr. Brad Feldner, w/V-JUV
Kathy Mills Chang, w/Foot Levelers
Dr. Dennis Baker, Acupuncture
Dr. Duane Marquart, X-Ray
Dr. Jack Kessinger, III, Physical Diagnosis
Dan Griffith, w/Griffith Equipment

On behalf of the entire MSCA, we thank our speakers for their generous donation of time and talent to present at our 2007 Summer Convention. These speakers are not paid for their time. They volunteer their services to help further the mission of the Missouri State Chiropractors Association. Thank you!

A Special MSCA
Thank You
2007 Summer Convention
Food & Golf Sponsors

Alletess Medical Laboratory
Biotics Research Corporation
Brown’s Medical Imaging
Cleveland Chiropractic College
G.W. Heel Lift, Inc.
Gateway X-Ray
IntelliBed/Advanced Comfort Tech.
Logan College of Chiropractic
MSCA District 1
MSCA District 2
MSCA District 4
MSCA District 5
Ortho Molecular Products
Standard Process
The Great Plains Laboratory
The Key Company

2007 MSCA Awards
Presented at the MSCA Summer Convention Awards Banquet
Saturday, July 28
Tan-Tar-A Resort, Osage Beach

Click here for awards and photos

MCSA Partners:


Bank of America