The Missouri Chiropractor - May 2008

• President’s Message by Edward A. Hengel, DC
• Executive Director Report by Kathleen Wilcoxson, MPA
• Government Report by Mo McCullough
• Feature Article: Chiropractic Care More Beneficial to Management of Common Neck Pain by Foundation for Chiropractic Progress
• The Multiple Hat Society by Robert Hart
  
• Insurance Report By Margaret Freihaut, DC, Insurance Committee Chair
• Membership Report By Michael Finley, DC, Membership Committee Chair
• The PAC Report By Paul W. Foster, DC, PAC President
• District 1 Report By Michael Finley, DC
• District 2 Report By Ron Manfredi, D.C.
• District 5 Report By Jeremy Thornton, D.C., DABCI
• News & Views
• Classified Ads
  

President's Report

by Edward A. Hengel, DC,  MSCA President

How Else Can I Say This?

For the last 1½ years my articles for our professional journal have been directed towards improving our membership as this is the driving force for all of our programs. It is the driving force behind our progress. So...

Reasons to join the MSCA & MSCA Committees

1. Membership increases our finances for educational programs.
2. Education for our lawmakers.
3. Reduced continuing education/seminar costs.
4. Maintains our office/staff in Jefferson City.
5. Retains legal counsel for MSCA purposes.
6. Free consultation by legal counsel.
7. Journal publication for all Missouri DCs.
8. Legal Action Fund to fight insurance injustices.
9. Practice management information.
10. MSCA liaison between DCs and Missouri insurance commission.
11. PAC finances protect your interests.
12. Insurance questions answered and addressed regularly.
13. Website for up-to-date information.
14. Legislative Day to work with legislators/promote chiropractic in Missouri.
15. Bad Check Recovery Program.
16. Disability and other insurance programs.
17. Bank of America Credit Card Program.

Reason Not to join the MSCA

1. You don’t care about your profession.
   

Just off the top of my head, here is a short list of 17 reasons to join the MSCA and other programs. There are many more reasons, but the bottom line remains as either you are part of the problem with chiropractic or you are part of the solution to our future. Which side of the line are you on?

Executive Directors Report

by Kathleen Wilcoxson, MPA

Do You Know What You’re Missing?

The MSCA is your professional association. It works to promote and protect your profession and your patients’ rights to access your care. It shields chiropractic from other entities that might wish to take away your rights and the rights of your patients.

What? You’ve heard this before? Probably so — many times, in many different ways. But there are still doctors out there who, no matter how many times they hear, no matter how many mailings and emails they receive, still choose not to become members of their professional association.

Do you think maybe they just don’t know what they are missing? I believe those who join the MSCA have a definite advantage over those who remain outside the association. Members who take advantage of the many benefits offered to them find extra support and more resources available to them as a result of their membership.

The MSCA is on call to address members’ questions and concerns. It directs members to valuable resources including insurance, legislative and legal contacts. The MSCA offers discounts on seminars for continuing education for doctors, and discounted office management training for staff.

From doctors who take advantage of their member benefits, we hear positive comments. They see and appreciate all their state association is doing for their practice and their profession. They take pride in supporting the MSCA.

THE GOVERNMENT REPORT

By Mo McCullough, Government Affairs Director

Legislative Year Unproductive

The 2008 session is winding down. The last day being May 16. It’s too early to predict the final outcome, but I think I can safely say nothing much will happen. There’s more energy being expended on the upcoming elections than on passing legislation. Controversial bills and issues are extremely unpopular with legislators during an election year, so unless problems can be worked out, they will go nowhere.

Our legislation is bogged down because most of our issues are opposed by the insurance carriers, and legislators don’t want to get in the middle this year. HB 2116, which prohibits carriers from treating chiropractic care as specialty care; HB 1971, which adds chiropractic care to MO HealthNet; and SB 1043, which requires carriers to cover out-of-network chiropractic services; are all still stuck in their committee of origin. We are still working to try to get some movement, but it doesn’t look promising for this year.

Next year could be a different story. With new legislators, new leadership and no elections, we’ll hit it hard and fight for more positive results. As always, you can help by getting involved locally in the election process; get to know your legislator; attend Legislative Day at the Capitol; and join the MSCA PAC. 

Chiropractic Care More Beneficial to Management of Common Neck Pain

By Foundation for Chiropractic Progress

In a study conducted by the International Neck Pain Task Force of the Bone and Joint Decade (BJD) of the World Health Organization (WHO) and reported in the journal SPINE (1/18/08), researchers marginalize commonly used approaches to treating neck pain and highlight interventions that were previously viewed with caution.  According to the study and confirmed by the Foundation for Chiropractic Progress (www.F4CP.org), in cases of neck pain without consistent radiating pain the shoulder or arm, surgery is rarely advised.
 
The findings result from a six-year review of more than 31,000 research citations with subsequent analysis of over 1,000 studies.  The multi-disciplinary report, involving persons from 19 areas of study and from eight collaborating universities in four countries, is widely regarded as one of the most extensive reports on the subject of neck pain ever developed, and it offers the most current perspective on the scientific evidence related to the care and management of neck pain.
 
"This study validates that interventions such as spinal manipulation or spinal adjusting that promote regaining function and a return-to-work are more beneficial than usual care, sham or alternative interventions," says Gerard W. Clum, D.C., president of CA-based Life Chiropractic College West and speaking on behalf of the not-for-profit Foundation.
 
The report proposes a new four-level classification system for neck pain, with the majority of neck pain problems falling into the Grade I and Grade II categories of this scale. Problems of this type do not involve fractures, neoplasms, myelopathy or radicular pain.  The report is provided online at www.spinejournal.com and will also be published as a special edition in both the North American and European editions of SPINE. 
 
"A pain in the neck is a common adage for a good reason- - it is a widespread, annoying, aggravating and disabling problem affecting up to 70 percent of the population annually," explains Dr. Clum.  "While this type of condition does not carry the life-or-death reality of a heart attack or cancer, it often undermines a person's quality of life over decades. People often say that time heals all wounds, but neck pain may be an exception that does not resolve well over time. In fact, it tends to worsen over time unless addressed effectively and efficiently."
 
He points out that neck pain is an important factor in the lives of millions of people around the globe, and is also an important cost center associated with many workplace injuries as well as many automobile injuries.
 
"This authoritative study offers health care professionals--including primary care physicians, surgeons, chiropractors, physical therapists and others--a thoroughly documented overview of the strategies that have been established in the scientific literature to address neck pain," says Dr. Clum.
 
The Neck Pain Task Force report offers, "an evidence-based analysis of what is known about neck pain as opposed to what has been believed or handed down from one generation of providers to another. 
 
"From my vantage point as a chiropractor, their recommendations greatly support the approach and forms of care provided by chiropractors, especially spinal adjustments that have been central to the practice of chiropractic," says Dr. Clum.
 
Also presented with the report of the Neck Pain Task Force were a number of neck-related studies. One important study brings considerable question to the linkage between cervical (neck) manipulation and the development of a unique form of vascular problem known as vertebrobasilar artery insufficiency or vertebrobasilar artery stroke. The findings from an analysis of nine years of data involving approximately 110 million patient years reveal no greater incidence of this type of problem among chiropractic patients than among patients of general practitioners.
 
The Neck Pain Task Force noted in its Executive Summary, "This is likely explained by patients with vertebrobasilar artery dissection-related neck pain or headache seeking care before having their stroke."
 
"When a patient develops a vertebrobasilar artery dissection, it produces neck pain prompting the patient to seek attention - with many patients choosing to access care from chiropractors or general practitioners," says Dr. Clum. "The study concludes that patients do develop stroke symptoms at the same rate regardless of the type of practitioner they select. This indicates that the type of care chosen does not contribute to their problem."
 
Among the factors that were found to contribute to a better recovery from bouts of neck pain were a preference for one type of care versus another from the patient perspective, as well as the attitude of the patient and the ability to return to normal activities of daily living and normal work activities.

A New Conceptual Model for Neck Pain
The Neck Pain Task Force proposes a new conceptual model for the course and care of neck pain. The model is centered on persons with neck pain or who are at risk for neck pain. The model describes neck pain as an episodic occurrence over a lifetime with variable recovery between episodes. It outlines the options available to deal with neck pain; the factors that determine available options, choices, and consequences; and the short- and long-term impacts of neck pain.

A New Classification System for Neck Pain
For the subset of individuals who seek clinical care, the Neck Pain Task Force recommends a 4-grade classification system of neck pain severity that is intended to help in the interpretation of scientific evidence. The new system will also help people with neck pain, researchers, clinicians, and policy makers in framing their questions and decisions:
Grade I neck pain: No signs or symptoms suggestive of major structural pathology and no or minor interference with activities of daily living; will likely respond to minimal intervention such as reassurance and pain control; does not require intensive investigations or ongoing treatment.
Grade II neck pain: No signs or symptoms of major structural pathology, but major interference with activities of daily living; requires pain relief and early activation/intervention aimed at preventing long-term disability.
Grade III neck pain: No signs or symptoms of major structural pathology, but presence of neurologic signs such as decreased deep tendon reflexes, weakness, and/or sensory deficits; might require investigation and, occasionally more invasive treatments.
Grade IV neck pain: Signs or symptoms of major structural pathology, such as fracture, myelopathy, neoplasm, or systemic disease; requires prompt investigation and treatment.

When choosing treatments to relieve grades I and II neck pain, patients and their clinicians should consider the potential side effects and personal preferences regarding treatment options.

Preventing Neck Pain
Preventive efforts are best directed at reducing major injuries and dealing effectively with neck pain to avoid the development of disabling neck pain. It is clear that we need more conceptually sound and theory driven research in this area.

The Need for Future Research
Neck pain is multifactorial in its etiology and in its impact on affected persons. Future research should be directed to assessing the impact of modifiable risk factors through innovative treatment approaches. Changes in public policy which address these risk factors may significantly reduce the burden and cost of neck pain in society.

© 2008 Lippincott Williams & Wilkins, Inc.

About the Foundation for Chiropractic Progress
For more information about the report of the Neck Pain Task Force or the Foundation for Chiropractic Progress visit www.f4cp.com.

The Multiple Hat Society

By Robert Hart

Mr. Smeds and Mr. Spats

by Shel Silverstein

Mr. Spats
Had twenty-one hats,
And none of them were the same.
And Mr. Smeds
Had twenty-one heads
And only one hat to his name.
Now, when Mr. Smeds
Met Mr. Spats,
They talked of the
Buying and selling of hats.
And Mr. Spats
Bought Mr. Smeds' hat!
Did you ever hear anything
Crazier than that?

Most chiropractors are charter members of the "Multiple Hat Society". The roles of doctor, office manager, sales and marketing, billing, human resources and accounting are just some of the responsibilities of the contemporary practitioner. Wearing that many hats is a good news, bad news kind of thing. First the bad news - it comes with the job and you will never reduce the load to only one or two hats; and lest you feel picked on, you should know that all small business owners wear multiple hats. Now for the good news - it's not necessary to build bulky neck muscles. You can take off a few of the hats and minimize the weight of those that you have to wear. It boils down to creating and then sticking to systems and procedures.
 
Let's take the marketing "hat" as an example. By developing a marketing calendar for the next 12 months and then by assigning responsibility for each promotion to various members of your team, you will reduce the direct responsibility that you currently shoulder. Your staff will have more of a stake in the success of each strategy and you will not be guilty of doing the cyclical panic marketing that only occurs when the new patient visits are down. Additionally, the job gets easier and less expensive each successive year. You will repeat the promotions that worked, reusing some of the materials, and will only have to find new things to replace those that were less successful than you would have liked. Sound too good to be true? In my experience, you should be able to plan the whole year in a couple of hours.
 
Another example is the human resource "hat". Imagine how much easier your job would be if you were able to give each new team member a written job description, a copy of the office policies and an operations manual. Unrealistic? Not really. A few years ago my daughter was hired by a local chiropractor and that is just what she got. Right away she knew what was expected of her and with the subsequent training she was quickly integrated into the office. I know what you are thinking as you read this, "sure that sounds great, but first I have to create the job description, office policies and operations manual." Well, you have me on that one. There is no doubt that developing that material will take some time, but it only has to be done once and then, with minor revisions, you will have it forever. Suddenly, magically, you will have cut your hiring and training effort substantially.
 
You may have heard that it is better to work smart than it is to work hard and that is generally true. I would rewrite the expression to read, "you will sometimes have to work hard, but you should always work smart". You won't be able to take off all of your hats, but you should be able to shed a couple of them. Those that you have to keep can be lightened considerably if you will work a little smarter, set up the systems and act like every other successful small business. 

About the Author
Robert Hart is the founder and owner of Hart Consulting. Through seminars and personal coaching he has been assisting Doctors of Chiropractic achieve both their practice and personal goals for the past 18 years. Mr. Hart can be contacted at 480-892-4621, rob@hart-consulting.com, or www.hart-consulting.com.

INSURANCE REPORT

By Margaret Freihaut, DC, Insurance Committee Chair

2008 Physician Quality Reporting Initiative
Reporting period Jan. 1- Dec.1, 2008.
Voluntary program.
NPI is required.
2008 program includes measures applicable to DCs.
Pain assessment prior to patient therapy (quality measure).
Reporting thresholds to qualify for incentive.
Must be at least 80% of the cases in which the measure was reported.
The bonus is 1.5% based on the allowed charges during the reported period.
Claims must reach the National Claims History by Feb. 28, 2009.
Lump payments will be paid mid 2009.
How to Report Quality Measures
The measure is to be reported for each initial evaluation occurring during the reporting period for all patients age 18 and over.
Percentage of patients age 18 and older with documentation of a pain assessment (if pain present, including location, intensity and description) through discussion with the patient or a standardized tool on each initial evaluation prior to initiation of therapy.
A CPT code is required to identify patients included in this measure.
CMT 98940-98942 included.

If Pain assessment prior to therapy -
       -G8440 (pain assessment documented)
       -G8442 (patient not eligible, exclusion documented)
       -G8441 (no documentation of pain assessed)

Remember these codes are only used on initial visits or episodes, not exacerbations.
They can only be used with CMT codes.
They go behind the AT modifier.
You must report 80% of the time.

It is important that the profession gets involved with these quality measures so that we can continue to
be included, and to show we are concerned with quality care.
 
New ABN Forms
New ABN forms are required after September 1, 2008, but can be used now. The ABN must be verbally explained to the patient, and all questions answered before it is signed. All blanks must be filled in, and copy goes to the beneficiary and into the file. The new form may now be used for non-covered services and voluntary notification of financial liability. The providers name and address are to be on the top of the form, as well as the patient's name and Medicare ID number.
 
Legacy Numbers
Legacy numbers will no longer be accepted on Medicare claim forms after May 23, 2008. You can start sending test claims now. Any claims with legacy numbers, in any field, will be rejected after the May 23 deadline.
 
Wisconsin Physicians Service
The new carrier took over for western Missouri as of March 1, 2008. The rest of the state will begin sending claims to WPS as of June 1, 2008.
 
MSCA Legal Action Fund
The MSCA Legal Action Fund needs you. As anyone in practice knows, the insurance environment changes frequently, and carriers are getting more creative in figuring out how to save their bottom line.  Saving this bottom line is often at a price that affects your patients’ healthcare and your ability to practice the way you are trained. The MSCA Legal Action is your voice fighting for your rights and the rights of your patients.

JOIN TODAY AT WHATEVER LEVEL YOU CAN, be it a one-time donation or a monthly contribution. Don’t think someone else will carry the burden. IT TAKES US ALL!

File Insurance Complaints
The insurance committee continues to collect your insurance complaints and encourages you to continue to file complaints to the Division of Insurance. We would also like to thank you for sharing information with us and keeping us abreast of the changes you see as they happen. We can't do it without you.

MEMBERSHIP REPORT

By Michael Finley, DC
Membership Committee Chair

One of the MSCA's most popular and most utilized membership benefits is the availability of our attorney for a one-on-one phone consultation. To ensure the continued availability of this invaluable benefit, please take note of the following guidelines when utilizing this service.

This benefit is for members only and not available to non-members.

Call the MSCA central office in Jefferson City (573-636-2553) for a referral. In some cases, frequently asked questions can be answered without legal counsel.

Legal counsel is available to answer non-complex legal questions, via the telephone, that do not involve legal research or document review.

Any opinions expressed by counsel are advisory only due to the limited scope of the contact.

There is no attorney client relationship created; and, thus, copying MSCA legal counsel on correspondence or other documents to third parties should be avoided.

This benefit is provided as a courtesy to members; and there are times when legal counsel cannot respond right away; thus, if an immediate response is required, members should consult their own legal counsel.

The PAC Report

by Paul W. Foster, DC, PAC President

Our eternal thanks to Wanda Munson and The Key Company for their many years of service that they have given to the MSCA on Legislative Day.
 
At the April 26 PAC Board of Trustees meeting, we made final plans for the live and silent auction at convention.
 
If you have any items large or small that you would like to donate, please contact your district PAC trustee or Mo.
 
Keep in mind that we have discontinued the PAC raffle.  So we need your help and input for fund-raisers to assist in electing our friends in the legislature.
 
As of April 3, 2008, we have $28,500 in checking.

DISTRICT 1 REPORT

Elections
District 1 election of officers will be held May 27 at 7:30 p.m. at Logan College in room 156B.

District 1 President and all five (5) representative positions are open. To be eligible to run, you must be a member in good standing with the MSCA.

As a board member, it is requested that you attend three (3) annual board meetings on Saturdays from 12 p.m. to 4 p.m. in Jefferson City at the MSCA office. There is also one (1) board meeting on Sunday at the MSCA Summer convention at Tan-Tar-A Resort in Osage Beach.

As a board member, you will be able to vote on numerous topics (legislation, legal action issues, MSCA finances, insurance concerns, national issues, etc.) If you like, or dislike, the direction of the profession in our state, this is your chance to make a change.

The MSCA is the largest it has ever been in our state and in District 1. It’s been on a roll passing major pieces of legislation, organizing a Legal Action Fund, and to many other things to list.

The Truth!
The problem is with the rapid growth of District 1. It has been challenging to find people to take leadership roles and board member positions. We have had many of the same people for several years. It is vital to have new energy and ideas to see continued growth and advancement of our profession.

We do not have enough people to fill these board member positions!! If these positions are not filled, you will not be represented!! Chiropractors across the state work hard to advance the profession, but there are differences on the direction, focus and action to be taken. Over the years, just one or two votes have made major decisions for the profession in our state.

If you are interested in running for a position, or would like more information, contact Michael Finley, DC at doctorfinley95@yaoo.com , or call 636-461-2265.

DISTRICT 2 REPORT

By Ron Manfredi, D.C.

Member chiropractors in Kansas City and its nine surrounding counties of Benton, Cass, Clay, Henry, Jackson, Johnson, Lafayette, Platte, and Ray are strong and well and united in their support of the chiropractic profession.  This unity was evident at the recent April 3 Board meeting held at the new Cleveland Chiropractic College, 10850 Lowell, Overland Park, Kansas. The new facility is beautiful and elegant, and the Board elected to have the upcoming Medicare lecture and District 2 General meeting at the new college facility on April 24 at 7 p.m. The board hopes that this event is both educational and informative regarding the new Medicare changes.

A District 2 election is scheduled for another General meeting on Thursday, May 1, 2008, at 7:30 p.m. at the Ararat Shrine Temple, located at “exit 65” on I-435 in Kansas City, Missouri. Candidates for offices which are unopposed at the time of this writing are: President, Dr. Paul Foster; Vice President, Dr. Jim Gray; Treasurer, Dr. Russ Matthias; and Secretary, Dr. Jerry Witt.

For information regarding the cookbook, call Dr. Linda Buckmiller in Smithville at 816-532-8966.  For other MSCA District 2 information, call Dr. Russ Matthias in Blue Springs at 816-228-5113. 

DISTRICT 5 REPORT

By Jeremy Thornton, DC, DABCI

Our Winter Seminar Extravaganza was a great success, providing 24 hours of continuing education to Missouri doctors. Many positive comments were made on the content and quality of the classes presented.  District 5 works hard to not only provide required continuing education hours, but to include dynamic and interesting speakers with updated and state of the art information.  Feel free to submit ideas or suggestions for next year to docjeremyt@hotmail.com.

Keep an eye on the MSCA website for our next meeting which will be held before the Summer Convention at Osage Beach.

NEWS & VIEWS

“Sense of Congress” legislation calling on the US Secretary of Defense to immediately take steps to commission doctors of chiropractic as health care officers in the US Armed Forces has been introduced in the US House of Representatives at the request of the ICA. On February 13, 2008, Representative Neil Abercrombie (D-HI), joined by The Hon. Thelma Drake (R-VA) and two other members, The Hon. Ron Paul (R-TX) and The Hon. Robert Brady (D-PA), introduced Congressional Joint Resolution 294 which states:

That it is the sense of Congress that the Secretary of Defense should take immediate steps to establish a career path for doctors of chiropractic to be appointed as commissioned officers in all branches of the Armed Forces for purposes of providing chiropractic services to members of the Armed Forces.

ICA urges every doctor of chiropractic, student, family member or interested citizen to contact their Member of the US House of Representatives and ask for their immediate co-sponsorship of House Resolution 294. You can locate your Representative via the Internet at http://www.house.gov/.

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