MARCH 2010 ISCA REPORT 1 Greetings Doctors, Spring brings with it “New Life”. As each day begins anew we must reflect on yesterday’s accomplishments or shortcomings and prepare for tomorrow by improving ourselves today! This year’s ISCA Spring Seminar was a great success! ISCA members had a selection from various topics delivered by a great line up of speakers. From CPR Certification to Medicare Information to Golf Injury/Swing Diagnosis to Practice Management and more. We were honored to have ACA President Dr. Rick McMichael with us all weekend. Dr. McMichael was able to share with our membership the many great advances the ACA has accomplished on a national level. The actions of the ACA truly affect our bottom line and protect the practice of chiropractic. We should all be members of the ACA to support the numerous ways they fight for our individual and collective rights as Doctors of Chiropractic. Currently, yearly ACA dues are $630.00. After doing some quick math, I calculate this as .5% of the gross of $120,000 per year. If a doctor grosses $250,000 year, this would be only .25% of the gross income. A small price to pay to protect your profession. There are many doctors that gross more than $250,000/year. The same scenario can be used for the ISCA membership dues. At $600/year for the 5th year members, the calculations would be roughly the same as for the ACA membership. A $250.00/year BackPac contribution would represent only .1% of the average 5th year Doctor’s gross income. Did you know that each legislative session during the first 3 weeks of January, our Lobbyist/Executive Director, Pat McGuffey analyzes 800 to 1200 bills to determine if they will affect our profession? She will then present all of the bills that may have a potential to affect us to the ISCA Legislative Committee. By teleconference we review each bill every Friday to determine whether to support, oppose or monitor a particular bill. She will then meet with Senators, Representatives and Lobbyists to ensure the proper language is inserted or deleted to protect our interests. For example, one particular bill had terminology that would only allow us to request a cease and desist order from the Attorney General for an unlicensed person but not for licensed physical therapists, massage therapists or acupuncturists practicing outside their scope. This terminology was removed from this bill at the request of Pat McGuffey. The ISCA also eliminated language in legislation that would have allowed the physical therapists licensing board to have a lower standard in determining if a physical therapist was practicing recklessly and knowingly outside their scope of practice and training. This is only one example of numerous changes made to bills this year by Pat McGuffey to protect our profession. No way could we as individual doctors do this on our own, and have any remnant of a life or a practice! To many of you, I am “Preaching to the Choir” as you are already members. Of course, continue to keep your dues current, consider elevating your membership to Gold or Platinum which also carries added benefits and certainly encourage other doctors you know that are not members and are riding our “coat tails” to become members. BACKPAC Our very existence relies on our ability to retain current laws to protect all aspects of our ability to practice chiropractic in Indiana. Our future depends on our ability to create and pass new bills to be pro-active to support and strengthen our position in today’s healthcare industry. This will be critical as the physical therapists are going to be back in full force to claim they are qualified to perform spinal manipulation. INSIDE THIS ISSUE Dr. Anthony Wolf, D.C., FICC MARCH 2010 PRESIDENT'S MESSAGE..................................................................................... 1 ISCA BOARD OF DIRECTORS & STAFF INFO...................................................2 EXECUTIVE DIRECTOR'S MESSAGE................................................................3 OIG ALLOWS CHIROPRACTIC REFERRAL NETWORK..................................4 PATIENTS IN MEDICARE GIVE CHIROS HIGH MARKS...............................5 WELLPOINT BLAMES RATE HIKE ON LOSS OF HEALTHY CUSTOMERS..........6 ERCHONIA MEDICAL INC. DONATES $50,000 TO F4CP ...................6 STUDY EXPERT VALIDATES CHIROPRACTIC STANDARD OF CARE..............7 NEW STATUTE IN NJ REVISES OUTDATED SCOPE-OF-PRACTICE......................8 ISCA PHOTOS FROM 2010.............................................................................9 RECESSION EXPECTED TO IMPACT GROWTH IN HEALTH EXPENDITURES..... 10 MEDICARE FEE CUTS DELAYED.................................................................... 11 PROFESSIONAL FOOTBALL CHIROPRACTIC SOCIETY ANNOUNCES ROLE...11 WELLPOINT TO DELAY INSURANCE HIKE IN CALIFORNIA....................... 12 CHIRO CARE INCLUDED IN 2010 OLYMPIC WINTER GAMES.................. 13 THANKS TO OUR SPONSORS & EXHIBITORS............................................ 13 A QUICK REFERENCE GUIDE: GENERAL INDIANA LAW................................ 14 SEBELIUS ASKS INSURERS TO JUSIFY RATE HIKES.............................. 16 CONGRESSIONAL MAP OF INDIANA................................................................ 17 ISCA CLASSIFIEDS...................................................................................... 18-19
Transcript
MARCH 2010 ISCA REPORT 1
Greetings Doctors,Spring brings with it “New Life”. As each day begins anew we must reflect on yesterday’s accomplishments or shortcomings and prepare for tomorrow by improving ourselves today!
This year’s ISCA Spring Seminar was a great success! ISCA members had a selection from various topics delivered
by a great line up of speakers. From CPR Certification to Medicare Information to Golf Injury/Swing Diagnosis to Practice Management and more. We were honored to have ACA President Dr. Rick McMichael with us all weekend. Dr. McMichael was able to share with our membership the many great advances the ACA has accomplished on a national level. The actions of the ACA truly affect our bottom line and protect the practice of chiropractic. We should all be members of the ACA to support the numerous ways they fight for our individual and collective rights as Doctors of Chiropractic. Currently, yearly ACA dues are $630.00. After doing some quick math, I calculate this as .5% of the gross of $120,000 per year. If a doctor grosses $250,000 year, this would be only .25% of the gross income. A small price to pay to protect your profession. There are many doctors that gross more than $250,000/year. The same scenario can be used for the ISCA membership dues. At $600/year for the 5th year members, the calculations would be roughly the same as for the ACA membership. A $250.00/year BackPac contribution would represent only .1% of the average 5th year Doctor’s gross income.
Did you know that each legislative session during the first 3 weeks of January, our Lobbyist/Executive Director, Pat McGuffey analyzes 800 to 1200 bills to determine if they will affect our profession? She will then present all of the bills that may have a potential to affect us to the ISCA Legislative Committee. By teleconference we review each
bill every Friday to determine whether to support, oppose or monitor a particular bill. She will then meet with Senators, Representatives and Lobbyists to ensure the proper language is inserted or deleted to protect our interests.
For example, one particular bill had terminology that would only allow us to request a cease and desist order from the Attorney General for an unlicensed person but not for licensed physical therapists, massage therapists or acupuncturists practicing outside their scope. This terminology was removed from this bill at the request of Pat McGuffey. The ISCA also eliminated language in legislation that would have allowed the physical therapists licensing board to have a lower standard in determining if a physical therapist was practicing recklessly and knowingly outside their scope of practice and training.
This is only one example of numerous changes made to bills this year by Pat McGuffey to protect our profession. No way could we as individual doctors do this on our own, and have any remnant of a life or a practice!
To many of you, I am “Preaching to the Choir” as you are already members. Of course, continue to keep your dues current, consider elevating your membership to Gold or Platinum which also carries added benefits and certainly encourage other doctors you know that are not members and are riding our “coat tails” to become members.
BACKPACOur very existence relies on our ability to retain current laws to protect all aspects of our ability to practice chiropractic in Indiana. Our future depends on our ability to create and pass new bills to be pro-active to support and strengthen our position in today’s healthcare industry. This will be critical as the physical therapists are going to be back in full force to claim they are qualified to perform spinal manipulation.
INSIDE THIS ISSUE
Dr. Anthony Wolf, D.C., FICC
MARCH 2010
PRESIDENT'S MESSAGE.....................................................................................1ISCA BOARD OF DIRECTORS & STAFF INFO...................................................2EXECUTIVE DIRECTOR'S MESSAGE................................................................3OIG ALLOWS CHIROPRACTIC REFERRAL NETWORK..................................4PATIENTS IN MEDICARE GIVE CHIROS HIGH MARKS...............................5WELLPOINT BLAMES RATE HIKE ON LOSS OF HEALTHY CUSTOMERS..........6ERCHONIA MEDICAL INC. DONATES $50,000 TO F4CP...................6STUDY EXPERT VALIDATES CHIROPRACTIC STANDARD OF CARE..............7NEW STATUTE IN NJ REVISES OUTDATED SCOPE-OF-PRACTICE......................8ISCA PHOTOS FROM 2010.............................................................................9
RECESSION EXPECTED TO IMPACT GROWTH IN HEALTH EXPENDITURES.....10MEDICARE FEE CUTS DELAYED....................................................................11PROFESSIONAL FOOTBALL CHIROPRACTIC SOCIETY ANNOUNCES ROLE...11WELLPOINT TO DELAY INSURANCE HIKE IN CALIFORNIA.......................12CHIRO CARE INCLUDED IN 2010 OLYMPIC WINTER GAMES..................13THANKS TO OUR SPONSORS & EXHIBITORS............................................13A QUICK REFERENCE GUIDE: GENERAL INDIANA LAW................................14SEBELIUS ASKS INSURERS TO JUSIFY RATE HIKES..............................16CONGRESSIONAL MAP OF INDIANA................................................................17ISCA CLASSIFIEDS......................................................................................18-19
District NineJohn Krawchinson D.C.Seymour, IN812.524.2273
ALTERNATES: The ISCA by-laws allow for the Directors at Large and the District Directors to have Alternate Directors. The Alternate At Large Directors may reside anywhere in the state. The Alternate District Directors must reside within their district. There are 9 districts and their boundaries are the same as per the national census. This is done to keep the Districts in line on a proportional basis. When the Directors are not present, the Alternate Directors have the full voting powers as the Directors and may take their place at any meetings. This system was initiated to involve more people in the association’s decision-making process and to serve as a training ground for future board members. The Alternate Directors at Large are nominated by the Directors at Large and then must be approved by the Board of Directors. The District Director Alternates are recommended by the District Directors and approved by the board.
200 S. Meridian St., Suite 350Indianapolis, IN 46225info@indianastatechiros.orgwww.indianastatechiros.org317.673.4245 phone 800.572.8002 toll-free 317.673.4210 fax
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INDIANA STATE CHIROPRACTIC ASSOCIATION STAFF & INFO
INDIANA STATE CHIROPRACTIC ASSOCIATION BOARD OF DIRECTORS
MARCH 2010 ISCA REPORT 3
STORY CONTINUED...The physical therapists want:1. Physician Status-Portal of entry provider2. Direct Access-without referral3. Incident to-which means physical therapy can only be
performed by licensed physical therapist or physical therapy assistant. This would eliminate Chiropractors from performing physical therapy.
4. Spinal manipulation
The physical therapists will not quit.• Fact: Physical therapists outnumber DC’s in Indiana
by nearly 10 to 1. Therefore, their PAC and grassroots efforts are Huge.
• Fact: State Medical Association PAC is over $100,000.00
• Fact: The ISCA PAC is $30,000.00 on average with only 10% of Indiana DC’s contributing.
We must increase our current membership and BackPac levels to continue to compete.
Some Doctors contribute more, some contribute less, while over 500 DC’s in the State of Indiana do nothing at all. Clearly, without a doubt, the chiropractic profession would not exist today without the efforts of the ACA and a strong State Association such as the ISCA. The future of this profession will not only be to continue to “survive” but to become more organized to attain a strength the world has not seen before. Energy (effort) is needed to maintain organization in any living matter. The same holds true for our professional organizations. The ISCA continues to strengthen by the commitment of our members each and every year. The efforts by our members to coordinate and strengthen our various committees have been remarkable. I am truly humbled to work side by side with each of our members.
We ALL need to devote our time, talent and treasure to continue to build on all our profession has gained.
Our time is NOW! The Future is ours!We all need to step up and share the responsibility!
Yours in chiropractic,Anthony C. Wolf, D.C., F.I.C.C.
It was great seeing so many of you at our very successful “Spring Conference”. The weather did not feel like spring but the conference felt like spring as we discussed new ideas and opportunities for the Chiropractic profession.
The ISCA leadership and Committee Chairpersons talked about new services they have initiated for our members. One of the new member benefits includes brown bag lunches (conference calls) that allow our members to ask questions and obtain information regarding various practice issues. Also, the Insurance committee spends numerous hours on researching and addressing a plethora of complicated insurance questions from our members.
In addition to the seminars with our dynamic educational speakers, the ACA President Dr. McMichael gave an inspirational presentation on the importance of chiropractic and what we all need to do to help the profession grow and prosper.
I encourage all of you to make a point of attending our Gala dinner and dance next spring. We had so much fun this year. The Gala helps to build friendships and promote collegiality. Please plan on attending and join in the fun next year.
Turning to our work at the legislature, the Indiana General Assembly's short session adjourned March 13. It was widely reported that this session was one of the most frustrating and unproductive in many years. First, the State has no money so the Legislature made it clear from the beginning that they would not hear a bill with a fiscal attached. In addition, since this is a big election year, it was clear the legislature would not hear any controversial issues and that all proposed legislation would be weighed carefully to determine if it presented potential political gain or loss.
However, the ISCA was successful in amending a number of bills that would have had a significant negative impact on your practice. The Attorney General’s office and the Professional Licensing agency introduced a number of lengthy, complicated, substantive bills that took a great deal of study and negotiation. We were successful in amending a bill to eliminate the requirement for you to have a surety bond to be a provider in a State Health Plan (Medicaid). In addition, the legislation would have mandated that any health provider that had committed Medicaid fraud to be placed on a list that would not be allowed to provide services in any State Health Program. The problem with the language was that Medicaid fraud was defined in such a way that it would have included legal and acceptable practices. We successfully amended and defeated those provisions.
Also, a bill was introduced that would have deleted the Board of Chiropractor’s cease and desist ability for those practicing
MARCH 2010ISCA REPORT4
chiropractic without a license. We restored that language. The ISCA also eliminated language in legislation that would have allowed the physical therapists licensing board to have a lower standard in determining if a physical therapist was practicing outside their scope of practice and training.
Unfortunately, for the ISCA, the fiscal problems prevented our priority bill (SB 404) from being heard. (It had a fiscal of 2.5 million.) SB 404, authored by Sen. Ron Alting, would have provided parity for reimbursement for all chiropractic treatment services in the Health Insurance Program (HIP). We have been working hard on this issue and will continue to pursue this legislation next year when the State has to pass a biennial budget.
The insurance industry, business community, and the labor unions all opposed ISCA’s other priority legislation, HB 1022. The bill was not called down for a vote on the House floor after it passed out of the House Health Committee. The open access bill would have given Health care providers the opportunity to run their practice as they wished, granting them the option to stop seeing new patients from one particular insurance plan without closing their doors to all new patients. The ISCA will join with other health care provider associations and begin to work on important insurance reform for the 2011 session.
Speaking of insurance reform, when Anthem announced they were going to increase premiums 39%, the House Insurance committee interrogated Anthem regarding their decision. After the Indiana Department of Insurance and WellPoint Anthem unsuccessfully defended their move, the Committee added language in SB 357 that required health insurers licensed in Indiana to provide timely and transparent information to the Indiana Department of Insurance to be
displayed for consumers to review. Information would have had to be readily available on the IDOI website and updated on an annual basis. The purpose of "premium transparency" was to limit the amount of money that health insurance companies ("insurers") may spend on administrative expenses and keep as profit. As DC's reimbursements are decreasing premiums continue to rise, this transparency would prove that providers are not the cause of the problem. Language in Senate Bill 357 would have only sought to provide the reporting and transparency of a "medical loss ratio." The utilization of a medical loss ratio forces insurers to spend more on direct medical benefits and a tightly regulated amount on a very specific and detailed list of "administrative expenses." After passing out of Committee, legislators sought to add controversial amendments on the House floor so Rep Fry withdrew the bill. This issue will likely be studied this summer and legislation introduced in the 2011 legislative session.
Lastly, I predict that physical therapists will make a strong move next year to get direct access and perform spinal manipulations. It is crucial for you to meet with your local legislatures after the Session adjourns. You need to explain to them the difference in your education and training and why this would be unsafe for patients if physical therapists were allowed to perform spinal manipulation. Also, please donate to the ISCA BACKPAC. It is more important than ever to support legislators that support chiropractic. Please help us to keep the Chiropractic profession strong and successful.
Please contact me if you have questions or we can be of assistance. Regards, Pat
OIG ALLOWS CHIROPRACTIC REFERRAL NETWORK By David Elliott Jose, Esq.
EXECUTIVE DIRECTOR'S MESSAGE CONTINUED...
The federal Office of Inspector General recently issued an Advisory Opinion in response to a request from a state chiropractic association. The request related to whether sanctions would be imposed under the anti-kickback or fraud and abuse laws relating to a proposed referral service for chiropractors in that state. The OIG issued its Advisory Opinion indicating
that the proposed network did not fit into any established safe harbor, but it decided that there would be insufficient concerns to pursue sanctions against the proposed network.
This situation seems like such a simple and typical arrangement, so I thought it would be helpful to understand some of the strict scrutiny applied in these situations by enforcement authorities. The proposed network would
advertise and provide referral services for chiropractors throughout the state. Since chiropractors would be paying money to the referral service organization in exchange for receiving referrals, then the OIG acknowledged that this potentially violated the fraud and abuse laws, but ultimately concluded that the risk for fraud and abuse is low. The referral service is actually operated by an independent for-profit corporation that would advertise chiropractic services throughout the state. It would then provide referrals for such services to potential consumers looking to identify a chiropractor for the professional services. The referral service would be open to participation by any chiropractor licensed in that state for a flat fee of $200 per month. However, the chiropractic association in the state was proposing to enter into an arrangement that would permit its members to participate in the network’s referral service for a reduced fee of $60 per month.
MARCH 2010 ISCA REPORT 5
According to long-awaited results from a congressionally mandated pilot project testing the feasibility of expanding chiropractic services in the Medicare program, patients have a high rate of satisfaction with the care they receive from doctors of chiropractic.
When asked to rate their satisfaction on a 10-point scale, 87% of patients in the study gave their doctor of chiropractic a level of 8 or higher. What’s more, 56% of those patients rated their chiropractor with a perfect 10.
Contributing to that satisfaction was the attention given to patients’ needs and the accessibility of chiropractic care. Patients reported that doctors of chiropractic listened to them carefully and spent sufficient time with them. Some 95% said they had to wait no longer than one week for appointments.
“Doctors of chiropractic everywhere should feel pride in these patient satisfaction results and in being part of a profession that still sees the great need for spending time with patients and truly listening to them,” said Dr. Rick McMichael, president of the American Chiropractic Association (ACA). “It’s clear that patients deeply value the time their chiropractic providers spend with them and the expert care that DCs offer.”
The pilot, known as a “demonstration project” in Congress, was conducted from April 2005 to March 2007 throughout the states of Maine and New Mexico, and also in Scott County, Iowa, 26 counties comprising the Chicago metropolitan area, and 17 counties in central Virginia.
Current chiropractic coverage under Medicare is limited to spinal manipulation. Under the demonstration project, however, chiropractic care was expanded to include
diagnostic and other services, such as X-rays, examinations, physical therapy and rehabilitation services.
The final report to Congress also includes information on the costs of expanding chiropractic services in the demonstration sites. The report indicates that in all but one of the demonstration sites, patients’ health care costs were not significantly changed by expanding coverage of chiropractic services. In contrast, a cost increase was found in the Chicago metropolitan area. Further research into the reasons why the results in Chicago differ from the rest of the demonstration project sites is needed to better understand these findings.
“We already know that Medicare costs in general tend to be higher in Chicago than other similar areas of the country. We must find the underlying cause of the cost difference found in the chiropractic demonstration project and determine whether it had anything at all to do with the expansion of chiropractic services,” Dr. McMichael noted.
To further analyze the results of the demonstration project, ACA is creating a taskforce of Medicare experts and researchers who will review the report and develop a response for the Centers of Medicare and Medicaid Services.
View the report online www.acatoday.org/pdf/demo_report.pdf.
Source ACATODAY.org
PATIENTS IN MEDICARE DEMONSTRATION PROJECT GIVE CHIROPRACTORS HIGH MARKS
Separately, the chiropractic association also formed a for-profit subsidiary, and that subsidiary received a flat fee of $10 per month for each association member who participated in the network’s referral service. In exchange for that $10 fee, the association would advertise and promote the network’s referral service through regular communications to its members (and incidentally to its non-members). The network would advertise its chiropractic referral service through the internet, print, radio, or television advertising. A prospective patient would contact the network, and the network would then provide the name of a chiropractor in that patient’s zip code or neighboring zip code. If more than one participating chiropractor were in that zip code, then the referral network would rotate the names being given to prospective patients.
The OIG noted that the participation fee by chiropractors would not vary on the basis of referrals of any Medicare or Medicaid business. It was also important that the referral
of potential patients to participating chiropractors would be on a rotating basis within specific geographic areas, and not influenced by the variation in fees paid by the participating chiropractors. The OIG further determined that the $10 fee paid by the referral network to the association’s for-profit subsidiary did not implicate the anti-kickback statute, because the referral network was not providing items or services payable by the Medicare or Medicaid programs. It is important to recognize that referral relationships and similar opportunities arise through various business relationships. Even standard referral services must be carefully evaluated to make sure that they fit a safe harbor or that the facts can be assured so that the likelihood of any enforcement or violation is minimized or avoided. If you have questions about these or similar business relationship issues, you may contact David E. Jose at (317) 238-6211 or [email protected].
WELLPOINT BLAMES RATE HIKE ON LOSS OF HEALTHY CUSTOMERS
Health insurer WellPoint blames a shift in demographics and rising medical costs for its planned 39 percent rate hike for some California customers.
In a memo obtained by The Associated Press, WellPoint Inc. tells Health and Human Services Secretary Kathleen Sebelius that because of the weak economy, healthy people are dropping coverage or buying cheaper plans. The decline in premium revenue means there's less money to cover claims from sicker customers who are keeping their coverage. That resulted in a 2009 loss for the unit. The insurer says its 2010 rates aim to cover the shortfall expected from the continuation of that trend.
WellPoint said a minority of customers will see 39 percent increases and that those customers have an option to choose plans with a lower premium but higher out of pocket costs.
The federal inquiry was launched earlier this week after the premium increase planned for some customers who buy individual policies from WellPoint's Anthem Blue Cross subsidiary was widely publicized.
Congress also has asked for information on the increases and requested testimony from WellPoint CEO Angela Braly at a Feb. 24 hearing.
"When the healthy leave and the sick stay, that is going to dramatically drive up costs," WellPoint executive Brian Sassi said in an interview with The Associated Press.
Sassi is president of the consumer business unit for WellPoint, the largest publicly traded health insurer based on membership. WellPoint runs Blue Cross and Blue Shield
plans in 14 states and Unicare plans in several others.
Sebelius had called the increases "extraordinary" and told the insurer in a letter she was disturbed to learn about them. She also has demanded that the insurer answer questions about how much of a profit it will make from the hike.
Sassi said in the letter to Sebelius that the Anthem Blue Cross unit at the heart of the inquiry lost millions in 2009. He declined to offer specifics in an interview.
The executive said Anthem Blue Cross set some of its prices, or premiums, too low last year for the claims it received. It set 2010 prices based on what it thinks future prices will be.
"We need to make sure that our premiums cover the cost of claims," he said.
Sassi said a minority of Anthem Blue Cross's 800,000 individual policy holders in California will see rate increases as high as 39 percent. Most premiums will rise around 24 percent when the rates take effect March 1.
WellPoint as a whole made a profit of $4.75 billion in 2009, though $2 billion of that came from the sale of a business.
The letter to Sebelius said insurance costs also continue to rise because medical prices are increasing faster than inflation, and people are using more health care. That use increase is driven by an aging population, new treatments and "more intensive diagnostic testing," the letter said.
Sassi also said that as much as one-third of their individual insurance customers leave every year. That volatility can lead to big changes in the mix of people covered and rate swings.
ERCHONIA MEDICAL INC. DONATES $50,000 TO F4CPErchonia Medical Inc. pledged a two-year commitment and $50,000 donation to the Foundation for Chiropractic Progress (F4CP).
Charlie Shanks, vice president of sales and marketing for Erchonia, made the announcement during the 2010 Parker Seminars held in Las Vegas, N.V., Jan. 14th-17th.
“We are delighted to be able to work with the Foundation and be able to support the profession that has done so much for the health and well being of the Erchonia family,” said Shanks.
Erchonia’s two year monetary support will be issued to the Foundation on a yearly basis, providing the not-for-profit
with $25,000 per year to go directly into the positive press campaign, which includes advertisements, public service announcements, and press releases.
“The Foundation is extremely grateful for Erchonia’s multi-year commitment to supporting our national press campaign,” states F4CP Chairman, Kent S. Greenawalt. “Receiving support from a global leader like Erchonia demonstrates the true value behind the Foundation’s mission. We hope other vendors will follow Erchonia’s lead and recognize how our organization’s accomplishments directly impact their company’s success.”
Source: Foundation for Chiropractic Progress, www.f4cp.org
MARCH 2010 ISCA REPORT 7
STUDY EXPERT VALIDATES CHIROPRACTIC STANDARD OF CARE“The most recent research (Neck Pain Task Force Report of the Bone and Joint Decade 2000-2010, a study sanctioned by the United Nations and the World Health Organization) indicates neck manipulation is a safe and effective form of health care,” according to Matt Pagano, DC, chiropractic profession spokesperson.
Respected researcher and epidemiologist J. David Cassidy, DC, PhD, DrMedSc, testified as a key witness last week at the hearings on informed consent before the Connecticut Board of Chiropractic Examiners in Hartford, Conn. Speaking as an expert witness and consultant to the International Chiropractors Association (ICA)—and with the support of all chiropractic organizations involved in the process, including the American Chiropractic Association, Association of Chiropractic Colleges, Foundation for Chiropractic Progress, Life West, New York College of Chiropractic, Parker College of Chiropractic, Palmer College of Chiropractic, and the University of Bridgeport College of Chiropractic—Dr. Cassidy addressed key facts and issues on the basis of the existing science and research record, to which he has been a significant contributor. The objective of his testimony was to bring the discussion from an emotional issue back to science and the objective research record.
Dr. Cassidy joined an extensive list of witnesses representing the chiropractic profession, including William J. Lauretti, DC; James J. Lehman, DC, MBA; J. Clay McDonald, DC, JD, MBA; Gerard W. Clum, DC; Stephen M. Perle, DC, MS; Gina Carucci, DC, MS, DICCP, who appeared on behalf of the Connecticut Chiropractic Association (CCA); and George Curry, DC, FICA, who appeared on behalf of the Connecticut Chiropractic Council (CCC).
“The chiropractic profession unequivocally supports a patient’s right to be informed of the material benefits and risks of any type of health care treatment – not just chiropractic. Legislation or regulatory mandates governing informed consent should apply to all health care providers and all treatments in equal measure. However, a new law, regulation or mandate highlighting one specific treatment by a specific health care profession, which carries with it an extremely rare association and no causal link identified in the research, is simply not good public health policy. It would set an unnecessary precedent for all health care providers, procedures and products that would be virtually impossible to implement,” said Pagano.
The existing informed consent standards in Connecticut allow for the best opportunity for shared decision making between a patient and his or her health care provider. Further, the chiropractic organizations participating in the hearing process all believe informed consent is more than a piece of paper; it is a process. It should occur in the context of a discussion between a doctor and a patient, and it should be appropriately documented.
In a finding highly relevant to the issue before the Connecticut Board of Chiropractic Examiners, the Neck Pain Task Force study demonstrated that patients suffering from headache and neck pain are no more likely to suffer from a stroke following a visit to a chiropractor than they are after a visit to a family medical physician. This implies that there are factors involved other than the type of care provided by doctors of chiropractic. It’s important to note that millions of patients safely benefit from chiropractic care every year—they are able to return to their normal activities and enjoy a better quality of life.
Dr. Cassidy was an investigator with the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. The work of this international task force affirms the safety and benefits of chiropractic care for people with neck pain—a condition frequently treated by doctors of chiropractic. The Task Force initiated this new population-based, case-control and case-crossover study, which appeared in the Feb. 15, 2008 edition of the journal Spine. The study, which analyzed nine years’ worth of data from a population of 110-million person years, concluded that vertebrobasilar artery (VBA) stroke is a very rare event and that the risk of VBA stroke following a visit to a chiropractor’s office appears to be no different than the risk of VBA stroke following a visit to the office of a primary care medical physician (PCP). The study goes on to say that any observed association between VBA stroke and chiropractic manipulation—as well as its apparent association with PCP visits—is likely due to patients with an undiagnosed vertebral artery dissection seeking care for neck pain and headache prior to their stroke. Over the years, popular media has all too often sensationalized the association between chiropractic cervical manipulation and cerebral vascular accidents—even though the evidence would strongly indicate that this assertion is incorrect. The organizations representing the chiropractic profession believe this most recent evidence should help to dispel any myths on this issue, as well as provide more data to support the safety and effectiveness of chiropractic procedures. As a profession, doctors of chiropractic remain committed to expanding the research and clinical understanding of VBA injuries, because even one cerebral vascular incident that could have been prevented or detected early is one too many.
SOURCE ACATODAY.ORG
MARCH 2010ISCA REPORT8
New Jersey Governor Jon Corzine signed new scope-of-practice legislation on Jan. 18, 2010 - just one day before being defeated in his quest for re-election - updating a practice statute considered antiquated and overly restrictive by the Association of New Jersey Chiropractors (ANJC) and many other DCs in the state. The signing marks the first time New Jersey's scope-of-practice regulations have been amended since 1953.
"We are very proud of our efforts on behalf of this bill and the impact it will have not just for the chiropractic profession, but most importantly, the 1 million patients we treat statewide each year that benefit from chiropractic care," said ANJC President Dr. Steven Clarke in an association press release issued Jan. 19, which summarizes key elements of the new scope law as follows: Scope-of-Practice Stipulations
• [The] term chiropractic subluxation, for the first time, is now written into statute.
• Permits chiropractors to provide dietary/nutritional counseling, and the ability to dispense nutritional supplements.
• Permits chiropractors to diagnose, analyze and treat all joints and soft tissues of the body independent of spinal subluxation.
• Splinting and bracing, for the first time, will be put into law so that collars, braces and sports taping are forever adjuncts to chiropractic care.
• Requires chiropractors to maintain malpractice liability insurance.
• Requires chiropractors every two years to complete 30 credits for continuing education.
• Permits chiropractors to administer physical modalities and therapeutic, rehabilitative and strengthening exercises.
• Chiropractors can sign or certify temporary or permanent impairments and other certifications consistent with a chiropractic practice, such as pre-employment screenings.
• Makes it unlawful for any person, other than a N.J. licensed chiropractor, to render a utilization management decision that limits, restricts or curtails a course of chiropractic care.
• Consistent with chiropractic practice, allows DCs to provide a full complement of diagnostic and analytical tests similar to other physicians.
The continuing-education requirement is particularly noteworthy, as New Jersey chiropractors have been the only DCs in the nation not required to accrue periodic CE credits. The new law, says the ANJC, requires doctors to complete 30 CE credits per biennial registration period, "with a minimum of two credits consisting of the study of State laws and regulations governing professional ethics and
record-keeping, and a minimum of two credits in nutrition education."
The ability to provide dietary and nutritional counseling, and to dispense nutritional supplements as part of that counseling, is also new for N.J. chiropractors. As with the CE requirement, New Jersey had been the only state in the nation whose chiropractors were unable to provide such services to their patients, despite the fact that nutrition is routinely taught in chiropractic college.
"This has been a long and deliberative process and we have been honored to work with such outstanding legislators as Senators Sweeney and Weinberg, Assembly Leader Bonnie Watson Coleman, and other legislators and interested groups, such as the N.J. Medical Society, in developing a new scope of practice," said Dr. Clarke in an ANJC release issued 10 days before Gov. Corzine signed the bill into law. "This bill will allow the more than 3,000 chiropractors in N.J. the opportunity to enhance the way they treat and manage patients."
More Good News for N.J. DCsAround the same time the new scope-of-practice legislation was being approved, the ANJC learned that longtime insurance nemesis Horizon Blue Cross Blue Shield of New Jersey had at long last decided to comply with the Department of Banking and Insurance, which had ordered Horizon to cease and desist from globally bundling evaluation and management (E&M) and physical modality services as "chiropractic manipulative treatment services." Although the October 2009 decision also mandated that Horizon accept reimbursement filings previously disallowed based on its bundling tactic, the insurer failed to do so, according to the ANJC, which received numerous reports to that end from its members.
When ANJC alerted the department about Horizon's inaction, DOBI met with the insurer to "review" the situation. That meeting resulted in a Jan. 15 letter from Horizon, notifying chiropractors throughout the state that it was implementing the DOBI's directive and recruiting an outside vendor within 30 days to help do so.
"We are very pleased that the officials at DOBI recognized the injustice our members were experiencing in not having their claims processed by Horizon following the October Decision and Order by DOBI," said Dr. Sigmund Miller, ANJC executive director. "This is a further example of the ability of our organization to unite on behalf of our membership to further the chiropractic profession in this state."
Source: Dynamic Chiropractic
NEW PRACTICE STATUTE IN NEW JERSEY : REVISES STATE'S OUTDATED CHIROPRACTIC SCOPE-OF-PRACTICE LAW
MARCH 2010 ISCA REPORT 9
PHOTOS FROM ISCA SPRING CONFERENCE
ISCA Spring Conference ExhibitorISCA Spring Conference Exhibitor
Dr Clements Receiving Lifetime Achievement Award From Dr Tony Wolf
ISCA Spring Conference Luncheon - Dr. Vince DeBono of National Health Sciences University speaking.
Dinner Gala Reception: Dr. Jim Vuoto, Dr. Diane Vuoto, Mrs. Michelle Wolf and Dr. Anthony WolfISCA Dinner Gala Attendees
Gala Reception Dancing with the Lemon Wheel BandISCA Dinner Gala Attendees
MARCH 2010ISCA REPORT10
Growth in national health expenditures (NHE) in the United States is expected to have increased faster than the growth in the Gross Domestic Product (GDP) last year, according to a report issued today by the Centers for Medicare & Medicaid Services (CMS). The report was prepared by CMS’s Office of the Actuary and published on-line by the journal Health Affairs.
In 2009, NHE is projected to have reached $2.5 trillion and grown 5.7 %, up from 4.4 % in 2008 (the latest available historical year), while GDP, with the economy still in recession, is anticipated to have declined 1.1 %.
Note that although we are in the year 2010, health spending estimates for 2009 represent projections as data for all of calendar year 2009 are not yet available.
The projected acceleration in growth for 2009 was due in part to faster spending growth for the Medicaid program (9.9 %; up from 4.7 % in 2008), reflecting increasing growth in enrollment associated with the recession. Also contributing to the acceleration was faster growth in the use of a variety of health care services as many sought treatment for the H1N1 virus and an expected increase in the take-up rate for coverage provided through the Consolidated Omnibus Budget Reconciliation Act (COBRA) in response to the government's subsidization of COBRA premiums. As a result of NHE growth outpacing GDP growth in 2009, the health share of GDP is expected to have increased from 16.2 % of GDP in 2008 to 17.3 % in 2009, which would represent the largest one-year increase in history.
In 2010, NHE growth is expected to decelerate to 3.9 % while GDP is anticipated to rebound to 4.0 % growth. Much of the projected slowdown in NHE growth is attributable to a deceleration in Medicare spending growth (1.5 % in 2010, from 8.1 % in 2009) that is driven by a 21.3-% reduction in Medicare physician payment rates called for under current law’s Sustainable Growth Rate (SGR) provisions.
Under a scenario where the SGR provisions of law are revised and physician payment rates are held at 2009 levels, total health spending is projected to grow 4.7 %—0.8 %age points faster than under current law—and total Medicare spending is projected to grow 5.1 %.
Private spending in 2010 is projected to grow just 2.8 %, which is related to both declining private health insurance enrollment because of sustained high rates of unemployment and the expiration of Federal subsidies associated with COBRA coverage.
Over the projection period (2009-2019), average annual health spending growth (6.1%) is anticipated to outpace
average annual growth in the overall economy (4.4%). By 2019, national health spending is expected to reach $4.5 trillion and comprise 19.3% of GDP. Public spending is projected to grow faster on average than private spending (7.0% versus 5.2%, respectively) for 2009 through 2019. As a result of more rapid growth in public spending, the public share of total health care spending is expected to rise from 47 % in 2008, exceed 50 % by 2012, and then reach 52 % by 2019.
Opposite trends in spending growth for Medicare and Medicaid are projected to have occurred in 2009. Medicare spending ($507.1 billion) is projected to have increased 8.1 % in 2009, down from 8.6 % in 2008, partly due to slower growth in hospital spending. Medicaid spending ($378.3 billion) is projected to have increased 9.9 % in 2009, up from 4.7 % in 2008, due largely to rapidly increasing Medicaid enrollment during the recession. From 2009 through 2019, Medicare and Medicaid spending growth rates are projected to average 6.9 % and 7.5 %, respectively.
Spending on private health insurance premiums ($808.7 billion) is projected to have increased 3.3 % in 2009, up from 3.1 % in 2008. The steady rate of growth in premiums is the net result of a reduction in the number of people with private health insurance coverage due to job losses associated with the recession, somewhat offset by an increase in the take-up rate of COBRA due to government subsidization of these premiums. Growth in out-of-pocket spending is expected to have slowed from 2.8 % in 2008 to 2.1 % in 2009 and have reached $283.5 billion. Recessionary effects resulting in slowing growth in the demand for services with significant out-of-pocket costs have helped drive the projected slowdown in out-of-pocket spending growth. Between 2009 and 2019, out-of-pocket spending growth is projected to average 4.8 %.
Spending growth in three of the major health care sectors is expected to have accelerated in 2009. Hospital spending growth is expected to have increased 5.9 % in 2009, up from 4.5 % in 2008, and reached $760.6 billion. Physician and clinical services spending growth is expected to have increased 6.3 % in 2009, up from 5.0 % in 2008, and reached $527.6 billion.
The 2009 accelerations in spending growth for hospital services and physician and clinical services were in part driven by higher Medicaid spending growth and increased demand for services associated with treating persons who contracted the H1N1 virus.
Prescription drug spending growth is expected to have increased 5.2 % in 2009, up from 3.2 % in 2008, and
RECESSION EXPECTED TO IMPACT GROWTH IN NATIONAL HEALTH EXPENDITURES OVER THE NEXT SEVERAL YEARS
MARCH 2010 ISCA REPORT 11
MEDICARE FEE CUTS DELAYED UNTIL MARCH 31, 2010 By: Dr. Robert Tennant, D.C., FICC - ISCA First Vice President
Recently, President Obama signed into law a bill that delays until March 31, 2010, the 21% Medicare fee cuts that were scheduled to take effect in 2010. Further congressional action will be necessary to stop the implementation of these cuts for the remainder of the year. Please contact your federal legislators in Washington today to urge them to take permanent action on this issue.
PROFESSIONAL FOOTBALL CHIROPRACTIC SOCIETY ANNOUNCES ITS ROLE WITH EVERY TEAM IN THE NATIONAL FOOTBALL LEAGUE
The Professional Football Chiropractic Society (PFCS, www.profootballchiros.com) takes pride in announcing that all 32 teams in the National Football League offer their players and personnel chiropractic physician services as part of the triage in managing and preventing injuries. According to the Foundation for Chiropractic Progress (www.f4cp.org), this distinction is a benchmark for the profession and documents the important role that chiropractic care plays in optimizing athletic performance. "The robust need for chiropractic care in the NFL has been deeply driven by the players’ desire for peak physical conditioning and not simply for injuries,” states Spencer H. Baron, D.C., DACBSP, immediate past President of the PFCS and Miami Dolphins team chiropractor for the past 14 years. “From the earliest years of full contact football, their bodies are subject to structural stress that doctors of chiropractic (DCs) are specially trained to care for. Many DCs who provide their services to professional athletes travel with their respective teams throughout the season, treating players up until game time, during the game and sometimes immediately following.”
Rob Lizana D.C., who treats many of the players of the Super Bowl Champion New Orleans Saints, even moved with the team when they relocated to San Antonio, TX following Hurricane Katrina. He treated players in Miami leading up to the Super Bowl game, an advantage that many players were especially thankful for. According to Saints wide receiver Marques Colston, who had seven catches for 83 yards in Super Bowl XLIV, "I always see Dr. Rob for chiropractic care on game day to get my body balanced, flexible and ready for action. I see him several times a week for rehab and to recover faster from the last game.” Saints 2006 first round pick, Reggie Bush, has been receiving regular chiropractic care since playing football in high school and during his collegiate years. “I look at chiropractic care as important
to keeping me healthy and at the top of my game," said the former Heisman Trophy winner and two-time National Champion while playing for the University of Southern California (USC).
Saints wide receiver, Lance Moore, who converted a crucial 2-point conversion during Super Bowl XLIV also relies on chiropractic treatment to be game-time ready.
“Not only did my chiropractor get me back on the field, but he helped me to stay on the field. My body just feels much better overall because of the care I’ve gotten,” quotes Moore. In fact, many professional athletes are outspoken about their experiences with chiropractic care.
Most notably, 2010 NFL Hall Of Fame inductee Jerry Rice, who is a spokesperson for the Foundation for Chiropractic Progress, a not-for-profit organization dedicated to educating the public of the many benefits associated with chiropractic care.
“I did a lot of things to stay in the game, but regular visits to my chiropractor made all thedifference,” Rice asserts.
reached $246.3 billion. This increase is due in part to higher use of antiviral drugs, as well as faster price growth for brand-name prescription drugs.
Over the projection period (2009-2019), average annual spending growth for hospital, physician and clinical services, and prescription drugs is projected to increase 6.1%, 5.9 %, and 6.3 %, respectively.
The health care spending projection data can be found on the CMS web site at http://www.cms.hhs.gov/NationalHealthExpendData/03_NationalHealthAccountsProjected.asp
RECESSION CONTINUED...
MARCH 2010ISCA REPORT12
WELLPOINT TO DELAY INSURANCE RATE HIKE IN CALIFORNIAAssociated Press
Health insurer Anthem Blue Cross will postpone its much-criticized plan to raise rates for some California residents who buy insurance on their own, after reaching a deal Saturday with state regulators.
Anthem's planned rate hike, which the state estimates would affect about 700,000 customers, averaged 25% and would have been as high as 39% for some.
Anthem Blue Cross of California, based in Thousand Oaks, agreed to postpone the increase from March 1 until May 1 so California could have outside experts review the company's complex and detailed plan filing, including data on the medical costs it expects to incur.
The California Department of Insurance had been working with Anthem since mid-November to get more information about the increase, Insurance Commissioner Steve Poizner said. He wanted to have experts comb through the company's figures to confirm the new rates comply with a 2006 state law that insurers spend 70 cents of every premium dollar on medical care.
"Medical cost inflation in California is in the 10 to 15% range, so I have a healthy skepticism how they can get to 39%" and comply with the law, Poizner said.
If they don't, he said, he will direct the company to reduce its prices, "or I will take away their license to sell insurance" in California.
He officially requested the delay on Monday, but said Anthem stuck to its position that the individual insurance plan had lost money last year and the rate increases were justified — until Saturday. The change of heart came after a week of extensive media reports about the rate hikes, harsh criticism from the Obama administration and two Congressmen scheduling a hearing to look into the rates on Feb. 24.
"They did the right thing today," Poizner said. "These are huge, massive rate increases, very concerning to me and my team."
The insurance department, which doesn't have legal authority to regulate the rates insurers set, has hired consulting firm Axene Health Partners LLC of Southern California to work with actuaries within the department, review Anthem's rate proposal and determine whether it complies with the 70-cent rule. They should finish by mid-April.
Anthem, a subsidiary of insurance giant WellPoint Inc. of Indianapolis, said its proposed rates reflect anticipated
medical costs.
"They are actuarially sound and in full compliance with all requirements in the law," said Brian Sassi, president of Anthem Blue Cross of California.
The company has blamed the increased rates on the recession, rising medical costs and more healthy people dropping out of the plan, leaving fewer premium dollars to cover costs. It has insisted that the situation shows the need for a health-care overhaul that requires everyone to have health insurance.
But Health and Human Services Secretary Kathleen Sebelius said Thursday "it remains difficult to understand" how premium increases of that size can be justified when WellPoint Inc. reported a $4.75 billion profit in the last quarter of 2009.
"While a two-month delay offers some temporary relief, what California families need is long-term health insurance security, so that they don't face sharply higher prices or fewer benefits," Sebelius said Saturday. "This rate increase underscores the urgency of passing real health insurance reform."
Anthem's plan comes as more people lose employer-sponsored health insurance — and more insurers start raising rates on individual customers.
"We are seeing some significant price increases from other companies" filing new rates for individual insurance plans, which cover about 30% of Californians, Poizner noted. He said he did not have details.
Consumers in at least three other states who buy their own health insurance are getting hit with premium increases of 15% or more. The Anthem Blue Cross plan in Maine is asking for increases of about 23% this year for some individual policyholders. Last year, they raised rates up to 32%.
Kansas had one recent case where an insurer wanting to raise most individual rates 20% to 30% was persuaded by state insurance officials to reduce the increases to 10 % to 20%. The insurance department would not identify the company but said it was not Anthem.
And in Oregon, multiple insurers were granted rate hikes of 15% or more this year after increases of around 25% last year for customers who buy individual health insurance, rather than getting it through their employer.
While the California insurance department oversees individual plans and another California agency oversees managed care health plans, Anthem said the postponement would pertain to customers getting either type of insurance from the company.
MARCH 2010 ISCA REPORT 13
For the first time in the history of the Olympic Games, the 2010 Winter Games in Vancouver, Canada, will include chiropractic care inside the Olympic Village Polyclinic, a multi-disciplinary facility that offers comprehensive health care and medical services. While doctors of chiropractic (D.C.s) have historically been included on the Olympic medical staff, the upcoming events mark the first time that D.C.’s from the host country will be treating athletes and officials from around the world directly inside the Polyclinic.
“This is an historic event not only for the chiropractic profession, but also the athletes who will now have access to the care that will help them prepare their bodies for competition”
“This is an historic event not only for the chiropractic profession, but also the athletes who will now have access to the care that will help them prepare their bodies for competition,” states Michael Reed, D.C., MS, DACBSP, and Team USA Medical Director (USOC). “These athletes train hard and endure significant physical demands. Sports-focused D.C.s, along with other members of the sports medicine team, are specially skilled to assist them in reaching peak performance.”
Throughout the years, chiropractic has become a mainstay in the care of world-class athletes, leading to a growing number of D.C.s included in the Olympic Games. Countless athletes attribute the care they receive from their chiropractors -- working along-side other health care professionals – as a key to properly preparing their bodies to perform optimally.
Chiropractic care has experienced several major moments in Olympic history, dating back to Leroy Perry, D.C., who provided chiropractic care to athletes representing Antigua during the 1976 Games in Montreal, Canada. During the 1980 Winter Olympic Games in Lake Placid, NY, George Goodheart, D.C., became the first official chiropractor appointed to the U.S. team. With each subsequent Olympic
Games and Pan American Games, the U.S. teams -- along with a growing number of other national teams -- have included at least one doctor of chiropractic on their medical staff, culminating with the 2010 Winter Games incorporation of chiropractic care inside the Polyclinic.
“Inclusion inside the Polyclinic is another major milestone for the chiropractic profession, and we are grateful to the Host City of Vancouver, the head of Medical Services at the Polyclinic, Jack Taunton, M.D., and to Robert Armitage, D.C., who helped make this possible,” concludes recently promoted USOC Director of Sports Medicine Clinics, Bill Moreau, D.C., DACBSP. About the Olympic Polyclinic:
The polyclinic is a 10,000-square-foot multi-disciplinary facility that includes comprehensive health care and medical services including emergency medicine (available 24 hours); primary care and sports medicine; a full range of therapy services; dentistry; an eye clinic; imaging; a diagnostic laboratory; and a full spectrum of consultant specialists. Essentially, most health-care needs for athletes or officials residing at the village will be provided at the polyclinic. For life/limb-threatening conditions, Vancouver General Hospital (VGH) is a short distance away. About F4CP
A not-for-profit organization, the Foundation for Chiropractic Progress (F4CP) embraces a singular mission to promote positive press for the profession in national, regional and local media. Through effective and ongoing initiatives, the Foundation’s goal is to raise awareness to the many benefits provided by doctors of chiropractic. The F4CP relies upon strategic marketing campaigns that span prominent spokespersons, monthly press releases, public service announcements, and advertisements in high-profile media outlets. To learn more about the Foundation, please visit us on the web at www.foundation4cp.com or call 866-901-f4cp.
THANKS TO OUR SPONSORS & EXHIBITORS!The Indiana State Chiropractic Association’s meetings and conferences are successful due in large part to the support of our sponsors & exhibitors. The following companies sponsored this year’s Spring Conference:
A1 Therapy Supply • Aliign • American Chiropractic Association • American Express OPEN • Anabolic Labs/Owen Health Care Inc. • Chiropractors Buying Group • Christian ICONS & X-Ray, LLC • Denis Behm Supply, Inc. • Erchonia Medical • Foot Levelers • Haffner X-Ray • Indiana Spine Group • Indiana Scoliosis Specialists • Joy T Life • Performance Medical Bracing • Three Rivers Spas • Wells Fargo Insurance Services
ISCA Exhibitors contribute to the success of the conference and offer attendees a convenient way to meet potential vendors and learn about the latest technology.
CHIROPRACTIC CARE INCLUDED IN 2010 OLYMPIC VANCOUVER WINTER GAMES AT ON-SITE POLYCLINIC – A FIRST FOR OLYMPIC ATHLETES
MARCH 2010ISCA REPORT14
14
A QUICK REFERENCE GUIDE: GENERAL INDIANA LAW
General negligence and products liability claims are governed by the Indiana Comparative Fault Act. Ind. Code 34-51-2 and 34-20-8-1. If plaintiff’s fault is greater than 50% of the total fault, plaintiff is barred from recover. Ind Code 34-51-2-7.
Claims against governmental entities are governed by Indiana’s common law of contributory negligence, in which the plaintiff is barred from recovery if found to be at fault to any extent. Nesvig v. Town of Porter, 668 N.E.2d 1276 (Ind.Ct.App. 1996).
Medical malpractice is also governed by common law contributory negligence. King v. Clark, 709 N.E.2d 1043 (Ind. Ct. App. 1999). Medical malpractice claims against qualified healthcare providers must first be filled with the Indiana Department of Insurance for preliminary review and the non-binding but admissible opinion of a three-member panel. IND. COD 34-18-8-4. If the healthcare provider is not qualified, the complaint must be filed in a court of competent jurisdiction. Guinn v. Light, 558 N.E.2d 820 (Ind. 1990).
Each motorist shall have minimum limits of liability coverage of $25,000 per person and $50,000 per accident. Ind. Code 9-25-4-5.
Statute of LimitationsMedical Malpractice: Two (2) years after the date of the alleged act, omission, or neglect, except that a minor less than six (6) years of age has until the minor’s eight birthday to file. Ind. Code 34-18-7-1. If plaintiff does not discover the malpractice or did not know or should not have known of the malpractice within two (2) years of the malpractice, two
(2) years from the date of discovery. Jacobs v. Manhart, 770 N.E.2d 344 (Ind. Ct. App. 2001). The filing of a proposed complaint tolls the applicable statute of limitations to an including a period of ninety (90) days following the receipt of the opinion of the medical review panel by the claimant. Ind. Cod 34-18-7-3.
Statutory Damage CapsMedical Malpractice: Maximum $1,250,000 for injury or death resulting from an act of malpractice by a qualified healthcare provider. Ind. Code 34-18-14-3.
Fee SharingFees may be divided between lawyers in different firms if: (1) the division is in proportion to the services performed by each lawyer or each lawyer assumes joint responsibility for the representation; (2) the client agrees to the arrangement, including the share each lawyer will receive, and the agreement is confirmed in writing; and (3) the total fee is reasonable. Ind. Prof. Conduct R. 1.5(e).
The information provided above is believed to be accurate as of its printing. It is intended to provide general information only and is not intended to provide legal advice. For legal advice on a specific issue or case, please contact an attorney licensed to practice law in the state of Indiana.
The U.S. House of Representatives passed HR 3590, the Senate-passed version of national health care reform legislation, tonight. The final vote took place after a nearly 13 month battle, culminating in a contentious struggle to garner votes from undecided members of the Democratic majority in Congress.
These provisions include an important provider non-discrimination provision long championed by the American Chiropractic Association (ACA). Incorporation of this provider non-discrimination provision, also known as the “Harkin Amendment,” was achieved primarily due to the efforts of Sen. Tom Harkin (D-Iowa), with help from other key players such as Sen. Chris Dodd (D-Connecticut). Although he did not support the final bill overall, Sen. Orrin Hatch (R-Utah) also lent his support for the advancement of the non-discrimination provision.
“Regardless of how you feel about this legislation and its overall impact on the nation, it has to be recognized as
an historic first for the chiropractic profession. We now have a federal law applicable to ERISA plans that makes it against the law for insurance companies to discriminate against Doctors of Chiropractic and other providers relative to their participation and coverage in health plans. Such discrimination based on a provider's license is inappropriate and now must stop,” said ACA president, Dr. Rick McMichael. “While this does not fully level the playing field for doctors of chiropractic in our health care system, this is a highly significant step that has the potential for positive, long-range impact on the profession and the patients we serve. Congress has finally addressed the issue of provider discrimination based on one's license, and they have said that such discrimination must stop.”
The provider non-discrimination provision (Section 2706) to be enacted into law reads in part: “A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against
HOUSE PASSES HEALTH CARE REFORM BILL: HISTORIC PRO-CHIROPRACTIC PROVISIONS WILL BECOME LAW
MARCH 2010 ISCA REPORT 15
Q: Can DCs order an EKGA: The short answer to this question is "Yes" chiropractors can bill for EKG - with a caveatDoctors of Chiropractic are considered primary health care providers and a portal of entry to the health delivery system. By virtue of their education, chiropractors are qualified to treat a large variety of health problems, and through consultation, examination and testing procedures are qualified to determine a working diagnosis or differential diagnosis. The utilization of EKG (electrocardiographic study), is a specialized examination that falls within the purvue of chiropractic, and may be carried out only if the chiropractor has undertaken appropriate education and training in this field, or hold adequate credentials in that given specialty from a body recognized by the Council on Chiropractic Education. A separate written report of examination findings is required for the undertaking of an EKG.
846 IAC 1-3-1 Scope of Practice; diagnostic, treatment
procedures / Authority: IC 25-10-1-1.5 /Affected: IC 25-10-1-1 Sec. 1 (a) The practice of chiropractic will include and permit the use of such diagnostic and treatment procedures as are taught by board approved chiropractic colleges except as prohibited by law and/or the rules and regulations of this board (Board of Chiropractic Examiners)(b) In the conduct of the practice of chiropractic no chiropractor shall perform any service that is beyond the scope of his education, training and experience. (Emphasis added) (c)The exclusion set out in subsection (1)(E) of IC 25-10-1-1 shall mean only the introducing of contrast medias into the blood-vascular system, but shall not include Doppler examinations, electromyograms with surface electrodes, electrocardiograms, endocardiograms, echocardiograms, thermography, moire photography, blood analysis, or any other diagnostic test which a chiropractor may require to prepare a proper diagnosis of a patient in his/her practice of chiropractic. (Board of Chiropractic Examiners; 846 IAC 1-3-1; filed Jul 28, 1983)
any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.”
Regarding this provision, John Falardeau, ACA’s Vice President of Government Relations said, “The Harkin non-discrimination language will be applicable to all health benefit plans both insured and self-insured. National health care reform is designed to eventually cover 30 million currently uninsured Americans. The non-discrimination language will, over time, apply to those individuals as well. However, that number of covered individuals pales in comparison to the 55% of workers who are currently covered by self-insured plans that will be affected by the Harkin non-discrimination language. The potential impact in this regard cannot be overstated.”
Additionally, the legislation passed by the House includes two other provisions that impact the chiropractic profession. Doctors of chiropractic are specifically included as potential members of interdisciplinary community health teams. These teams support the development of medical homes by increasing access to comprehensive, community based, coordinated care. Community health teams are integrated teams of providers that include primary care providers, specialists, other clinicians, licensed integrative health professionals and community resources to enhance patient care, wellness and lifestyle improvements. The language in the bill ensures that doctors of chiropractic can be included in these patient-centered, holistic teams. Dr. McMichael noted, “This language was a critical inclusion to give doctors of chiropractic increased opportunities to be fully engaged as part of the health care team.”
Furthermore, the legislation establishes a National Health Care Workforce Commission to examine current
and projected needs in the health care workforce. The commission specifically includes doctors of chiropractic by defining them as part of the health care workforce, and includes them in the definition of health professionals. In addition, chiropractic colleges are included among the health professional training schools to be studied. The National Health Care Workforce Commission is tasked with providing comprehensive, unbiased information to Congress and the Obama Administration about how to align federal health care workforce resources with national needs. Congress will use this information when providing appropriations to discretionary programs or in restructuring other federal funding. The language in the bill guarantees that the need for doctors of chiropractic will be addressed when considering federal health care workforce programs, another very important inclusion.
Assuming final modifications to the bill are ultimately agreed to by the Senate; ACA will then publish a detailed analysis of the entire legislation, including a timeline for when certain provisions become effective. Additionally, ACA will maintain an active watch over the implementation of the legislation over the next several years and will offer its views regarding proposed regulations that will likely be developed in order to fully implement the new law. ACA will also respond to any future legislation such as “technical corrections” and other modifications that might be considered. Dr. McMichael noted, “Our partners on the Chiropractic Summit were important team members in securing these critical inclusions for the benefit of our profession and our doctors. We thank all team members for their good collaborative work on this major effort and future efforts to come.”
ACA is the largest chiropractic organization in the United States.
MARCH 2010ISCA REPORT16
Health and Human Services Secretary Kathleen Sebelius told the nation's leading health insurers Thursday to publicly justify a spate of double-digit premium hikes that have infuriated consumers in at least a half-dozen states.
Meeting at the White House with the CEOs of Indianapolis-based WellPoint, Aetna, Cigna, UnitedHealth Group, as well as several state insurance commissioners, Sebelius asked the companies to post online their justification for proposed rate hikes primarily affecting customers who directly purchase their coverage.
"At the very least, we need some transparency," Sebelius told reporters after the meeting. "We need people to understand what's going on." The information can be difficult to obtain, since it's usually filed state-by-state.
The White House staged the event to underscore what it calls the urgent need to pass President Barack Obama's health care overhaul. Obama advisers hope that highlighting the rate hikes will put pressure not just on insurers to lower rates but also on Congress to agree on final legislation after a year-long effort.
Obama has pointed to the rate hikes as one of the main arguments for Congress to pass his plan. It would set up a new competitive marketplace for individual customers and small businesses, leading to more predictable premiums. It also would create a new consumer protection body with the power to deny unreasonable rate hikes, roll them back and obtain refunds for policy holders.
Sebelius got a polite hearing from the executives, but there was no agreement on her request for full disclosure.
"I think the response to it was constructive, but there were no commitments of any kind," said UnitedHealth CEO Stephen Hemsley.
Angela Braly, the head of WellPoint, said she wants to explore with the National Association of Insurance Commissioners better ways to tell consumers about the reasons for rate hikes. Doctors and hospitals are charging more, she explained, and "we're often in the position of being the bearer of bad news."
Noting that the companies are making healthy profits, Sebelius said she will keep pressing her request. "At least the bright spotlight may help to discourage some of these wildly exorbitant increases from occurring," she said.
Obama dropped by the meeting in the Roosevelt Room and underscored Sebelius' point that such rate hikes can't go on
forever. The president has painted a bleak picture of spiraling costs and eroding coverage if lawmakers fail to pass his plan — and he's keeping the pressure on insurers as he demands a vote in Congress.
The rate increases mainly affect people buying their own coverage directly, as opposed to the majority who have employer-provided policies. Wellpoint subsidiary Anthem Blue Cross recently announced plans to boost individual insurance premiums in California by as much as 39 percent.
Since then, Sebelius said she's heard from many Americans who are worried they won't be able to afford insurance. Wellpoint has temporarily put its rate hike on hold.
Sebelius said the long-term solution is the new health insurance marketplace that Obama wants to create for individuals and small businesses. Once it goes into operation in 2014, it would foster competition and help keep rate increases in check.
Although the insurance industry opposes much of Obama's overhaul plan, the CEOs said they share the administration's concern about rising cost. It's leading their healthiest customers to drop coverage, leaving the companies with a relatively sicker pool of people.
Aetna's Ronald Williams praised the administration for bringing the group together and said: "This is what we need more of — everyone at the table collaborating."
"People are reaching the breaking point," when it comes to premiums, said Sandy Praeger, Kansas' insurance commissioner.
SEBELIUS ASKS INSURERS TO JUSTIFY RATE HIKES Associated Press
District NineJohn Krawchinson D.C.Seymour, IN812.524.2273ALTERNATES: The ISCA by-laws allow for the Directors at Large and the District Directors to have Alternate Directors. The Alternate At Large Directors may reside anywhere in the state. The Alternate District Directors must reside within their district. There are 9 districts and their boundaries are the same as per the national census. This is done to keep the Districts in line on a proportional basis. When the Directors are not present, the Alternate Directors have the full voting powers as the Directors and may take their place at any meetings. This system was initiated to involve more people in the association’s decision-making process and to serve as a training ground for future board members. The Alternate Directors at Large are nominated by the Directors at Large and then must be approved by the Board of Directors. The District Director Alternates are recommended by the District Directors and approved by the board.
WELCOME NEW ISCA MEMBERS! James Hopkins
Dwayne HoskinsBrandon Coleman
Jess Brower Thomas
Moorehead Brett McPeak
Steven Brinson Colette Hittner
Shaunnon Flickinger
Susan BatesSteven Hart
Brian Watters
MARCH 2010ISCA REPORT18
PRACTICES FOR SALE
Southside Indianapolis. Established 14 years. Located in professional building with Dentist, MDs and MRI facility. High growth community near St Francis Hospital. Gorgeous, open floor plan with rehab area, part time PT and fulltime LMT. 1000 visits monthly. 17 hr work week. Contact [email protected] Posted 10/22/09 (M)
Perfect opportunity for a new practitioner or someone looking for a satellite office. Established practice located in Peru Indiana (215 W. Main). 1 Exam room, 2 tables, and waiting room furniture included. Willing to negotiate. Contact Dr. Smelser at 765-472-7610. Posted 10/17/09 (M)
Practice which pays for itself and a doctor's paycheck! Collections about ¼M per year. Small town practice. Doctors semi-retired. With down payment and contract, owner carries paper for associate doctor ready to own and grow. Contact [email protected] Posted 09/17/09 (M)
Nice office on NW side of Indianapolis for sale. Good mix of PI and Insurance. Office has new equipment including, Kodak Digital CR x-ray processor with 37" LCD TV for viewing x-rays, X-ray machine, Back Project's ATM-2, 1 Hydro-massage table, 4 Intersegmental traction tables. Drop adjusting table. Necksys and Synergy low tech rehab, 2 exam rooms, open adjusting/rehab area. Office has been established 16 months and sees around 400 patient visits per month on a 3 1/2 day week. Office markets well and is in a very visible location. This office is NICE!! Call 317-464-7530 or email [email protected] Posted 05/27/09 (M)
ASSOCIATES AVAILABLE
Independent Contractor Available: New Independent Contractor looking to rent space in greater Indianapolis area from established doctor who has extra room. Why not make money on the extra space you are not using and help a new doctor get established? Contact Shelley Coughlin at 317-453-7005 or [email protected]. Posted 2/9/10 (M)
Seeking full time associate position in successful Indiana practice. I am currently a student at Logan College of Chiropractic and plan to graduate in April, 2010. I am conscientious, reliable, and self motivated ATC (certified athletic trainer) seeking an associate position that provides growth and learning opportunities. Main Techniques are Cox and Diversified, and also trained in Thompson & Graston. Please feel free to contact me with any questions or to request a copy of my resume. [email protected] Posted 1/29/10 (M)
Seeking full time associate position. Current student at Palmer in Florida, will graduate in March. Looking to join practice in Louisville/Southern IN area. Hard worker, dedicated, and passionate about chiropractic. Techniques used: Diversified, Gonstead, Thompson, Motion Palpation, Activator, Flexion Distraction, Graston. Contact Kyle Bowling (502) 594-8326, [email protected] Posted 1/21/10 (M)
Seeking part-time or full-time associate position. Very good rapport with patients and comfortable with fast-paced office. Mainly diversified technique, but comfortable with others. Adam Davis, DC (812) 767-0394 or [email protected] Posted 9/29/09 (M)
Seeking Part-time Associate Position. I am available on Tuesdays and Thursdays. I work in my own office on the other days. Excellent adjusting and people skills. Comfortable with high volume. Diversified technique. References available. Email me at [email protected] or contact me at my office. Dr. Chris Whiteman (765) 864-1877. Posted 5/18/09 (M)
ASSOCIATES WANTED
Associate wanted to take over practice of Doctor ready to retire. Call 877-897-9968.Posted 3/1/10 (M)
Rapidly expanding Lake County practice in Crown Point, Indiana, is looking for full time position to be filled. Enthusiastic doctor is a must. Must be proficient in Cox Distraction, Palmer Diversified, and Thompson techniques. Salary and profit share of clinic are offered. E-mail resume to: [email protected] Posted 2/24/10 (M)
Energetic and busy Fishers practice looking for a DC who is passionate about subluxation based chiropractic care. Family wellness is our specialty. Join our team of professionals who feel called to do what we do. Contact us at [email protected] 1/14/10 (M)
Associate position available at vibrant, busy 30-year practice. Located in beautiful, recession-proof Bloomington, home of Indiana University. Newly remodeled clinic with exceptional visibility. A chiropractor will see more patients, earn more income, and work less hours in this position compared to starting a solo practice. Send CV resume to [email protected] or 2501 E. Third St. Bloomington, IN 47401.Posted 12/10/09 (M)
Chiropractor wanted for a beautiful clinic in Fishers. Must be highly energetic, confident, a good communicator and willing to put in the time and effort to market and build a successful practice. Pay will be based on production. Come be part of a great team of four chiropractors, two massage therapists and a great staff. Please respond to [email protected] 12/03/09 (M)
Licensed or soon to be licensed Associate Doctor needed for busy Northwest Indiana chiropractic office. Great location, in a growing practice, located less than an hour from Chicago. Please send resume to [email protected] or call 219-776-3781. Posted 10/28/09 (M)
Excellent position open for the right doctor in our expanding wellness center. Must be wellness focused with integrity and strong personal ethics non negotiable. Nine year established practice. Email resume and vision statement to [email protected] - East central Indiana. Posted 10/1/09 (M)
Southern Indiana - Excellent opportunity at an established chiropractic office of 20 years in a small town in southern Indiana. Work independently but benefit from successful 3 affiliated clinic's shared expertise. Email resume to [email protected]. Posted 6/26/09 (M)
INDIANA STATE CHIROPRACTIC ASSOCIATION CLASSIFIEDS
MARCH 2010 ISCA REPORT 19
VACATION DOCTORS
Available for short term or extended absences. Great people skills and comfortable with fast-paced office. Please contact Adam Davis, DC (812)767-0394 or [email protected] Posted 9/29/09 (M)
Office Coverage: Traveling Chiropractors, America's first Chiropractic employment agency, has been Providing quality, caring Temporary and Associate Doctors nationally for over 25 years. Call 1-800-624-8876; or visit our web site @travelingchiropractors.com Posted 8/12/09 (NM)
Vacation - Fill-in, Etc. I have sold my practice in Iowa and am moving to Indiana. Logan grad and 40+ years experience with multiple techniques specializing in extremities. Call Dr. Larry Phipps at 641-751-7755. Posted 8/7/09 (M)
Vacation, Maternity Leave, Seminar Fill-in, Etc. Palmer graduate, 20+ years of experience, licensed in Indiana, NCMIC insured. Proficient in multiple techniques; diversified, activator, soft tissue, drop, flexion/distraction, basic. Able to travel statewide. Excellent adjusting & people skills. Call Dr. Guest - 317-462-0022 or email [email protected]. Posted 6/8/09 (M)
Vacation Doctor - Do you want a day off? Available Tuesdays and/or Thursdays. I work in my own office on the other days. Excellent adjusting and people skills. Comfortable with high volume. Diversified technique. $400 a day base fee. References available. Email me at [email protected] or contact me at my office. Dr. Chris Whiteman (765)864-1877. Posted 4/28/09 (M)
EQUIPMENT FOR SALE
Titan Table Automatic flexion-Distraction table with cervical, thoracic and pelvic drops. Very good condition. Black with automatic shut off timer and smooth running motor. Asking $2000.00. Contact me at 765-342-2000 or [email protected] 2/3/10 (M)
Bennett HFQ300 w/anatomical programming, dark room accessories, and AFP mini med red 90 automatic film processor w/stand and tanks. If interested, please call office for details Case Chiropractic, Greencastle, 765-630-8191.Posted 1/14/10 (M)
X-RAY SUITE for sale: Chirotech 300/125 Anatomical Generator, rare earth screens, Bolan type filtration system, total floor footprint 4 X 6 feet, ~600 shots on new Varian tube, add digital tomorrow. Automatic computer/digital calculations on LCD Illuminated control board. ***Qualifies for huge section 44 tax reduction*** Electrical components for connection equipment included. All darkroom accessories also included EXCEPT processor which is also available. Pictures on request. NEED ROOM FOR REHAB !! MUST SELL!! $7,800.00 or best offer! Call Dr. Gary Shaw at (317) 507-1376. ALSO AVAILABLE Custom grey oak 36 X 48 viewbox Indestructible Kodak 100 processor w/ extra heat element and motherboard Removable wall leading & 3 sliding lead door/window shields. Associate foot scanner (unopened) from Foot Levelers. Posted 11/30/09 (M)
Omni elevation table in perfect condition for $4500. The table has been recently re-upholstered (blue) and has all drops. This table will last forever, one of the best made tables on the market. Great time of year to get the elevation tax credit. Email [email protected] for more information or pics. Posted 11/11/09 (M)
Lead Barrier - 10x72 joined to 26x72 with 8x10 window, plywood based on both sides for $100. Call Dr. Hal Miller 574-295-7250.Posted 10/28/09 (M)
Like NEW Triton DTS decompression system complete with lumbar and cervical decompression and patient treatment cards. Purchased in 2008 for 10K, only used with three patients, excellent results. Will sell for 8K. Call Dr. Huffman @ 765 593-9355. Posted 10/1/09 (M)
Chattanooga Intellect Legend Combo E-Stim Pre-mod, Russian Stim, IFC, high Volt, Ultrasound Machine is like new. 3 years old, but hardly used. Selling b/c I do not use it at all anymore. $3000 Brand new. I will sell for $1500 to get rid of it. Contact Mark Jones at 317-867-4323 or [email protected] Posted 7/8/09 (M)
Mobile Lead Barrier 30" X 72" with 8" X 10" window $650.00. Contact [email protected] or 574-546-3435. Posted 05/01/09 (M)
POST A CLASSIFIED AD
ISCA members may place classified ads for free and will run for two consecutive issues unless otherwise requested.
ISCA Report: Quarterly Member Printed Newsletter
Deadlines are for ads to be included in the printed version of the ISCA Report
Classified ads will also be posted online until the next issue’s deadline.
March IssueAd Submission DeadlineFeb 25
June IssueAd Submission DeadlineMay 25
DECEMBER Issue Ad Submission DeadlineAugust 25
December IssueAd Submission DeadlineNovember 25
To place a classified ad visit us online at www.indianastatechiros.org or call 317.673.4245.
INDIANA STATE CHIROPRACTIC ASSOCIATION CLASSIFIEDS
ISCA Report200 S. Meridian St. Suite 350Indianapolis, IN 46225317.673.4245www.IndianaStateChiros.org
