Re: Excessive Frequency and Duration of Treatment

[Guest guest]

Vern and colleagues:

re: "

3) The establishment of standards with respect to the type of treatment, the frequency and the duration of treatment is critical."

General agreement on this point is one of the biggest problems separating the extreme tips of the wings of our profession.........

We have those who continue to insist we play as a 'special team'.....even though it's _their(medico/ins model)_ court and it's _their_ (medico/ins model) ball; we insist _THEY_ play by _OUR _ rules......... This is the very definition of 'cognative dissonance'.........

I do feel confident should we continue as in the past our mutual goose will be cooked....

I do not understand the conflict between the philosophical basis of chiropractic and admitting the benefits of making a written defintion of 1) what the patient problem is; 2) how does it specifically relate to a mechanism of injury; 3)estimatation of return to pre-injury status; 4)demonstration of continuing benefits of chiropractic care..... If we are going to expect to be paid by the carriers, they will insist on this. There are few rational health care conditions that do not have a beginning, a middle, and an end....we are not so good at demonstrating we have reached the therapeutic end of our care and a loathe to admit it, perhaps, seeing personal failing or financial conflict with releasing patients who no longer have demonstrable benefits from our care.....

Of course whatever we do will not satisfy them regardless of whatever standards we establish. If we don't want to ride the 'special student' short bus to school, we better have a specific plan and implement it soon....

regards,

kindly Dr Pedersen

Short Bus Special Tours, Inc

[Guest guest]

Vern, Me Darlin' Buddy:

One could argue and refute many, if not all of Dr. Nyiendo's conclusions, ie, MD's really do not treat patients with physical injury other than via RX, surgery or examination; DC's treat the long term consequences of permanent disability more so than MD's because the medical profession has little or NOTHING to offer these individuals other than drugs, etc., ad nauseum. I saw these same exact "conclusions" in the infamous Tillinghast "study" that was used in Hawaii to rid their WC system of DC's in the mid 1990's.

In her last comment "3) The establishment of standards with respect to the type of treatment, the frequency and the duration of treatment is critical.",

she bolsters the EXACT reason we must stop farting around and endorse the Croft guidelines for categorizing the different grades of personal injury in MVC's, along with their appropriate treatment frequencies and durations. This information is well researched, and is already in the referenced literature for PIP carriers, the legislature, the OBCE, and us common DC's to read.

Sincerely

Ray, DC

-------------- Original message --------------

More on why we must have a administrative rule that is more specific as to what constitutes "excessive or under treatment."

As most of you are aware in the 80's prior to SB 1197, the Oregon Worker's Compensation system was one of only two forms of health insurance that allowed chiropractic physicians to remain attending physicians through out the life of the claim. We had 100% coverage of our services under W/C, with the only other health insurance to do the same being PIP of course. As a consequence it was natural that colleagues would tend to emphasize Worker's Comp and PIP cases in their practices.

We have been told by the policy makers that we lost true attending physician status in W/C because of our failure to eliminate the excessive treatment abuses within the profession. Some colleagues have legitimately challenged the need for such a rule as they have seen no independent study that validates that there indeed is a problem.

Over the weekend I was going through some of my personal archives I save everything I believe of consequence (wife's translation = I'm a "pack rat"), I came across an April 12, 1990 letter from WSCC's head researcher at the time Joanne Nyiendo, PhD. She had just completed a review of chiropractic vs medical treatment within the Oregon Worker's Compensation System and I asked her as an independent observer to tell me where if any, were the profession's short comings?

Dr. Nyiendo's letter to me and supporting documentation are quite telling and I believe clearly validate that we as a profession indeed had and more probably than not still have an excessive treatment problem that we simply must address.

Here are the key points in her letter to me dated April 12, 1990;

"One can clearly see that, for cases of similar severity, both the treatment duration and treatment frequency for chiropractic cases is much greater than for MD cases."

"Further analysis showed that treatment for chiropractic claims more often extended beyond the date of the first determination order (DO)." (determination of permanent partial disability or post MMI).

Category I, 54.3% of DC claims continued to have treatment after the first DO, compared to 20.9% of MD claims.

Category 2, 66.7% of DC claims and 33.3 of MD claims incurred treatment beyond the DO.

"38% of all DC claims received some treatment for the injury beyond one year from the date of injury. In contrast, only 9% of comparable MD claims received any treatment after one year."

In conclusion she makes three recommendations, her first recommendation questions whether "palliative treatment" should even be included in Worker's Compensation. Her second recommendation is in reference to vocational retraining if the worker cannot return to full duty within 6-9 months etc. However most Germaine to our recent discussions on the list serve is her last recommendation/statement;

3) The establishment of standards with respect to the type of treatment, the frequency and the duration of treatment is critical."

Vern Saboe, DC

President Chiropractic Association of OregonOregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

Yes, we must do something very soon Jack. Outcomes management is where the health care industry has been going for quite a bit of time. We must base what constitutes "reasonable and necessary" (frequency and duration)chiropractic treatment on that individual patient's response to that care, which is what outcomes assessment tools specifically do, and that which canned guidelines fail to do.

Vern SAboe

Re: "Excessive Frequency and Duration of Treatment"

Vern and colleagues:

re: " 3) The establishment of standards with respect to the type of treatment, the frequency and the duration of treatment is critical."

General agreement on this point is one of the biggest problems separating the extreme tips of the wings of our profession.........

We have those who continue to insist we play as a 'special team'.....even though it's _their(medico/ins model)_ court and it's _their_ (medico/ins model) ball; we insist _THEY_ play by _OUR _ rules......... This is the very definition of 'cognative dissonance'.........

I do feel confident should we continue as in the past our mutual goose will be cooked....

I do not understand the conflict between the philosophical basis of chiropractic and admitting the benefits of making a written defintion of 1) what the patient problem is; 2) how does it specifically relate to a mechanism of injury; 3)estimatation of return to pre-injury status; 4)demonstration of continuing benefits of chiropractic care..... If we are going to expect to be paid by the carriers, they will insist on this. There are few rational health care conditions that do not have a beginning, a middle, and an end....we are not so good at demonstrating we have reached the therapeutic end of our care and a loathe to admit it, perhaps, seeing personal failing or financial conflict with releasing patients who no longer have demonstrable benefits from our care.....

Of course whatever we do will not satisfy them regardless of whatever standards we establish. If we don't want to ride the 'special student' short bus to school, we better have a specific plan and implement it soon....

regards,

kindly Dr Pedersen

Short Bus Special Tours, Inc

OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

Vern:

Why do you say "canned" when referring to the Croft guidelines? There is nothing canned about them. I have been using his highly respected course information and his guidelines for almost 15 years. Perhaps you have something better? I agree that outcomes measures and individual treatment assessments are necessary, and are a good indicator of treatment success and keys to reasonable continuation or discontinuance of treatment. I use them all the time. But, after all these years, I have yet to have the Croft guidelines fail me in the trenches. Even Croft states that his guidelines are not prescriptive, and that each case needs to judged on its own merits. That is our job as a "physician". But just like a method of Chiropractic treatment, i.e., Gonstead, ect., it gives the treating doctor a template from which to judge the patient's condition and the doctor's treatment effectiveness, let alone prognostication for what the likely outcome of the patient's injuries may be.

If you don't have anything to put in their place, it seems that you don't have a leg to stand on when complaining about them. It seems you protest too much my good friend.

I think I will contact Dr. Croft and let him in on the discussion. It may prove to be enlightening.

Peace

SR

--------- Re: "Excessive Frequency and Duration of Treatment"

Vern and colleagues:

re: " 3) The establishment of standards with respect to the type of treatment, the frequency and the duration of treatment is critical."

General agreement on this point is one of the biggest problems separating the extreme tips of the wings of our profession.........

We have those who continue to insist we play as a 'special team'.....even though it's _their(medico/ins model)_ court and it's _their_ (medico/ins model) ball; we insist _THEY_ play by _OUR _ rules......... This is the very definition of 'cognative dissonance'.........

I do feel confident should we continue as in the past our mutual goose will be cooked....

I do not understand the conflict between the philosophical basis of chiropractic and admitting the benefits of making a written defintion of 1) what the patient problem is; 2) how does it specifically relate to a mechanism of injury; 3)estimatation of return to pre-injury status; 4)demonstration of continuing benefits of chiropractic care..... If we are going to expect to be paid by the carriers, they will insist on this. There are few rational health care conditions that do not have a beginning, a middle, and an end....we are not so good at demonstrating we have reached the therapeutic end of our care and a loathe to admit it, perhaps, seeing personal failing or financial conflict with releasing patients who no longer have demonstrable benefits from our care.....

Of course whatever we do will not satisfy them regardless of whatever standards we establish. If we don't want to ride the 'special student' short bus to school, we better have a specific plan and implement it soon....

regards,

kindly Dr Pedersen

Short Bus Special Tours, Inc

OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed. OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.