Guest guest Posted February 6, 2006 Report Share Posted February 6, 2006 Dear Ones All, Somehow this issue has come to be seen as a matter of a " vote " of the chiropractic profession...majority rules. Whoa!! This is not a matter of what the DCs in the state want as being " best for the profession " (sorry Vern), it is a matter of the OBCE executing its mission to protect the public and improve quality in the chiropractic profession. Ya with me, Board Members? A. Simpson, DC Fw: Recent trends in retroactive IME cut-offs Dear Dr. Grice and colleagues, In response to Dr. Grice's comments and relative to the most recent post from Dr. Setera I believe this earlier exchange between Dr. Setera and I are quite telling...considering he then went on to post the list-serve with the " Vern lost " deal....it seems no " olive branch " is green enough. Vern Saboe Re: Recent trends in retroactive IME cut-offs > > > > Dear Vern; Once again why not have the OBCE perform the survey on their > own > > with 250 word Max pro and con fallowed by a simple yer or no votes. Have > you > > read the Ors 684 yet? Setera > 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 28, 2006 Report Share Posted February 28, 2006 Judith, OR DCs, Thanks for your forbearance. I appreciate your willingness to continue the conversation. I must be a bit dense in that I still do not see the issue as you do. Your story about the long suffering patient and the case presented in your video at the last public session of the OBCE do not seem to fall astray under the scope of the CJ/R rule as you fear...to wit, the text of the rule as it now stands shows: (1) Clinical rationale, within accepted standards and understood by a group of peers, must be shown for all opinions, diagnostic and therapeutic procedures... I would trust that in your treatment of your patient with the vestibular disorder you were involved with some chiropractic analysis for subluxation and adjustments of same. I'd suggest that these would be understood by a group of peers. (2) Accepted standards mean skills and treatment which are recognized as being reasonable, prudent and acceptable under similar conditions and circumstances. And in the case of vertigo of long-standing, most colleagues would agree that extended treatment is to be expected. (3) All initial examinations and subsequent re-examinations performed by a chiropractor to determine the need for chiropractic treatment of neuro-musculoskeletal conditions shall include a functional chiropractic analysis... In a difficult case, particularly when your clinical documentation depicts findings of subluxation and the adjustments that you performed to correct them, I think most peers would have no problem seeing the clinical rationale behind the care plan. (4) Chiropractic physicians shall treat their patients as often as necessary to insure favorable progress. Evidence based outcomes management shall determine whether the frequency and duration of curative chiropractic treatment has been necessary. Outcomes management shall include both subjective or patient-driven information as well as objective provider-driven information. My supposition would be that your patient was satisfied with your care. By the sound of it, insurance, " medical necessity, " and all of that were not in play. So the issue would come down to quibbling about your care being " curative. " Seems to me that if the patient is satisfied with the outcomes of treatment and you are satisfied that your adjustments are making a difference (even for the first years of no apparent progress) the requirements of the rule have been met. The rub of course would occur if someone, your patient or someone else, called your care plan into question. Would you then be comfortable and able to provide your clinical rationale for the care of this unusual case in the presence (or the absence) of the rule? A. Simpson, DC RE: Re: CJ or CR? getting specific Judith, OR DCs, Thank you, Dr Boothby, for coming forward to the OR DCs listserve with this important discussion. Your last post contained the central theme of your opposition to the CJ/R rule (and apparently the whole notion of evidence-based guidelines in general) when you state...<< your wizard behind the curtain is making a rule that excludes me... to not disallow my truth and compassionate centered paradym >> I have heard you and others make this case before and frankly I am puzzled by it. You say that it is so, but offer no explanation, examples or proof. You express that it is your fear that EB practices somehow will make what you do illegal or outside the bounds of EB chiropractic, if I understand you correctly. Please help me and the others on this listserve understand why this is so. What is that you do that is threatened by the rule and/or EB practices? And how does the rule and EB chiropractic threaten it? A. Simpson, DC csimpson@... __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 28, 2006 Report Share Posted February 28, 2006 Chuck's response brings a question to mind... Can Chiropractors " counsel!? " And if so, are 3rd party payers responsible to pay for counseling, by Chiropractors, if counseling is " reasonable and necessary " in a case of a MVA that brings on PATS, vertigo, social anxiety, etc...? The reason I ask is, Dr. Boothby's case reminds me of a MVA patient I had who was a GREAT massage therapist in our area, who ultimately commited suicide because of the problems she had with her body post MVA (i.e., stress, anxiety, inability to work, TMJ, neck and back pain, etc). She was seeing multiple doctors, but the MVA stress did uncover some deep-seeded, nasty emotional issues that she had neatly " tucked away. " (i.e., her emotional traumas resurfaced as a result of the physical trauma). In retrospect, I can now see that NO BODY (including me, unfortunately) was dealing with the " emotional component " of her injury. We were all only dealing with the " objective physical findings " (which, in this case, had a particularly bad outcome). (:-) M. s, D.C. RE: Re: CJ or CR? getting specific > > Judith, OR DCs, > > Thank you, Dr Boothby, for coming forward to the OR > DCs listserve with > this important discussion. > > Your last post contained the central theme of your > opposition to the > CJ/R rule (and apparently the whole notion of > evidence-based guidelines > in general) when you state...<< your wizard behind the > curtain is > making > a rule that excludes me... to not disallow my truth > and compassionate > centered paradym >> > > I have heard you and others make this case before and > frankly I am > puzzled by it. > > You say that it is so, but offer no explanation, > examples or proof. > You > express that it is your fear that EB practices somehow > will make what > you do illegal or outside the bounds of EB > chiropractic, if I > understand > you correctly. > > Please help me and the others on this listserve > understand why this is > so. What is that you do that is threatened by the rule > and/or EB > practices? And how does the rule and EB chiropractic > threaten it? > > A. Simpson, DC > csimpson@... > > > > > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 28, 2006 Report Share Posted February 28, 2006 Well said Dr. Simpson, I would add again that the OBCE cannot act singularly, someone, realistically in this case your patient that you have just told us is satisfied with your care and believes that it indeed is helping would have to file a complaint with the Board...which of course isn't going to happen is it... Vern Saboe RE: Re: CJ or CR? getting specific > > Judith, OR DCs, > > Thank you, Dr Boothby, for coming forward to the OR > DCs listserve with > this important discussion. > > Your last post contained the central theme of your > opposition to the > CJ/R rule (and apparently the whole notion of > evidence-based guidelines > in general) when you state...<< your wizard behind the > curtain is > making > a rule that excludes me... to not disallow my truth > and compassionate > centered paradym >> > > I have heard you and others make this case before and > frankly I am > puzzled by it. > > You say that it is so, but offer no explanation, > examples or proof. > You > express that it is your fear that EB practices somehow > will make what > you do illegal or outside the bounds of EB > chiropractic, if I > understand > you correctly. > > Please help me and the others on this listserve > understand why this is > so. What is that you do that is threatened by the rule > and/or EB > practices? And how does the rule and EB chiropractic > threaten it? > > A. Simpson, DC > csimpson@... > > > > > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 28, 2006 Report Share Posted February 28, 2006 Hi , Thanks for sharing this unfortunate story. Anyone who has worked with trauma victims knows that mental health issues are a factor, from fear of getting back in the car, or on the bike, to everything just being " too much. " Reliving Trauma: Post-Traumatic Stress Disorder, <http://www.nimh.nih.gov/publicat/reliving.cfm>, is a good summary link from the NIMH describing the salient features of PTSD. If the trauma was life-threatening, or perceived as such, then the PTSD is much more likely. While we are not trained as DCs to diagnose or treat mental health problems, I've found that clinically involving patients in an active care protocol that helps create an " internal " orientation to their own health is very helpful. And, the treatment is very much chiropractic. By this I mean, an active care protocol involving a conscious breath combined with resting postures aligned to allow patients to deeply relax spinal musculature, enables patients to learn self-healing potentials. The human breath, performed properly, is capable of making patients feel very good in the moment. (You can get a small sense of this quickly by practicing Dr. Weil's 4-8-9 breathe: inhale through your nose for 4 seconds, then hold that breath GENTLY for 8 seconds, then exhale through the nostrils for 9 seconds, then smoothly repeat.... It's a radical breath for the beginner, so stop if it's too much! Feeling good from breath must be comfortable or it defeats the purpose.) But, if the patient is able to learn how they can make themselves feel better in the moment, then they may be motivated to use the breath with relaxing aligned resting postures to improve their body pain. The ability to feel better in the moment, and to reduce body pain through relaxation, contributes to the patient's knowledge that they are self-healing organisms. This is the internal orientation. It brings the responsibility for well-being to the patient, while the physician becomes the facilitator/teacher. It brings forth a clinical experience which de-emphasizes the victimization of the patient. Proper breathing increases cellular oxygen levels, among other important things, so people get smarter with this practice. Often, it is enough to redirect the patient's intention toward better health. Clearly, we are not diagnosing PTSD, or at least not claiming treatment for payment of PTSD. Referral may be necessary. We are treating around NMS criteria, but the benefits can potentially extend to one's mental health as well. Sears NW Portland On Feb 28, 2006, at 10:34 AM, s, D.C. wrote: > Chuck's response brings a question to mind... > > Can Chiropractors " counsel!? "  And if so, are 3rd party payers > responsible > to pay for counseling, by Chiropractors, if counseling is " reasonable > and > necessary " in a case of a MVA that brings on PATS, vertigo, social > anxiety, > etc...? > > The reason I ask is, Dr. Boothby's case reminds me of a MVA patient I > had > who was a GREAT massage therapist in our area, who ultimately commited > suicide because of the problems she had with her body post MVA (i.e., > stress, anxiety, inability to work, TMJ, neck and back pain, etc). > > She was seeing multiple doctors, but the MVA stress did uncover some > deep-seeded, nasty emotional issues that she had neatly " tucked away. " > (i.e., her emotional traumas resurfaced as a result of the physical > trauma). > > In retrospect, I can now see that NO BODY (including me, > unfortunately) was > dealing with the " emotional component " of her injury. We were all > only > dealing with the " objective physical findings " (which, in this case, > had a > particularly bad outcome). > > (:-) > M. s, D.C. > RE: Re: CJ or CR? getting specific > > > > Judith, OR DCs, > > > > Thank you, Dr Boothby, for coming forward to the OR > > DCs listserve with > > this important discussion. > > > > Your last post contained the central theme of your > > opposition to the > > CJ/R rule (and apparently the whole notion of > > evidence-based guidelines > > in general) when you state...<< your wizard behind the > > curtain is > > making > > a rule that excludes me... to not disallow my truth > > and compassionate > > centered paradym >> > > > > I have heard you and others make this case before and > > frankly I am > > puzzled by it. > > > > You say that it is so, but offer no explanation, > > examples or proof. > > You > > express that it is your fear that EB practices somehow > > will make what > > you do illegal or outside the bounds of EB > > chiropractic, if I > > understand > > you correctly. > > > > Please help me and the others on this listserve > > understand why this is > > so. What is that you do that is threatened by the rule > > and/or EB > > practices? And how does the rule and EB chiropractic > > threaten it? > > > > A. Simpson, DC > > csimpson@... > > > > > > > > > > > > __________________________________________________ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 1, 2006 Report Share Posted March 1, 2006 Dear All, Where in this "rule" is provision for care beyond the "curative" phase, i.e. 1. palliative care, 2. preventative care, 3. wellness care?? Also Vern, the sunset clause will not help one of our colleagues if an insurance company decides to use this rule against us as in the scenario that Les Feinberg outlined in a previous post. Take for example the current MISINTERPRETATION by BCBS of the CPT coding for 97124 on the same visit as a cmt code that Dr. Cimano (SP?) got hit with an exhorbitant amount of $ requested for and retroactive in refund. No sunset clause would have prevented his going out of business because he could not wait the 3 plus years it would take to revise the "rule". BTW, WHERE was the OBCE when Joe needed them to protect his patients (their first priority so i am lead to believe) and instruct BCBS to cease and desist or at least file a formal complaint the insurance division of the state of oregon so that he could still be able to serve said patients?? Knecht DC Namaste Chiropractic 1809 NW Portland, OR 97209 503-226-8010 From: "Vern Saboe" <vsaboe@...>"Boothby Judith" <boothbyj@...>,"listserve" < >,"Chuck Simpson, DC" <csimpson@...>Subject: Re: CJ/R ruleDate: Tue, 28 Feb 2006 15:45:08 -0800Well said Dr. Simpson,I would add again that the OBCE cannot act singularly, someone,realistically in this case your patient that you have just told us issatisfied with your care and believes that it indeed is helping would haveto file a complaint with the Board...which of course isn't going to happenis it...Vern Saboe RE: Re: CJ or CR? getting specific>> Judith, OR DCs,>> Thank you, Dr Boothby, for coming forward to the OR> DCs listserve with> this important discussion.>> Your last post contained the central theme of your> opposition to the> CJ/R rule (and apparently the whole notion of> evidence-based guidelines> in general) when you state...<< your wizard behind the> curtain is> making> a rule that excludes me... to not disallow my truth> and compassionate> centered paradym >>>> I have heard you and others make this case before and> frankly I am> puzzled by it.>> You say that it is so, but offer no explanation,> examples or proof.> You> express that it is your fear that EB practices somehow> will make what> you do illegal or outside the bounds of EB> chiropractic, if I> understand> you correctly.>> Please help me and the others on this listserve> understand why this is> so. What is that you do that is threatened by the rule> and/or EB> practices? And how does the rule and EB chiropractic> threaten it?>> A. Simpson, DC> csimpson@...>>>>>> __________________________________________________> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 1, 2006 Report Share Posted March 1, 2006 Dr. Knecht, When Joe Cimino called my office with a report of the BCBS problems he was having, I saw it as a direct call to public protection. I returned his call within the same day and have been in contact with him on a number of occasions. I asked for a special "Rules Advisory Committee" meeting to address this misinterpretation by BCBS. The OBCE put out a note for a public meeting and invited all 'interested public' to attend to help solve this issue of BCBS denying care based on a wrong interpretation of our 'scope' of practice rules. I don't have the actual attendance record in front of me, but I think about 15 docs showed up. LInda Stockton, a frequent listserv member/contributor, was there as well as many other docs. We spent the better part of a day, 5-6 hours in discussion and developed language to send to the board for adoption. The OBCE voted to accept the new language to better define our scope. The new language negates BCBS's interpretation and their rationale for denying payment on massage therapy when the therapist is hired by the doctor and contains 'retroactive' language to cover 'decades past' intent. However, the board has no control over insurance policy language. If an insurance company decides to deny massage therapy and addresses this in specific policy language, we have no jurisdiction over their policy. We can only define our scope and show an insurance company where an error in interpretation lies. This is what we sought to do in the last RAC meeting. When you get a notice from the board about meetings, I would encourage all docs to see if the content of the meeting is of importance. Set aside time to attend and make your voice heard. Call the OBCE office and ask any questions about meeting content if you don't understand what's on the agenda and how it might affect your practice. Dr. Cimino knows how I much I personally wanted to help him; how much the entire board wanted to help him and the public, with this misinterpretation of the scope laws. Thanks to all who attended that meeting to help. We needed all the advice and group energy to come up with a solution. It's the beauty of the Rules Advisory Committee; Concensus and group effort. Please feel free to get that language from our website. If an insurance company sends you a denial that relates to thus particular scope of practice; "A DC can't hire an LMT" this language may help clairfy. I'd also like to address your other concern about a sunset clause being ineffective. A sunset clause gives the board the right to do small changes in the rule. Just as with BCBS's misinterpretation of our scope, the board has the job of defining policy, guideline and other questions relating to our profession. We do so at the request of our stakeholders; chiropractors are among this group, but it essentially includes ALL public. If field doctors contact the board with questions concerning public protection, we will answer to the best of our ability. A sunset clause is very helpful from an administrative point of view. It keeps things fluid and allows for adaptability in policy questions. Minga Guerrero DC president, OBCE In a message dated 3/1/2006 6:05:51 AM Pacific Standard Time, allenknecht@... writes: Dear All, Where in this "rule" is provision for care beyond the "curative" phase, i.e. 1. palliative care, 2. preventative care, 3. wellness care?? Also Vern, the sunset clause will not help one of our colleagues if an insurance company decides to use this rule against us as in the scenario that Les Feinberg outlined in a previous post. Take for example the current MISINTERPRETATION by BCBS of the CPT coding for 97124 on the same visit as a cmt code that Dr. Cimano (SP?) got hit with an exhorbitant amount of $ requested for and retroactive in refund. No sunset clause would have prevented his going out of business because he could not wait the 3 plus years it would take to revise the "rule". BTW, WHERE was the OBCE when Joe needed them to protect his patients (their first priority so i am lead to believe) and instruct BCBS to cease and desist or at least file a formal complaint the insurance division of the state of oregon so that he could still be able to serve said patients?? Knecht DC Namaste Chiropractic 1809 NW Portland, OR 97209 503-226-8010 From: "Vern Saboe" <vsaboe@...>"Boothby Judith" <boothbyj@...>,"listserve" < >,"Chuck Simpson, DC" <csimpson@...>Subject: Re: CJ/R ruleDate: Tue, 28 Feb 2006 15:45:08 -0800Well said Dr. Simpson,I would add again that the OBCE cannot act singularly, someone,realistically in this case your patient that you have just told us issatisfied with your care and believes that it indeed is helping would haveto file a complaint with the Board...which of course isn't going to happenis it...Vern Saboe RE: Re: CJ or CR? getting specific>> Judith, OR DCs,>> Thank you, Dr Boothby, for coming forward to the OR> DCs listserve with> this important discussion.>> Your last post contained the central theme of your> opposition to the> CJ/R rule (and apparently the whole notion of> evidence-based guidelines> in general) when you state...<< your wizard behind the> curtain is> making> a rule that excludes me... to not disallow my truth> and compassionate> centered paradym >>>> I have heard you and others make this case before and> frankly I am> puzzled by it.>> You say that it is so, but offer no explanation,> examples or proof.> You> express that it is your fear that EB practices somehow> will make what> you do illegal or outside the bounds of EB> chiropractic, if I> understand> you correctly.>> Please help me and the others on this listserve> understand why this is> so. What is that you do that is threatened by the rule> and/or EB> practices? And how does the rule and EB chiropractic> threaten it?>> A. Simpson, DC> csimpson@...>>>>>> __________________________________________________> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 1, 2006 Report Share Posted March 1, 2006 Hi , Colleagues, The rule applies to "curative" care only as in your going to "fix" the patient, or "cure" the patient hence palliative, preventive, wellness care etc. has nothing to do with this rule and do not apply. Again, the rule was design for those situations wherein the patient has no financial accountability, no "out of pocket expense." This historically as we all know is the environment that has been ripe for abuse e.g.., PIP and Workers' Compensation.....we lost Work Comp in 1990 and we were in my opinion a hair's breath away from losing PIP to managed care as well in 2005. HB 3668 passed in the 2003 session and an outside group lobbying for managed care in PIP (lobbying the very state farm officials I was speaking with) made the threat extreme and why I suggested first to the CAO Exec. Board that we inform our members of the situation and ask if they would like to develop such a rule. We then did the same letter/survey to the entire field and received 89% consensus etc., etc. Lastly just because the rule sunsets in three years doesn't mean we would have to wait that long to change the rule. ....and give me one example wherein the sky has indeed fallen in due to this rule....just one would be fine. I can tell you and colleagues having this rule in my back pocket last session made a world of difference as the "excessive treatment" you can't give'em attending physician status cause they will over treat comments were many. If we wish to gain insurance parity, any willing provider, hospital staff privileges, a return to full attending in Workers' Comp we must have something like the CJ rule to address excessive treatment. Vern RE: Re: CJ or CR? getting specific>> Judith, OR DCs,>> Thank you, Dr Boothby, for coming forward to the OR> DCs listserve with> this important discussion.>> Your last post contained the central theme of your> opposition to the> CJ/R rule (and apparently the whole notion of> evidence-based guidelines> in general) when you state...<< your wizard behind the> curtain is> making> a rule that excludes me... to not disallow my truth> and compassionate> centered paradym >>>> I have heard you and others make this case before and> frankly I am> puzzled by it.>> You say that it is so, but offer no explanation,> examples or proof.> You> express that it is your fear that EB practices somehow> will make what> you do illegal or outside the bounds of EB> chiropractic, if I> understand> you correctly.>> Please help me and the others on this listserve> understand why this is> so. What is that you do that is threatened by the rule> and/or EB> practices? And how does the rule and EB chiropractic> threaten it?>> A. Simpson, DC> csimpson@...>>>>>> __________________________________________________> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 1, 2006 Report Share Posted March 1, 2006 Hi , OR DCs, <<Can Chiropractors " counsel!? " >> Very interesting question. And your story is a sad (but not uncommon) one. In my time on the OBCE I think the interpretation was that in the course of chiropractic care for a condition, some counseling is appropriate and within the scope of practice. Use of mental health CPT and ICD-9 codes however tends to cross licensing boundaries into other professions (PhD psychs, LCSWs, etc, and MD shrinks) wherein the going gets pretty murky...practicing psychology without a license for example. DC training in mental health is pretty skimpy in my experience. To make much of a case that DCs are trained as counselors is weak IMHO. I do note that WSCC offers a hypnosis seminar, however. That being said, it is obvious that many patients that we see have " mental health " issues causing, as a result of or coexisting with " what " they came to see the DC about. My guess is that we all spend time " counseling " patients about the various sources of their clinical problems including psychosocial stress, what they can do about it and even make referrals when needed. In regard to insurance coverage, my guess is that most companies exclude " mental health " from coverage except by the above mentioned mental health specialists. " Counseling " that might go on appropriately in a DC office ( " You know, if you hate your job, chances are it'll make your back hurt " ) would be done legitimately under the E/M service. A. Simpson, DC Re: CJ/R rule Chuck's response brings a question to mind... Can Chiropractors " counsel!? " And if so, are 3rd party payers responsible to pay for counseling, by Chiropractors, if counseling is " reasonable and necessary " in a case of a MVA that brings on PATS, vertigo, social anxiety, etc...? The reason I ask is, Dr. Boothby's case reminds me of a MVA patient I had who was a GREAT massage therapist in our area, who ultimately commited suicide because of the problems she had with her body post MVA (i.e., stress, anxiety, inability to work, TMJ, neck and back pain, etc). She was seeing multiple doctors, but the MVA stress did uncover some deep-seeded, nasty emotional issues that she had neatly " tucked away. " (i.e., her emotional traumas resurfaced as a result of the physical trauma). In retrospect, I can now see that NO BODY (including me, unfortunately) was dealing with the " emotional component " of her injury. We were all only dealing with the " objective physical findings " (which, in this case, had a particularly bad outcome). (:-) M. s, D.C. RE: Re: CJ or CR? getting specific > > Judith, OR DCs, > > Thank you, Dr Boothby, for coming forward to the OR > DCs listserve with > this important discussion. > > Your last post contained the central theme of your > opposition to the > CJ/R rule (and apparently the whole notion of > evidence-based guidelines > in general) when you state...<< your wizard behind the > curtain is > making > a rule that excludes me... to not disallow my truth > and compassionate > centered paradym >> > > I have heard you and others make this case before and > frankly I am > puzzled by it. > > You say that it is so, but offer no explanation, > examples or proof. > You > express that it is your fear that EB practices somehow > will make what > you do illegal or outside the bounds of EB > chiropractic, if I > understand > you correctly. > > Please help me and the others on this listserve > understand why this is > so. What is that you do that is threatened by the rule > and/or EB > practices? And how does the rule and EB chiropractic > threaten it? > > A. Simpson, DC > csimpson@... > > > > > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 1, 2006 Report Share Posted March 1, 2006 This is a wonderful post. The only thing I would add is that for people in severe acute stress there is nothing wrong with medical help - including medication. Medication can give the person some quick relief that hopefully will allow them time and patience to think about where they are and how to help themselves. sharron fuchs dcFrom: [mailto: ] On Behalf Of dm.bones@...Sent: Tuesday, February 28, 2006 7:27 PM s, D.C.Cc: OregondcsSubject: Re: CJ/R ruleHi , Thanks for sharing this unfortunate story. Anyone who has worked with trauma victims knows that mental health issues are a factor, from fear of getting back in the car, or on the bike, to everything just being "too much." Reliving Trauma: Post-Traumatic Stress Disorder, <http://www.nimh.nih.gov/publicat/reliving.cfm>, is a good summary link from the NIMH describing the salient features of PTSD. If the trauma was life-threatening, or perceived as such, then the PTSD is much more likely. While we are not trained as DCs to diagnose or treat mental health problems, I've found that clinically involving patients in an active care protocol that helps create an "internal" orientation to their own health is very helpful. And, the treatment is very much chiropractic. By this I mean, an active care protocol involving a conscious breath combined with resting postures aligned to allow patients to deeply relax spinal musculature, enables patients to learn self-healing potentials. The human breath, performed properly, is capable of making patients feel very good in the moment. (You can get a small sense of this quickly by practicing Dr. Weil's 4-8-9 breathe: inhale through your nose for 4 seconds, then hold that breath GENTLY for 8 seconds, then exhale through the nostrils for 9 seconds, then smoothly repeat.... It's a radical breath for the beginner, so stop if it's too much! Feeling good from breath must be comfortable or it defeats the purpose.) But, if the patient is able to learn how they can make themselves feel better in the moment, then they may be motivated to use the breath with relaxing aligned resting postures to improve their body pain. The ability to feel better in the moment, and to reduce body pain through relaxation, contributes to the patient's knowledge that they are self-healing organisms. This is the internal orientation. It brings the responsibility for well-being to the patient, while the physician becomes the facilitator/teacher. It brings forth a clinical experience which de-emphasizes the victimization of the patient. Proper breathing increases cellular oxygen levels, among other important things, so people get smarter with this practice. Often, it is enough to redirect the patient's intention toward better health. Clearly, we are not diagnosing PTSD, or at least not claiming treatment for payment of PTSD. Referral may be necessary. We are treating around NMS criteria, but the benefits can potentially extend to one's mental health as well. Sears NW Portland On Feb 28, 2006, at 10:34 AM, s, D.C. wrote: Chuck's response brings a question to mind... Can Chiropractors "counsel!?" And if so, are 3rd party payers responsible to pay for counseling, by Chiropractors, if counseling is "reasonable and necessary" in a case of a MVA that brings on PATS, vertigo, social anxiety, etc...? The reason I ask is, Dr. Boothby's case reminds me of a MVA patient I had who was a GREAT massage therapist in our area, who ultimately commited suicide because of the problems she had with her body post MVA (i.e., stress, anxiety, inability to work, TMJ, neck and back pain, etc). She was seeing multiple doctors, but the MVA stress did uncover some deep-seeded, nasty emotional issues that she had neatly "tucked away." (i.e., her emotional traumas resurfaced as a result of the physical trauma). In retrospect, I can now see that NO BODY (including me, unfortunately) was dealing with the "emotional component" of her injury. We were all only dealing with the "objective physical findings" (which, in this case, had a particularly bad outcome). (:-) M. s, D.C. RE: Re: CJ or CR? getting specific > > Judith, OR DCs, > > Thank you, Dr Boothby, for coming forward to the OR > DCs listserve with > this important discussion. > > Your last post contained the central theme of your > opposition to the > CJ/R rule (and apparently the whole notion of > evidence-based guidelines > in general) when you state...<< your wizard behind the > curtain is > making > a rule that excludes me... to not disallow my truth > and compassionate > centered paradym >> > > I have heard you and others make this case before and > frankly I am > puzzled by it. > > You say that it is so, but offer no explanation, > examples or proof. > You > express that it is your fear that EB practices somehow > will make what > you do illegal or outside the bounds of EB > chiropractic, if I > understand > you correctly. > > Please help me and the others on this listserve > understand why this is > so. What is that you do that is threatened by the rule > and/or EB > practices? And how does the rule and EB chiropractic > threaten it? > > A. Simpson, DC > csimpson@... > > > > > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 1, 2006 Report Share Posted March 1, 2006 I would like to state that I agree that the CJ/R rule seems to me to be reasonably written, and that we need it. I agree that our profession needs to be squeaky clean on this issue, that this is a major issue with public perception of chiropractors. I had an occupational health doc tell me that she was glad to see a chiropractic case that I treated, that had a "reasonable" length of time, and that she had seen treatment that went on and on without resolution under chiro management. I appreciate Vern's work on this, and know that he is probably taking some heat for his leadership on this. Marc Heller, DC mheller@... marc Chuck Simpson, DC wrote: Judith, OR DCs, Thanks for your forbearance. I appreciate your willingness to continue the conversation. I must be a bit dense in that I still do not see the issue as you do. Your story about the long suffering patient and the case presented in your video at the last public session of the OBCE do not seem to fall astray under the scope of the CJ/R rule as you fear...to wit, the text of the rule as it now stands shows: (1) Clinical rationale, within accepted standards and understood by a group of peers, must be shown for all opinions, diagnostic and therapeutic procedures... I would trust that in your treatment of your patient with the vestibular disorder you were involved with some chiropractic analysis for subluxation and adjustments of same. I'd suggest that these would be understood by a group of peers. (2) Accepted standards mean skills and treatment which are recognized as being reasonable, prudent and acceptable under similar conditions and circumstances. And in the case of vertigo of long-standing, most colleagues would agree that extended treatment is to be expected. (3) All initial examinations and subsequent re-examinations performed by a chiropractor to determine the need for chiropractic treatment of neuro-musculoskeletal conditions shall include a functional chiropractic analysis... In a difficult case, particularly when your clinical documentation depicts findings of subluxation and the adjustments that you performed to correct them, I think most peers would have no problem seeing the clinical rationale behind the care plan. (4) Chiropractic physicians shall treat their patients as often as necessary to insure favorable progress. Evidence based outcomes management shall determine whether the frequency and duration of curative chiropractic treatment has been necessary. Outcomes management shall include both subjective or patient-driven information as well as objective provider-driven information. My supposition would be that your patient was satisfied with your care. By the sound of it, insurance, "medical necessity," and all of that were not in play. So the issue would come down to quibbling about your care being "curative." Seems to me that if the patient is satisfied with the outcomes of treatment and you are satisfied that your adjustments are making a difference (even for the first years of no apparent progress) the requirements of the rule have been met. The rub of course would occur if someone, your patient or someone else, called your care plan into question. Would you then be comfortable and able to provide your clinical rationale for the care of this unusual case in the presence (or the absence) of the rule? A. Simpson, DC RE: Re: CJ or CR? getting specific Judith, OR DCs, Thank you, Dr Boothby, for coming forward to the OR DCs listserve with this important discussion. Your last post contained the central theme of your opposition to the CJ/R rule (and apparently the whole notion of evidence-based guidelines in general) when you state...<< your wizard behind the curtain is making a rule that excludes me... to not disallow my truth and compassionate centered paradym >> I have heard you and others make this case before and frankly I am puzzled by it. You say that it is so, but offer no explanation, examples or proof. You express that it is your fear that EB practices somehow will make what you do illegal or outside the bounds of EB chiropractic, if I understand you correctly. Please help me and the others on this listserve understand why this is so. What is that you do that is threatened by the rule and/or EB practices? And how does the rule and EB chiropractic threaten it? A. Simpson, DC csimpson@... __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 Dear Vern and et al, Then please add the appropriate qualifying language to the rule, i.e. this rule does not apply to palliative, wellness or preventative care. I think this would alleviate a lot of this discussion. Knecht DC Namaste Chiropractic 1809 NW Portland, OR 97209 503-226-8010 From: "Vern Saboe" <vsaboe@...><allen@...>,<boothbyj@...>,< >,<csimpson@...>Subject: Re: CJ/R ruleDate: Wed, 1 Mar 2006 07:18:02 -0800 Hi , Colleagues, The rule applies to "curative" care only as in your going to "fix" the patient, or "cure" the patient hence palliative, preventive, wellness care etc. has nothing to do with this rule and do not apply. Again, the rule was design for those situations wherein the patient has no financial accountability, no "out of pocket expense." This historically as we all know is the environment that has been ripe for abuse e.g.., PIP and Workers' Compensation.....we lost Work Comp in 1990 and we were in my opinion a hair's breath away from losing PIP to managed care as well in 2005. HB 3668 passed in the 2003 session and an outside group lobbying for managed care in PIP (lobbying the very state farm officials I was speaking with) made the threat extreme and why I suggested first to the CAO Exec. Board that we inform our members of the situation and ask if they would like to develop such a rule. We then did the same letter/survey to the entire field and received 89% consensus etc., etc. Lastly just because the rule sunsets in three years doesn't mean we would have to wait that long to change the rule. ....and give me one example wherein the sky has indeed fallen in due to this rule....just one would be fine. I can tell you and colleagues having this rule in my back pocket last session made a world of difference as the "excessive treatment" you can't give'em attending physician status cause they will over treat comments were many. If we wish to gain insurance parity, any willing provider, hospital staff privileges, a return to full attending in Workers' Comp we must have something like the CJ rule to address excessive treatment. Vern RE: Re: CJ or CR? getting specific>> Judith, OR DCs,>> Thank you, Dr Boothby, for coming forward to the OR> DCs listserve with> this important discussion.>> Your last post contained the central theme of your> opposition to the> CJ/R rule (and apparently the whole notion of> evidence-based guidelines> in general) when you state...<< your wizard behind the> curtain is> making> a rule that excludes me... to not disallow my truth> and compassionate> centered paradym >>>> I have heard you and others make this case before and> frankly I am> puzzled by it.>> You say that it is so, but offer no explanation,> examples or proof.> You> express that it is your fear that EB practices somehow> will make what> you do illegal or outside the bounds of EB> chiropractic, if I> understand> you correctly.>> Please help me and the others on this listserve> understand why this is> so. What is that you do that is threatened by the rule> and/or EB> practices? And how does the rule and EB chiropractic> threaten it?>> A. Simpson, DC> csimpson@...>>>>>> __________________________________________________> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 Dear Minga, Please forgive my naiveté, I stand corrected and informed. Thanks for sharing with us the level of support that you and the board gave to Dr. Cimino. I will definitely read the website for the pertinent information you referred to. I must have the definition of "sunset" clause wrong. As you have put it, does it mean that from day one of the adoption of the said rule, that modifications can be written into or ammended to the rule throughout the period of the rule? If indeed this is the case, then I feel much better. However, if the sunset clause refers to a waiting period before changes to the rule can be made, that would cause me concern. Again, thanks for your prompt response. In Dr. Cimimo´s case as an example, and if any other cases out there similar to his, would it be appropriate for the OBCE to write a letter of opinion that a doctor could forward to an insurance company in response and defense? Thanks again, Knecht DC Namaste Chiropractic 1809 NW Portland, OR 97209 503-226-8010 From: AboWoman@...To: Subject: Re: CJ/R ruleDate: Wed, 1 Mar 2006 14:08:32 EST Dr. Knecht, When Joe Cimino called my office with a report of the BCBS problems he was having, I saw it as a direct call to public protection. I returned his call within the same day and have been in contact with him on a number of occasions. I asked for a special "Rules Advisory Committee" meeting to address this misinterpretation by BCBS. The OBCE put out a note for a public meeting and invited all 'interested public' to attend to help solve this issue of BCBS denying care based on a wrong interpretation of our 'scope' of practice rules. I don't have the actual attendance record in front of me, but I think about 15 docs showed up. LInda Stockton, a frequent listserv member/contributor, was there as well as many other docs. We spent the better part of a day, 5-6 hours in discussion and developed language to send to the board for adoption. The OBCE voted to accept the new language to better define our scope. The new language negates BCBS's interpretation and their rationale for denying payment on massage therapy when the therapist is hired by the doctor and contains 'retroactive' language to cover 'decades past' intent. However, the board has no control over insurance policy language. If an insurance company decides to deny massage therapy and addresses this in specific policy language, we have no jurisdiction over their policy. We can only define our scope and show an insurance company where an error in interpretation lies. This is what we sought to do in the last RAC meeting. When you get a notice from the board about meetings, I would encourage all docs to see if the content of the meeting is of importance. Set aside time to attend and make your voice heard. Call the OBCE office and ask any questions about meeting content if you don't understand what's on the agenda and how it might affect your practice. Dr. Cimino knows how I much I personally wanted to help him; how much the entire board wanted to help him and the public, with this misinterpretation of the scope laws. Thanks to all who attended that meeting to help. We needed all the advice and group energy to come up with a solution. It's the beauty of the Rules Advisory Committee; Concensus and group effort. Please feel free to get that language from our website. If an insurance company sends you a denial that relates to thus particular scope of practice; "A DC can't hire an LMT" this language may help clairfy. I'd also like to address your other concern about a sunset clause being ineffective. A sunset clause gives the board the right to do small changes in the rule. Just as with BCBS's misinterpretation of our scope, the board has the job of defining policy, guideline and other questions relating to our profession. We do so at the request of our stakeholders; chiropractors are among this group, but it essentially includes ALL public. If field doctors contact the board with questions concerning public protection, we will answer to the best of our ability. A sunset clause is very helpful from an administrative point of view. It keeps things fluid and allows for adaptability in policy questions. Minga Guerrero DC president, OBCE In a message dated 3/1/2006 6:05:51 AM Pacific Standard Time, allenknecht@... writes: Dear All, Where in this "rule" is provision for care beyond the "curative" phase, i.e. 1. palliative care, 2. preventative care, 3. wellness care?? Also Vern, the sunset clause will not help one of our colleagues if an insurance company decides to use this rule against us as in the scenario that Les Feinberg outlined in a previous post. Take for example the current MISINTERPRETATION by BCBS of the CPT coding for 97124 on the same visit as a cmt code that Dr. Cimano (SP?) got hit with an exhorbitant amount of $ requested for and retroactive in refund. No sunset clause would have prevented his going out of business because he could not wait the 3 plus years it would take to revise the "rule". BTW, WHERE was the OBCE when Joe needed them to protect his patients (their first priority so i am lead to believe) and instruct BCBS to cease and desist or at least file a formal complaint the insurance division of the state of oregon so that he could still be able to serve said patients?? Knecht DC Namaste Chiropractic 1809 NW Portland, OR 97209 503-226-8010 From: "Vern Saboe" <vsaboe@...>"Boothby Judith" <boothbyj@...>,"listserve" < >,"Chuck Simpson, DC" <csimpson@...>Subject: Re: CJ/R ruleDate: Tue, 28 Feb 2006 15:45:08 -0800Well said Dr. Simpson,I would add again that the OBCE cannot act singularly, someone,realistically in this case your patient that you have just told us issatisfied with your care and believes that it indeed is helping would haveto file a complaint with the Board...which of course isn't going to happenis it...Vern Saboe RE: Re: CJ or CR? getting specific>> Judith, OR DCs,>> Thank you, Dr Boothby, for coming forward to the OR> DCs listserve with> this important discussion.>> Your last post contained the central theme of your> opposition to the> CJ/R rule (and apparently the whole notion of> evidence-based guidelines> in general) when you state...<< your wizard behind the> curtain is> making> a rule that excludes me... to not disallow my truth> and compassionate> centered paradym >>>> I have heard you and others make this case before and> frankly I am> puzzled by it.>> You say that it is so, but offer no explanation,> examples or proof.> You> express that it is your fear that EB practices somehow> will make what> you do illegal or outside the bounds of EB> chiropractic, if I> understand> you correctly.>> Please help me and the others on this listserve> understand why this is> so. What is that you do that is threatened by the rule> and/or EB> practices? And how does the rule and EB chiropractic> threaten it?>> A. Simpson, DC> csimpson@...>>>>>> __________________________________________________> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 Dear , This was also discussed, recommended, debated, and not included by the Administrative Rules Advisory Committee simple because we thought the term "curative care" speaks for itself. Nonetheless considering the intent of the rule I nor anyone else should be against a further dialog to address the concerns we have heard on the list serve. In short the current rule should go back to the Rules Advisory Committee and in a true consensus building manner have colleagues come together and pound out solutions. Again the current CJ Rule is an excellent rule and paid key and timely dividends last legislative session for the profession, lets not through the baby out with the bathwater.....nor circle the wagons yet again and quickly shoot inward. Due process will insure that the largest number of colleagues are included in any changes to the CJ rule. Lastly, I feel somewhat like the little kid at a NFL game attempting to shout over the cheers of the crowd but frustratingly can't be heard. The real danger and that which we need to be equally or even more proactive and pre-emptive with is "Evidence Based Best Practices" which are just around the corner. In my opinion we need to nexus the "Levels of Evidence" document we produced a few years ago with the current ESTSD Admin Rule Language. The current Outcomes language will guard against arbitrary or canned numbers of visits for particular conditions, and the "Levels of Evidence" linked to the current ESTSD language will protect against someone outside the profession raising the "evidence based bar" to high....e.g.., if the level of evidence is not high/strong enough to support the efficacy of this or that procedure/treatment then colleagues will not be reimburse for it by third party payers...or worse yet, simply be restricted from using the procedure at all. The current CJ rule should simply go back to the rules committee for continued discussion and amendments if needed. We need to then start addressing "Evidence Based Best Practices" and we need to do is very, very soon. Vern Saboe RE: Re: CJ or CR? getting specific>> Judith, OR DCs,>> Thank you, Dr Boothby, for coming forward to the OR> DCs listserve with> this important discussion.>> Your last post contained the central theme of your> opposition to the> CJ/R rule (and apparently the whole notion of> evidence-based guidelines> in general) when you state...<< your wizard behind the> curtain is> making> a rule that excludes me... to not disallow my truth> and compassionate> centered paradym >>>> I have heard you and others make this case before and> frankly I am> puzzled by it.>> You say that it is so, but offer no explanation,> examples or proof.> You> express that it is your fear that EB practices somehow> will make what> you do illegal or outside the bounds of EB> chiropractic, if I> understand> you correctly.>> Please help me and the others on this listserve> understand why this is> so. What is that you do that is threatened by the rule> and/or EB> practices? And how does the rule and EB chiropractic> threaten it?>> A. Simpson, DC> csimpson@...>>>>>> __________________________________________________> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 Hi all, Here's a Chiroweb review of past year's articles on " Best Practices " for your review. Sears NW Portland On Mar 2, 2006, at 5:11 AM, Vern Saboe wrote: > Dear , >  > This was also discussed, recommended, debated, and not included by the > Administrative Rules Advisory Committee simple because we thought the > term " curative care " speaks for itself. >  > Nonetheless considering the intent of the rule I nor anyone else > should be against a further dialog to address the concerns we have > heard on the list serve. >  > In short the current rule should go back to the Rules Advisory > Committee and in a true consensus building manner have colleagues come > together and pound out solutions. >  > Again the current CJ Rule is an excellent rule and paid key and timely > dividends last legislative session for the profession, lets not > through the baby out with the bathwater.....nor circle the wagons yet > again and quickly shoot inward. Due process will insure that the > largest number of colleagues are included in any changes to the CJ > rule. >  > Lastly, I feel somewhat like the little kid at a NFL game attempting > to shout over the cheers of the crowd but frustratingly can't be > heard. The real danger and that which we need to be equally or even > more proactive and pre-emptive with is " Evidence Based Best Practices " > which are just around the corner. >  > In my opinion we need to nexus the " Levels of Evidence " document we > produced a few years ago with the current ESTSD Admin Rule Language. > The current Outcomes language will guard against arbitrary or canned > numbers of visits for particular conditions, and the " Levels of > Evidence " linked to the current ESTSD language will protect against > someone outside the profession raising the " evidence based bar " to > high....e.g.., if the level of evidence is not high/strong enough to > support the efficacy of this or that procedure/treatment then > colleagues will not be reimburse for it by third party payers...or > worse yet, simply be restricted from using the procedure at all. >  > The current CJ rule should simply go back to the rules committee for > continued discussion and amendments if needed. We need to then start > addressing " Evidence Based Best Practices " and we need to do is very, > very soon. >  > Vern Saboe   >> RE: Re: CJ or CR? getting specific >>>>> > >>>>> > Judith, OR DCs, >>>>> > >>>>> > Thank you, Dr Boothby, for coming forward to the OR >>>>> > DCs listserve with >>>>> > this important discussion. >>>>> > >>>>> > Your last post contained the central theme of your >>>>> > opposition to the >>>>> > CJ/R rule (and apparently the whole notion of >>>>> > evidence-based guidelines >>>>> > in general) when you state...<< your wizard behind the >>>>> > curtain is >>>>> > making >>>>> > a rule that excludes me... to not disallow my truth >>>>> > and compassionate >>>>> > centered paradym >> >>>>> > >>>>> > I have heard you and others make this case before and >>>>> > frankly I am >>>>> > puzzled by it. >>>>> > >>>>> > You say that it is so, but offer no explanation, >>>>> > examples or proof. >>>>> > You >>>>> > express that it is your fear that EB practices somehow >>>>> > will make what >>>>> > you do illegal or outside the bounds of EB >>>>> > chiropractic, if I >>>>> > understand >>>>> > you correctly. >>>>> > >>>>> > Please help me and the others on this listserve >>>>> > understand why this is >>>>> > so. What is that you do that is threatened by the rule >>>>> > and/or EB >>>>> > practices? And how does the rule and EB chiropractic >>>>> > threaten it? >>>>> > >>>>> > A. Simpson, DC >>>>> > csimpson@... >>>>> > >>>>> > >>>>> > >>>>> > >>>>> > >>>>> > __________________________________________________ >>>>> > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 No! Here's the review: http://www.chiroweb.com/search-chiroweb.php? q=best+practices & searchtype=a & ul=http%3A%2F%2Fwww.chiroweb.com%2F%25 & cmd =Search%21 & Submit=SEARCH Sears On Mar 2, 2006, at 5:11 AM, Vern Saboe wrote: > Dear , >  > This was also discussed, recommended, debated, and not included by the > Administrative Rules Advisory Committee simple because we thought the > term " curative care " speaks for itself. >  > Nonetheless considering the intent of the rule I nor anyone else > should be against a further dialog to address the concerns we have > heard on the list serve. >  > In short the current rule should go back to the Rules Advisory > Committee and in a true consensus building manner have colleagues come > together and pound out solutions. >  > Again the current CJ Rule is an excellent rule and paid key and timely > dividends last legislative session for the profession, lets not > through the baby out with the bathwater.....nor circle the wagons yet > again and quickly shoot inward. Due process will insure that the > largest number of colleagues are included in any changes to the CJ > rule. >  > Lastly, I feel somewhat like the little kid at a NFL game attempting > to shout over the cheers of the crowd but frustratingly can't be > heard. The real danger and that which we need to be equally or even > more proactive and pre-emptive with is " Evidence Based Best Practices " > which are just around the corner. >  > In my opinion we need to nexus the " Levels of Evidence " document we > produced a few years ago with the current ESTSD Admin Rule Language. > The current Outcomes language will guard against arbitrary or canned > numbers of visits for particular conditions, and the " Levels of > Evidence " linked to the current ESTSD language will protect against > someone outside the profession raising the " evidence based bar " to > high....e.g.., if the level of evidence is not high/strong enough to > support the efficacy of this or that procedure/treatment then > colleagues will not be reimburse for it by third party payers...or > worse yet, simply be restricted from using the procedure at all. >  > The current CJ rule should simply go back to the rules committee for > continued discussion and amendments if needed. We need to then start > addressing " Evidence Based Best Practices " and we need to do is very, > very soon. >  > Vern Saboe   >> RE: Re: CJ or CR? getting specific >>>>> > >>>>> > Judith, OR DCs, >>>>> > >>>>> > Thank you, Dr Boothby, for coming forward to the OR >>>>> > DCs listserve with >>>>> > this important discussion. >>>>> > >>>>> > Your last post contained the central theme of your >>>>> > opposition to the >>>>> > CJ/R rule (and apparently the whole notion of >>>>> > evidence-based guidelines >>>>> > in general) when you state...<< your wizard behind the >>>>> > curtain is >>>>> > making >>>>> > a rule that excludes me... to not disallow my truth >>>>> > and compassionate >>>>> > centered paradym >> >>>>> > >>>>> > I have heard you and others make this case before and >>>>> > frankly I am >>>>> > puzzled by it. >>>>> > >>>>> > You say that it is so, but offer no explanation, >>>>> > examples or proof. >>>>> > You >>>>> > express that it is your fear that EB practices somehow >>>>> > will make what >>>>> > you do illegal or outside the bounds of EB >>>>> > chiropractic, if I >>>>> > understand >>>>> > you correctly. >>>>> > >>>>> > Please help me and the others on this listserve >>>>> > understand why this is >>>>> > so. What is that you do that is threatened by the rule >>>>> > and/or EB >>>>> > practices? And how does the rule and EB chiropractic >>>>> > threaten it? >>>>> > >>>>> > A. Simpson, DC >>>>> > csimpson@... >>>>> > >>>>> > >>>>> > >>>>> > >>>>> > >>>>> > __________________________________________________ >>>>> > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 Dear Marc: I hope if honest conversation goes on long enough then some wisdom will come to the surface. There are however some problems. I raised the significant issues I have with the CJ rule at many, many board meeting and the CJ rule was not refered back to the rules committe to evaluate what I was saying. 1)I believe the CJ rule was unjustly adopted. 2)It is not good policy to write rules to progress a small percentage of our profession's (20%) political agenda. It is not the best policy to try to change the public's perception of chiropractic with rules. Especially rules that are politically based and not truth based. 3)The public is not entirly wanting evidence based care. I have already presented the case of my patient who had her entire settlement ($50,000) spent on ineffective evidence based chiropractic and medicine. I work on many people who have not been healed by their previous chiropractic care which may have been evidence based or managed care based) I try to teach them to learn how to choose care that will be the most effective for their needs and then to take responcibility for the choice they make. I also guide them in the direction of not making fun of my profession, even though they do not like evidence based care, because I personally do not approve of moking my group called chiropractic. So I educate a lot of people about how empowering it is to lead and not mock. Trying to make a law to cover up some chiropractors shame about the profession is not going to work. The people unjustly denied access to chiropractic care are not going to be happy, the people slamed into some evidence box that actually doesn't match them are not going to be happy, and I might have to start recommending to my patients that they complain to board when they have been subjected to evidence based chiropractic care that was expensive and didn't suit their needs which I don't want to have to do because it will add further strife to a world with to much strife in it already. So what is a temporary solution while we continue to debate this issue: I think the board should adopt the clinical rational rule or go back to the previous excessive treatment rule. Sincerely Judith Boothby --- Marc Heller <mheller@...> wrote: --------------------------------- I would like to state that I agree that the CJ/R rule seems to me to bereasonably written, and that we need it. I agree that our profession needs to be squeaky clean on this issue,that this is a major issue with public perception of chiropractors. Ihad an occupational health doc tell me that she was glad to see achiropractic case that I treated, that had a " reasonable " length oftime, and that she had seen treatment that went on and on withoutresolution under chiro management. I appreciate Vern's work on this, and know that he is probably takingsome heat for his leadership on this. Marc Heller, DC mheller@... marc Chuck Simpson, DC wrote:Judith, OR DCs, Thanks for your forbearance. I appreciate your willingness to continue the conversation. I must be a bit dense in that I still do not see the issue as you do. Your story about the long suffering patient and the case presented in your video at the last public session of the OBCE do not seem to fall astray under the scope of the CJ/R rule as you fear...to wit, the text of the rule as it now stands shows: (1) Clinical rationale, within accepted standards and understood by a group of peers, must be shown for all opinions, diagnostic and therapeutic procedures... I would trust that in your treatment of your patient with the vestibular disorder you were involved with some chiropractic analysis for subluxation and adjustments of same. I'd suggest that these would be understood by a group of peers. (2) Accepted standards mean skills and treatment which are recognized as being reasonable, prudent and acceptable under similar conditions and circumstances. And in the case of vertigo of long-standing, most colleagues would agree that extended treatment is to be expected. (3) All initial examinations and subsequent re-examinations performed by a chiropractor to determine the need for chiropractic treatment of neuro-musculoskeletal conditions shall include a functional chiropractic analysis... In a difficult case, particularly when your clinical documentation depicts findings of subluxation and theadjustments that you performed to correct them, I think most peers would have no problem seeing the clinical rationale behind the care plan. (4) Chiropractic physicians shall treat their patients as often as necessary to insure favorable progress. Evidence based outcomes management shall determine whether the frequency and duration of curative chiropractic treatment has been necessary. Outcomes management shall include both subjective or patient-driven information as well as objective provider-driven information. My supposition would be that your patient was satisfied with your care. By the sound of it, insurance, " medical necessity, " and all of that were not in play. So the issue would come down to quibbling about your care being " curative. " Seems to me that if the patient is satisfied with the outcomes of treatment and youare satisfied that your adjustments are making a difference (even forthe first years of no apparent progress) the requirements of the rulehave been met. The rub of course would occur if someone, your patient or someone else, called your care plan into question. Would you then be comfortable and able to provide your clinical rationale for the care of this unusual case in the presence (or the absence) of the rule? A. Simpson, DC RE: Re: CJ or CR? getting specific Judith, OR DCs, Thank you, Dr Boothby, for coming forward to the OR DCs listserve with this important discussion. Your last post contained the central theme of your opposition to the CJ/R rule (and apparently the whole notion of evidence-based guidelines in general) when you state...<< your wizard behind the curtain is making a rule that excludes me... to not disallow my truth and compassionate centered paradym >> I have heard you and others make this case before and frankly I am puzzled by it. You say that it is so, but offer no explanation, examples or proof. You express that it is your fear that EB practices somehow will make what you do illegal or outside the bounds of EB chiropractic, if I understand you correctly. Please help me and the others on this listserve understand why this is so. What is that you do that is threatened by the rule and/or EB practices? And how does the rule and EB chiropractic threaten it? A. Simpson, DC csimpson@... __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2006 Report Share Posted March 3, 2006 Dear Judith: In your last post your stated; " I believe the CJ rule was unjustly adopted. " Could you please explain why you believe this to be true? Also you mentioned; " The people unjustly denied access to chiropractic care are not going to be happy, the people slammed into some evidence box that actually doesn't match them are not going to be happy... " The CJ rule has been active for over one year now, could you provide one example of the above? Thanks, Vern Saboe RE: Re: CJ or CR? getting specific > > Judith, OR DCs, > > Thank you, Dr Boothby, for coming forward to the OR > DCs listserve with > this important discussion. > > Your last post contained the central theme of your > opposition to the > CJ/R rule (and apparently the whole notion of > evidence-based guidelines > in general) when you state...<< your wizard behind the > curtain is > making > a rule that excludes me... to not disallow my truth > and compassionate > centered paradym >> > > I have heard you and others make this case before and > frankly I am > puzzled by it. > > You say that it is so, but offer no explanation, > examples or proof. > You > express that it is your fear that EB practices somehow > will make what > you do illegal or outside the bounds of EB > chiropractic, if I > understand > you correctly. > > Please help me and the others on this listserve > understand why this is > so. What is that you do that is threatened by the rule > and/or EB > practices? And how does the rule and EB chiropractic > threaten it? > > A. Simpson, DC > csimpson@... > > > > > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2006 Report Share Posted March 3, 2006 Vern: The reason I got into Chiropractic and not medicine is because I have very good intuition. I like to attend to things in a smaller way and set the grain before the disasters happen. I believe I have given you one example of a patient I have worked on who had her entire settlement spent for her care that was provided in an evidence based way. If you are not going to count this $50,000 example then I do not have evidence that you are actually trying to get it. Here is an example of how over standardization is harming another similar profession. Optometric state organizations currently have to battle a contact lens company who is trying to establish narrow standards for the optomotrists. The company 1-800 Contacts has proposed a bill in Indiana (HB1308) that would establish a standardized contact lens formulary to be created and maintained by the state attorney general. It would become a criminal offense for an optometrist toprescribe a custom lens not in the formulary. In Utah a similar bill has been introduced where an optomotrist woulde be subject to license suspension or revocation by prescribing unique lenses that are currently allowed. I believe the CJ rule was unjustly adopted because major changes where made in it by the board members without ever calling for another rule hearing even though there was strong pertinent opposition. Vern you better believe I will let you know for a long time every case that I see that has been unjustly terminated. So for now I am just offering the above mentioned case. I do not think it is necessary to chop up chiropractic this way. I think there is a lot a blame being placed on the sensitive people that actually need health care and the chiropractors that help them. I'm sure there are better ways that as chiropractor we can make referals especially to the mastors in our profession who have many unique nitches and to accupuncturists and naturopaths and all the other wonderful healthcare practitioners in this town. Think of a bicycle wheel. It is like 20% (a minority) of chiropractors in the state decided they are tired of flat tires and broken spokes so a rule was created that only allows the hubs to be used and no tires and spokes. I don't think that is such a great answer to periodic flat tires. So if you say to me one more time Vern to show you just one example then I will be even more certain you are only doing a political thing and perhaps don't know how to listen. Sincerely, Judith Boothby --- Vern Saboe <vsaboe@...> wrote: > Dear Judith: > > In your last post your stated; " I believe the CJ > rule was unjustly > adopted. " Could you please explain why you believe > this to be true? > > Also you mentioned; " The people unjustly denied > access to chiropractic care > are not going to be happy, the people slammed into > some evidence box that > actually doesn't match them are not going to be > happy... " The CJ rule has > been active for over one year now, could you provide > one example of the > above? > > Thanks, > > Vern Saboe > Re: CJ/R rule > > > > Dear Marc: > > > > I hope if honest conversation goes on long enough > then > > some wisdom will come to the surface. There are > > however some problems. I raised the significant > > issues I have with the CJ rule at many, many board > > meeting and the CJ rule was not refered back to > the > > rules committe to evaluate what I was saying. > > > > 1)I believe the CJ rule was unjustly adopted. > > 2)It is not good policy to write rules to progress > a > > small percentage of our profession's (20%) > political > > agenda. It is not the best policy to try to > change > > the public's perception of chiropractic with > rules. > > Especially rules that are politically based and > not > > truth based. > > 3)The public is not entirly wanting evidence based > > care. I have already presented the case of my > patient > > who had her entire settlement ($50,000) spent on > > ineffective evidence based chiropractic and > medicine. > > I work on many people who have not been healed by > > their previous chiropractic care which may have > been > > evidence based or managed care based) I try to > teach > > them to learn how to choose care that will be the > most > > effective for their needs and then to take > > responcibility for the choice they make. I also > guide > > them in the direction of not making fun of my > > profession, even though they do not like evidence > > based care, because I personally do not approve of > > moking my group called chiropractic. So I educate > a > > lot of people about how empowering it is to lead > and > > not mock. > > > > Trying to make a law to cover up some > chiropractors > > shame about the profession is not going to work. > The > > people unjustly denied access to chiropractic care > are > > not going to be happy, the people slamed into some > > evidence box that actually doesn't match them are > not > > going to be happy, and I might have to start > > recommending to my patients that they complain to > > board when they have been subjected to evidence > based > > chiropractic care that was expensive and didn't > suit > > their needs which I don't want to have to do > because > > it will add further strife to a world with to much > > strife in it already. > > > > So what is a temporary solution while we continue > to > > debate this issue: I think the board should adopt > the > > clinical rational rule or go back to the previous > > excessive treatment rule. > > > > Sincerely Judith Boothby > > > > > > > > --- Marc Heller <mheller@...> wrote: > > > > > > --------------------------------- > > I would like to state that I agree that the CJ/R > > rule seems to me to bereasonably written, and that > we > > need it. > > I agree that our profession needs to be squeaky > clean > > on this issue,that this is a major issue with > public > > perception of chiropractors. Ihad an occupational > > health doc tell me that she was glad to see > > achiropractic case that I treated, that had a > > " reasonable " length oftime, and that she had seen > > treatment that went on and on withoutresolution > under > > chiro management. > > I appreciate Vern's work on this, and know that he > is > > probably takingsome heat for his leadership on > this. > > > > Marc Heller, DC > > mheller@... > > > > marc > > > > Chuck Simpson, DC wrote:Judith, OR DCs, > > > > Thanks for your forbearance. I appreciate your > > willingness to continue > > the conversation. > > > > I must be a bit dense in that I still do not see > the > > issue as you do. > > Your story about the long suffering patient and > the > > case presented in > > your video at the last public session of the OBCE > do > > not seem to fall > > astray under the scope of the CJ/R rule as you > > fear...to wit, the text > > of the rule as it now stands shows: > > > > (1) Clinical rationale, within accepted standards > and > > understood by a > > group of peers, must be shown for all opinions, > > diagnostic and > > therapeutic procedures... > > > > I would trust that in your treatment of your > > patient with the > > vestibular disorder you were involved with some > > chiropractic analysis > > for subluxation and adjustments of same. I'd > suggest > > that these would > > be understood by a group of peers. > > > > (2) Accepted standards mean skills and treatment > which > > are recognized as > > being reasonable, prudent and acceptable under > similar > > conditions and > > circumstances. > > > > And in the case of vertigo of long-standing, > > most colleagues > > would agree that extended treatment is to be > > expected. > > > > (3) All initial examinations and subsequent > > re-examinations performed by > > a chiropractor to determine the need for > chiropractic > > treatment of > > neuro-musculoskeletal conditions shall include a > > functional chiropractic > > analysis... > > > > In a difficult case, particularly when your > > clinical > > documentation depicts findings of > subluxation > > and theadjustments that > > you performed to correct them, I think most > > peers would have no > === message truncated === __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 4, 2006 Report Share Posted March 4, 2006 Judith. What specifically were the major changes that Board members made that were not debated or discussed in the Administrative Rules Advisory Committee? To what particular language are you referring? Thanks, Vern Re: CJ/R rule > > > > > > > Dear Marc: > > > > > > I hope if honest conversation goes on long enough > > then > > > some wisdom will come to the surface. There are > > > however some problems. I raised the significant > > > issues I have with the CJ rule at many, many board > > > meeting and the CJ rule was not refered back to > > the > > > rules committe to evaluate what I was saying. > > > > > > 1)I believe the CJ rule was unjustly adopted. > > > 2)It is not good policy to write rules to progress > > a > > > small percentage of our profession's (20%) > > political > > > agenda. It is not the best policy to try to > > change > > > the public's perception of chiropractic with > > rules. > > > Especially rules that are politically based and > > not > > > truth based. > > > 3)The public is not entirly wanting evidence based > > > care. I have already presented the case of my > > patient > > > who had her entire settlement ($50,000) spent on > > > ineffective evidence based chiropractic and > > medicine. > > > I work on many people who have not been healed by > > > their previous chiropractic care which may have > > been > > > evidence based or managed care based) I try to > > teach > > > them to learn how to choose care that will be the > > most > > > effective for their needs and then to take > > > responcibility for the choice they make. I also > > guide > > > them in the direction of not making fun of my > > > profession, even though they do not like evidence > > > based care, because I personally do not approve of > > > moking my group called chiropractic. So I educate > > a > > > lot of people about how empowering it is to lead > > and > > > not mock. > > > > > > Trying to make a law to cover up some > > chiropractors > > > shame about the profession is not going to work. > > The > > > people unjustly denied access to chiropractic care > > are > > > not going to be happy, the people slamed into some > > > evidence box that actually doesn't match them are > > not > > > going to be happy, and I might have to start > > > recommending to my patients that they complain to > > > board when they have been subjected to evidence > > based > > > chiropractic care that was expensive and didn't > > suit > > > their needs which I don't want to have to do > > because > > > it will add further strife to a world with to much > > > strife in it already. > > > > > > So what is a temporary solution while we continue > > to > > > debate this issue: I think the board should adopt > > the > > > clinical rational rule or go back to the previous > > > excessive treatment rule. > > > > > > Sincerely Judith Boothby > > > > > > > > > > > > --- Marc Heller <mheller@...> wrote: > > > > > > > > > --------------------------------- > > > I would like to state that I agree that the CJ/R > > > rule seems to me to bereasonably written, and that > > we > > > need it. > > > I agree that our profession needs to be squeaky > > clean > > > on this issue,that this is a major issue with > > public > > > perception of chiropractors. Ihad an occupational > > > health doc tell me that she was glad to see > > > achiropractic case that I treated, that had a > > > " reasonable " length oftime, and that she had seen > > > treatment that went on and on withoutresolution > > under > > > chiro management. > > > I appreciate Vern's work on this, and know that he > > is > > > probably takingsome heat for his leadership on > > this. > > > > > > Marc Heller, DC > > > mheller@... > > > > > > marc > > > > > > Chuck Simpson, DC wrote:Judith, OR DCs, > > > > > > Thanks for your forbearance. I appreciate your > > > willingness to continue > > > the conversation. > > > > > > I must be a bit dense in that I still do not see > > the > > > issue as you do. > > > Your story about the long suffering patient and > > the > > > case presented in > > > your video at the last public session of the OBCE > > do > > > not seem to fall > > > astray under the scope of the CJ/R rule as you > > > fear...to wit, the text > > > of the rule as it now stands shows: > > > > > > (1) Clinical rationale, within accepted standards > > and > > > understood by a > > > group of peers, must be shown for all opinions, > > > diagnostic and > > > therapeutic procedures... > > > > > > I would trust that in your treatment of your > > > patient with the > > > vestibular disorder you were involved with some > > > chiropractic analysis > > > for subluxation and adjustments of same. I'd > > suggest > > > that these would > > > be understood by a group of peers. > > > > > > (2) Accepted standards mean skills and treatment > > which > > > are recognized as > > > being reasonable, prudent and acceptable under > > similar > > > conditions and > > > circumstances. > > > > > > And in the case of vertigo of long-standing, > > > most colleagues > > > would agree that extended treatment is to be > > > expected. > > > > > > (3) All initial examinations and subsequent > > > re-examinations performed by > > > a chiropractor to determine the need for > > chiropractic > > > treatment of > > > neuro-musculoskeletal conditions shall include a > > > functional chiropractic > > > analysis... > > > > > > In a difficult case, particularly when your > > > clinical > > > documentation depicts findings of > > subluxation > > > and theadjustments that > > > you performed to correct them, I think most > > > peers would have no > > > === message truncated === > > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
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