Fwd: The Latest Newsletter from Gerry Clum

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The Latest Stuff from Gerry

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August 1, 2010

Volume 11

Number 3

In This Issue

Speak Now or Forever Hold Your Peace!

Executive Order 13520

Fall Tuition Announcements Are Out!

H.R. 1017

Foundation for Chiropractic Progress

An Update on Cervical Spine Adjusting and Vertebral Artery Issues

Life West Homecoming Scheduled for October 22-23, 2010

CA Board of Chiropractic Examiners to Propose an Informed Consent Regulation

ACC/NYCC Alumni Survey Closed!

"Free" Preventive Services Under Health Reform Plan

The Newest (old) Twist in Health Care Cost Control

www.bolenreport.com

Speak Now or Forever (not quite) Hold Your Peace!

The Council on Chiropractic Education (CCE) is seeking input and comment on the latest iteration of the revision of the Standards for Doctor of Chiropractic Programs now titled Council on Chiropractic Education, Accreditation Standards; Principles, Processes & Requirements for Accreditation.

The Standards as they exist today can be found at www.cce-usa.org. Click on "publications". The proposed revisions can be found at the same URL. On the opening page, there is a comment form for your use.

I have said this several times before, if you have ever complained about the CCE, now is your chance to offer your thoughts on the pending revisions and how you think the Standards should be expressed.

One area I found to be intriguing is on page iii, the Foreword, where the document proposes to accredit DCP (Doctor of Chiropractic Programs) or their equivalent--as determined by the CCE--this is "code" that will allow CCE to include Doctor of Chiropractic Medicine programs for example. There are many nuances throughout the pending document, read them carefully and thoroughly...the devil is in the details!

Executive Order 13520

On November 20, 2009, President Obama signed an Executive Order entitled "Reducing Improper Payments". This action was taken, in part, in response to the feedback of the Office of the Inspector General (OIG). One of the impacts of the order is that it expands the authorities and responsibilities of Medicare's Comprehensive Error Rate Testing (CERT) program. Subsequent to the release of the Executive Order, four areas were identified for closer evaluation under the CERT program these include:

*Power Wheelchairs,

*Inpatient Hospital Short Stays,

*Pressure Reducing Support Surfaces,

*Chiropractic Services

The interest in chiropractic services is not due to the overall cost of the service to the Medicare program, rather it is due to the overall error rate associated with claims under the program. The goal on the part of the Medicare program is to bring the error rate in each area under the average error rate of 12.4%. When you consider that Colorado has an error rate of 99.8%, we have a long way to go. It is important to note that 99.8% of chiropractors didn't get their claims wrong; 57% didn't send the records when they were requested. As a result, they were automatically deemed to be in error. Many practitioners, across all disciplines, think that an error in claims filing is fraud. It may be, but in the vast majority of cases, it isn't so. The CERT program does not and cannot label a claim fraudulent.

Record requests will begin to go out in August. The response window practitioners will be given will be 30 days as compared to 75 days as was the case in the past. The take-away from that bit of news is simple--if and when you get a request don't dawdle, get the records in on time or they will be automatically deficient.

Don't bother sending a response that you cannot comply with their request under the provisions of the Health Insurance Portability and Accountability Act (HIPAA). There are standing provisions in the HIPAA regulations that make such a request by an agency such as Medicare an exempt exchange of protected health information.

The profession has been working for years to try and bring these error rates down. Progress is being made. This will be an opportunity for even more ground to be gained in moving the profession below that triggering point of a 12.4% error rate. Remember a no-response on your part is a loss for the profession and will only cause these inquiries to stay active and increase in scope and frequency.

In the misery-loves-company category, take a minute or two and visit the following website: https://www.cms.gov/CERT/Downloads/CERT_Report.pdf This will give you a broader context for the CERT process, its goals and its procedures. While we may have our problems in this area, we are not alone. We are not even close to being a big dollar issue. Relatively speaking, our circumstances relative to complexity of filings are in the simple category in comparison to other players.

If you are contacted--don't delay, seek advice from trusted sources in this area, let your association know of the request and comply!

Fall Tuition Announcements Are Out!

Fall tuition announcements are a fact of life in my world. I am very pleased to report that the cost of a D.C. degree at Life West is about $20,000 less than at some other programs in the state and across the country. Life West has the most cost effective D.C. offering on the West coast and is vying for the least costly program in the country. Thinkaboudit...

H.R. 1017

The U.S. House of Representatives has passed H.R. 1017, requiring the US Department of Veterans Affairs to have doctors of chiropractic on staff at no fewer than 75 major VA medical centers before the end of 2011 and at all VA centers by the end of 2013. Similar legislation, S. 1204 urgently needs your Senator's support.

Legislation "To amend the Department of Veterans Affairs Health Care Programs Enhancement Act of 2001 to require the provision of chiropractic care and services to veterans at all Department of Veterans Affairs (DVA) medical centers," S.1204, was introduced in the US Senate on June 8, 2009 by Senator Patty Murray (D-WA). That legislation now needs chiropractic's immediate help.

Senator Murray has fought hard throughout her Congressional career for the nation's veterans and has also been a consistent supporter of chiropractic issues. Her initiative will help end an unfair disparity in the availability of chiropractic care for veterans at a time when the need for chiropractic services is most urgent. S.1204 sets a deadline of December 31, 2011 for full inclusion of chiropractic services at all DVA facilities. The bill is now before the Senate Committee on Veterans' Affairs, where Senator Murray serves as the third ranking Majority Member.

Please contact both of your U.S. Senators today and urge them to co-sponsor S.1204. The following are already co-sponsors of the bill Senators Begich (AK), Brownback (KS), Grassley (IA), Isakson (GA), Whitehouse (RI), Brown (OH), Burris (IL), Harkin (IA), and Lincoln (AR). If they already co-sponsor the bill, please thank them. Do it, today!!

Foundation for Chiropractic Progress

The Foundation is ramping up for the busy Fall convention beginning with the end-of-summer Florida Chiropractic Association convention in Orlando in late August. There are a number of exciting activities underway including a contributor thank-you event...for every dollar a DC or chiropractic student donates to the Foundation between January 1, 2010 through January 15, 2010, they will receive a chance in a raffle for a 2011 Ford Mustang convertible on a two-year lease. For more information, visit: http://www.foundation4cp.com/pledge.php

We are looking forward to welcoming General Becky Halstead (Ret.) to our campus in October. This will be the General's first visit to our campus and we are very excited about her upcoming visit.

The Foundation will be running a number of regional ads in national publications...you can buy an ad in USA Today, for example, that runs in one part of the country...using this strategy, the Foundation has been able to magnify its presence with strategic buys across the country...very smart and very savvy.

An Update on Cervical Spine Adjusting and Vertebral Artery Issues...

This input comes by way of the physical therapy community ( and Kerry, University of Nottingham) and was published in the International Journal of Osteopathic Medicine in an article entitled: "A 'system based' approach to risk assessment of the cervical spine prior to manual therapy." (IJOM 2010:1-9)

One area and Kerry review carefully is the use of provocative testing, such as 's Test, to evaluate the functional capacity of the vertebral arteries. In chiropractic circles, the abandonment of these procedures has been recommended for the better part of a decade. These authors are now adding their caution with respect to these approaches.

"...the functional position tests have poor diagnostic utility, i.e. a positive test response does not necessarily mean that the condition (VBI) exists and a negative test response does not necessarily mean the condition does not exist."

These authors also offer a useful classification of patient symptoms that maybe related to VBI that is worthy of our consideration. They have grouped symptoms associated with a dissection in two categories, non-ischemic and ischemic. It is a simple distinction, but one I have never seen so clearly expressed. For example, they have classified ipsilateral posterior neck pain and occipital headache as being non-ischemic and local; that is, these problems are produced by the dissection itself as opposed to the ischemic events (dizziness, diplopia, drop attacks, dysarthria, dysphagia, nausea, numbness, nystagmus, ataxia, etc.) themselves that are the secondary results of the local problem. The next step in their reasoning is that the non-ischemic symptoms may precede the ischemic symptoms and as such offer a clue of what is going on for that patient.

Emphasis is placed on the type of headache the patient presents with as well as the feedback from the patient that this particular headache is "unlike any they have ever experienced". This unique headache characteristic is one of the most useful bits of information a patient can provide you and also one of the most useful pieces of clinical data to be explored fully. This is as close to an "early warning system" as we are likely to get for the arterially compromised patient.

They also discuss a questionnaire approach that may have some utility...the approach seeks feedback as it relates to patient position in real life. They accomplish this by asking the patient about 12 different symptoms (headaches, dizziness, drop attacks, ringing in the ears, numbness around the mouth, etc.) as they relate to the avoidance of three physical states (looking up as into an overhead cabinet, looking over your left shoulder as if backing out of the driveway, looking over your right shoulder as if backing out of the driveway). Any "yes" answer was considered a positive finding. Their data suggests that this questionnaire approach when compared to the Doppler ultrasound approach is more specific and more sensitive for potential arterial problems. ( EG, Houle S, A, San Lucas S, Papa D. Relationship between the duplex Doppler ultrasound and a questionnaire screening for positional tolerance of the cervical spine in subjects with suspected vascular pathology: a case series pilot study. J Man Manipulative Ther 2007;15:225-30.)

Life West Homecoming Scheduled for October 22-23, 2010

Life West's annual alumni gathering has been set for late October this year. In addition to welcoming back alums from over the years, the College will be celebrating 10 years at our present campus site! Hard to believe...not that we are celebrating, but that a decade has passed!

We will also be formally unveiling the College's new "Fitness Center" on campus. The new, 2,500 square feet facility will have been in use for a few weeks by that time, but we are going to act like no one has ever set a foot on a treadmill until that day! If you are a Life West alum who asked for this facility along the way, you will be pleased to know that those who have followed you will have the benefit of this amenity. We are seeking a donor who would like to have the Fitness Center named in their honor...if you are feeling particularly generous or in a mood to consider your legacy, please call Ms. Cheryl Nickerson at 510.780.4500, ext. 2400. She can fill you in on the details.

If you would like more information about the Homecoming festivities please call at 510.780.4500, x 2420. The website for Festival 2010 will be available soon. www.lifewest.org/Festival2010.htm Please check back for details and registration information.

California Board of Chiropractic Examiners to Propose an Informed Consent Regulation

On July 29, 2010, the CBCE indicated that they would be developing a regulation addressing the use of informed consent in chiropractic practice in California. The goal is to develop a reg calling for the use of the procedure, but they have no intention of defining the specific language that the consent should include.

The Association of Chiropractic Colleges developed a guideline on the subject of informed consent that can be accessed at the ACC website at www.chirocolleges.org. On the left-hand side, click on "Policies" and then Informed Consent Guideline to learn more about the ACC position.

At the same meeting, the Board voted to proceed with the proposed regulatory change related to continuing education...essentially the requirement would double if the regulation is passed by the Office of Administrative Law...they have been there before with a version of this regulation and had it returned to them as being in an unacceptable form, time will tell if it will fly this time.

ACC/NYCC Alumni Survey Closed!

The ACC/NYCC 2010 survey of three, five and seven-year alumni of participating chiropractic colleges closed recently. Now the folks at NYCC are in the "heavy lifting" phase of reviewing the data and developing the reports to go back to the participating institutions.

Since the inception of the survey, in 2005, Life West alums have been engaged in this survey. Life West, Life University and New York Chiropractic College were the original programs to participate in this effort. Our alums have given the College high marks and, in fact, based on our analysis of the data, we have placed number one on this survey for 2007, 2008 and 2009!

The 2010 data and our placement will be known within the College. A new requirement for participation in this survey prohibits us from using the information in any public manner. We agreed to this restriction, under protest, because we felt the data should be available for a program to use as it sees fit. That being said, the data is valuable to the College even on a restricted use basis.

"Free" Preventive Services Under Health Reform Plan Begin on September 23

In July, the Department of Health and Human Services (DHHS) finalized rules for the implementation of the "free preventive services" under the health care reform measures passed in March of this year. As of September 23, consumers with new health plans or policies will not be required to make any co-payment, coinsurance or deductible for services such as colonoscopy, mammograms, well-child visits, immunizations, cholesterol screening, depression screening, obesity counseling, tobacco and alcohol counseling, etc. The change covers smoking cessation counseling, but it would not cover the cost of nicotine patches for smoking cessation for example.

This change in coverage does not affect existing plans unless the plan makes "substantive changes". In this situation, these changes would trigger the inclusion of the no-cost-to-consumer coverage.

The Newest (old) Twist in Health Care Cost Control

Employers across the country are being offered plans for their employees that drastically limit the providers the insured can see. The return is about a 15% reduction in overall premium costs; the downside is less choice for the insured unless he or she wants to reach a little deeper into their own pockets.

If this sounds familiar, it is because it should as this is the approach that the Clinton administration floated in the mid-1990s. This was one of the nails that Harry and Louise drove into the coffin of ClintonCare. That was then, this is now and the economics of the matter have gotten far tighter and more serious. What was once a fatal element of a plan is now being welcomed as an answer to escalating costs. A recent New York Times article quoted a southern California employer as commenting, "What this does is it eliminates the Gucci doctors". In the case of this employer, his workers can no longer access providers at Scripps Health system in San Diego.

www.bolenreport.com

If you have a few minutes and you are old enough to have been around during the heyday of Barrett, you might find a visit to this website interesting. Barrett, a prolific writer and owner/operator of all sorts of websites that express serious concerns about us and our ilk, is being taken to task for his efforts. Mr. Bolen suggests they may be auctioning off old Steve's furniture before his legal woes are over. Barrett's anti-chiropractic rhetoric and similar commentary for other forms of alternative care appears to be coming back a generation later to bite him in the butt.

While I never wish misfortune on anyone, I must admit I took a degree of enjoyment in reading the rants in all directions. Grist for the mill. The best part about this discussion is that most chiropractors today will say, " who?"

Happy Birthday Cassie! August 6!

Life Chiropractic College West

25001 Industrial Blvd.

Hayward, California 94545

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The Latest Stuff from Gerry is a FREE newsletter from Dr. Gerry Clum, President of Life Chiropractic College West (http://www.lifewest.edu). The Latest Stuff from Gerry keeps you in the know by giving you a brief summary of the news and events of importance to your practice, your patients, and your family.

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Life Chiropractic College West | 25001 Industrial Blvd. | Hayward | CA | 94545