Track and Field event today in Lakewood NJ

Today I attended a track and field event in Lakewood NJ. As many of you know, I am the medical director for USATF NJ and I am responsible for chiropractic coverage for their sponsored events. This event today featured athletes 18 and under. I was mentoring a chiropractor from southern NJ, Fred Mayer DC who had never attended one of these events before. Together, we saw a number of competitors who needed help and he learned about the different types of events and what to look for when runners are having problems. I will be attending additional events toward the end of February, 2010

Patients in Medicare Demonstration Project Give Chiropractors High Marks

For those who are in Medicare or are about to be enrolled, this is a great thing.  The history of chiropractic inclusion in Medicare is that the limited benefit was negotiated in the 1970's before chiropractic had the widespread acceptance it has now as the top complementary health care profession in the country, if not the world.  It is safe, effective and cost effective and studies support these statements.  Unfortunately, in Medicare, chiropractic is only covered for manipulation and nothing else.  Seniors are required to pay for their own evaluations, x rays and therapies done even though these procedures are paid for when they visit other providers.  Many seniors value chiropractic as the best way to limit their exposure to harmful medications and stay out of pain and active.

Two years ago, after much chiropractic lobbying, Medicare was forced to create a chiropractic demonstration project in a few markets.  The purpose of this was to see if chiropractic would add to the cost, lower the cost or be budget neutral.  The good news is that chiropractic in most areas was chosen instead of other interventions without higher costs and the better news was the level of satisfaction most seniors reported.

What this all means - The American Chiropractic Assn.  now has an opportunity to change the Medicare problem forever which means if you are enrolled in Medicare, you will be covered for everything just as you are when you visit other doctors and it will end the discrimination against chiropractic patients under Medicare.  This is in the public's best interests and they should have the right to choose chiropractic as their intervention for their health care issues.

If you have seen the nonsense that went on as health care debated, you should realize that full inclusion for chiropractic is an uphill battle.  Last night pres Obama scolded congress for not doing their job and he is right. They are not there to get elected.  They are there to pass laws to help you and I.  Hopefully, chiropractic will be finally fully covered.

Here is the ACA press release for your reading

Patients in Medicare Demonstration Project Give Chiropractors High Marks

According to long-awaited results from a congressionally mandated pilot project testing the feasibility of expanding chiropractic services in the Medicare program, patients have a high rate of satisfaction with the care they receive from doctors of chiropractic.

When asked to rate their satisfaction on a 10-point scale, 87 percent of patients in the study gave their doctor of chiropractic a level of 8 or higher. What’s more, 56 percent of those patients rated their chiropractor with a perfect 10.

Contributing to that satisfaction was the attention given to patients’ needs and the accessibility of chiropractic care. Patients reported that doctors of chiropractic listened to them carefully and spent sufficient time with them. Some 95 percent said they had to wait no longer than one week for appointments.

“Doctors of chiropractic everywhere should feel pride in these patient satisfaction results and in being part of a profession that still sees the great need for spending time with patients and truly listening to them,” said Dr. Rick McMichael, president of the American Chiropractic Association (ACA). “It’s clear that patients deeply value the time their chiropractic providers spend with them and the expert care that DCs offer.”   

The pilot, known as a “demonstration project” in Congress, was conducted from April 2005 to March 2007 throughout the states of Maine and New Mexico, and also in Scott County, Iowa, 26 counties comprising the Chicago metropolitan area, and 17 counties in central Virginia.

Current chiropractic coverage under Medicare is limited to spinal manipulation. Under the demonstration project, however, chiropractic care was expanded to include diagnostic and other services, such as X-rays, examinations, physical therapy and rehabilitation services. 

The final report to Congress also includes information on the costs of expanding chiropractic services in the demonstration sites. The report indicates that in all but one of the demonstration sites, patients’ health care costs were not significantly changed by expanding coverage of chiropractic services.  In contrast, a cost increase was found in the Chicago metropolitan area. Further research into the reasons why the results in Chicago differ from the rest of the demonstration project sites is needed to better understand these findings.

“We already know that Medicare costs in general tend to be higher in Chicago than other similar areas of the country. We must find the underlying cause of the cost difference found in the chiropractic demonstration project and determine whether it had anything at all to do with the expansion of chiropractic services,” Dr. McMichael noted.  

To further analyze the results of the demonstration project, ACA is creating a taskforce of Medicare experts and researchers who will review the report and develop a response for the

Centers of Medicare and Medicaid Services.

To view the report online, visit www.acatoday.org/pdf/demo_report.pdf.

Signing of the Chiropractic Practice Act for New Jersey

I just received word that we should have our scope of practice signed into law by Gov Corzine today.  It has been a long road to get to this point. Stay tuned for more stuff.

Chiropractor in NJ have a new scope of practice finally

Five years in the making to get our legislature to approve a new chiropractic scope of practice bill. We had many people who did not want this to happen, even though our previous scope has not been changed since 1953 and was antiquated and one of the worst in the nation. With the new scope of practice (parameters under which I can function as a chiropractor), I can now fully council patients on nutrition (before I had my hands tied), perform extremity work without relating it to the spine (I was fined years ago for those semantics) and practice the way most chiropractors are taught to in school. The bill also has continuing education requirements that were not required previously, although I had to get continuing ed for my sports certification. This one requirement is necessary to protect the public and to improve the chiropractor. Check out this press release:

Bill expands what New Jersey's chiropractors can do

By BEN LEACH Staff Writer | Posted: Tuesday, January 12, 2010 | Press of AC

Chiropractors in New Jersey are going beyond the back.

Thanks to a measure that passed in both the state Senate and Assembly on Monday, state-licensed chiropractors would be able to treat extremities, prescribe medical tests and give nutritional advice as well as sell nutritional supplements in their offices.

The bill brings New Jersey in line with many other states that have similar regulations.

For example, under New Jersey’s current standards, a chiropractor can treat problems in the extremities such as hands and feet only if they directly relate to problems in the spine, according to Dr. James P. Farrell, a chiropractic physician at Farrell Chiropractic and Rehabilitation in Cape May Court House.

“If someone came into my office with carpal tunnel syndrome, I would have to relate it to the spine or I couldn’t treat it,” Farrell said.

Farrell explained that patients such as athletes, who might need immediate treatment, would be in a difficult position if the injury they sustained wasn’t along the spine.

“There’s only so much time in the day to be writing notes to the insurance companies,” Farrell said.

Farrell said today’s chiropractors are trained to treat beyond the spine, and that includes giving nutrition advice to their patients.

“It brings us into the 21st century,” said Dr. Robert Olivieri, a chiropractic orthopedist at Olivieri Chiropractic and Rehabilitation Center in Rio Grande.

Olivieri said chiropractors are trained to consult patients about nutrition — for example, skeletal pain might not be the result of an injury; it could be related to a vitamin D deficiency, which can lead to bone problems such as rickets and osteomalacia.

Under the new legislation, chiropractors still would not be able to write prescriptions for medications, but they would be able to recommend them.

“Your body’s not lacking Lipitor,” Olivieri said. “But it might be lacking in vitamin D.”

Some opponents of the legislation argued that since chiropractors could sell nutritional supplements in their offices, it could create a conflict of interest.

“We prohibit physicians from selling prescription drugs because if they sell they have a profit motive,” said Assemblyman Sam Thompson, R-Monmouth. “The same would apply to chiropractors.”

Local chiropractors disagree with that argument.

“We sell pillows and other supplies in our practice, and no one has said anything against that,” Farrell said.

Another argument some legislators presented against the bill was one concerning a chiropractor’s ability to perform pre-employment screenings, since they could apply to conditions related to the brain or heart and not to injuries or the spine.

Farrell said that chiropractors are more qualified to give the screenings than nurse practitioners who are currently allowed to give the same pre-employment screenings in the state.

While the bill expands the definition of a chiropractor’s duties in New Jersey, it also requires chiropractors to participate in continuing education programs.

Chiropractors have to complete 30 additional credits of annual training, while those who want to give out nutritional advice must participate in 45 hours in a nutritional study program.

The Assembly passed the bill 64-4 with eight people declining to vote. The Senate voted 23-11. Gov. Jon S. Corzine has to sign the bill for it to become law.

2009 was a tough year for many people. It looks like things in NJ are about to improve markedly for chiropractors and the patients they treat

Horizon Blue Cross Blue Shield must pay for all chiropractic services

For many years, Horizon Blue Cross Blue Shield has not paid for chiropractic evaluations on their patients and the other services practically all insurance carriers provide. A few years ago, they also reduced chiropractic reimbursements by over 30 percent as well making chiropractors suffer financially. Many, like myself would basically eat the cost of evaluations and the time we spent because of our ethos (chiropractors are all about the patients they serve). A couple of years ago, we had no choice but to charge our patients for their examinations since their policies, combined with other carriers may have made being a practicing chiropractor financially impossible.

On October 7th, 2009, an administrative action we had taken a number of years ago had finally found by the Department of Banking and Insurance ( DOBI) that they had indeed abused their stature and that they must now cover all services performed by chiropractors.

On 1/15/10, all chiropractors will receive the following letter

Horizon Letter:

January 15, 2010

Dear Chiropractor:

Pursuant to the New Jersey Department of Banking and Insurance (DOBI) Decision and

Order pertaining to Order Number A09-113, Horizon Blue Cross Blue Shield of New Jersey

is revising our policy regarding the consideration of Evaluation and Management (E&M)

services and physical therapy modalities for reimbursement separate from the reimbursement

of Chiropractic Manipulative Therapy (CMT) codes.

Horizon BCBSNJ is in the process of implementing Order Number A09-113, which requires

that we evaluate whether E&M and/or physical therapy modality services billed by you are

separately compensable from the CMT and other services billed by you.

Horizon BCBSNJ will engage the services of an external vendor to help us implement this

Order. We will advise you of further details regarding this vendor in the next 30 days.

Our goal is to implement this Order with the least amount of administrative burden and/or

inconvenience to your office and to our members.

Please be advised that any claims that have been processed for dates of service on or after

October 7, 2009 that are not in compliance with this Order, as well as any appeals that have

been received by Horizon BCBSNJ relating to dates of service on or after October 7, 2009,

will be evaluated for consideration within the next 90 days. Any additional reimbursement

amounts will be paid with interest, in accordance with New Jersey Law, based upon the

receipt date of the original claim.

The evaluation of E&M services and physical therapy modalities may require the submission

of portions of your patients’ medical records to support the appropriateness of the services

being billed.

Further communications outlining the details will be forthcoming.

Sincerely,

James F. Albano - Vice President

Healthcare Services

Of course, there was no apology since they clearly knew what they did over the years was wrong. In the end, justice was served for the chiropractic profession and the patients they treat. Perhaps now, I can afford to replace my worn carpeting and touch up the trim in my office.

Dr. C