NCLC Conference Addresses New Legislative Agenda
The American Chiropractic Association (ACA) released a new legislative agenda for 2003 and presented important chiropractic issues at ACA’s National Chiropractic Legislative Conference (NCLC) March 5–8 in Washington. The new agenda emphasizes working out details and implementation plans for recently passed legislation concerning chiropractic integration into the Department of Defense, the Department of Veterans Affairs, and the National Health Service Corps. The agenda also addresses several less-resolved issues including the passage of Medicare legislation based on House Resolution 902, which was introduced in the 107th Congress by then-Representative Wes Watkins (R-Okla) at ACA’s request. The Medicare legislation would allow doctors of chiropractic to be reimbursed for any existing Medicare-covered service that they are licensed to provide under state law. This year’s NCLC marked the first time that two presidential cabinet members attended the conference. Secretary of Veteran’s Affairs Anthony Principi and Health and Human Services Secretary Tommy Thompson both made positive comments about the contributions that doctors of chiropractic make to the nation’s health care system. Thompson called chiropractic a “smart investment” and pointed to prevention and exercise as ways of “changing the direction of health care in America.” Because implementation of the new chiropractic benefit for America’s veterans is one of ACA’s biggest tasks at hand, ACA welcomed Principi to NCLC. Principi discussed the makeup of the chiropractic advisory committee that is charged with developing recommendations for how the benefit will be provided for veterans. Principi stated he would consider any recommendation from the chiropractic advisory committee, including direct access to chiropractic care. He also stated that he is glad the chiropractic profession has joined the Veterans Administration. Following Principi’s address, ACA President Daryl D. Wills, DC, presented him with ACA’s “Patient Champion Award.” In addition to the appearances from Principi and Thompson, Senator Norm Coleman (R-Minn), Senator Tom Harkin (D-Iowa), Senator Arlen Specter (R-Pa), Representative Bob Filner (D-Calif), Representative Chris Chocola (R-Ind), and Representative Jim Ramstad (R-Minn) attended the conference. |
Pediatric Subluxation Theory Confirmed by Medical Doctors
A recent study in the February 2003 issue of Neurosurgical Focus1 supports various chiropractic models for traumatic subluxation in children. It showed medical doctors have begun to realize atlanto-occipital dislocations can occur in children from trauma.
The study reviews anterior and posterior dislocations, and longitudinal dislocations of the occiput on the atlas. The formation of the dislocations discussed in the paper is similar to chiropractic subluxation theory.
“Because ligaments in the child are growing and undergoing considerable remodeling, the capacity for repair is greater in the musculoskeletally immature child than in the adult,” the study reports. “Infants and toddlers have a different bone composition compared with older children, and also have a higher propensity to heal a ligamentous injury.”
Chiropractic has known that atlantooccipital subluxation among others can be induced by trauma, including birth, and that atlantooccipital subluxations as well as atlantoaxial subluxations can influence a child’s chances for life or death. Birth trauma by use of vacuums and forceps, and inutero constraints have also been known to induce subluxation. Until the recent study, these conditions recognized in chiropractic had been ignored by the medical profession, unless overt symptomology was present.
Chiropractors Face Billing Errors
Doctors of chiropractic in Florida and Ohio are working to resolve claim payment errors. Errors include the deduction of double co-pays and bundled independent billable codes. Other errors centered on the bundling of physical therapy/manual therapy with chiropractic manipulative therapy (CMT) codes—CPT code #97112 neuromuscular reeducation and CPT code #97140 for manual therapy.
The Florida Chiropractic Association, the Ohio State Chiropractic Association, and the American Chiropractic Association are working together to identify and solve the reimbursement errors. United Healthcare (UHC) was responsive to the concerns, as National UHC officials have identified all co-pay claims that have been processed in error. Payment will be made within the next 34 weeks. Denials for physical therapy services will need to be resubmitted, however, doctors will not have to file an appeal or resubmit any claims.
To reduce future claim payment errors, chiropractors can include modifier ‘-59’ when billing manual therapy, CPT code #97140.
COA Reaffirms Accreditation
Reaffirmation of accreditation has been granted to Life Chiropractic College West for a period of 8 years by the Commission on Accreditation (COA) of the Council on Chiropractic Education (CCE).
The reaffirmation represents the last step in a 2-year process that involved a detailed institutional self-study and an onsite 4-day, six-person accreditation review.
“Life West’s latest CCE reaffirmation of accreditation acknowledges our continued commitment to providing an outstanding chiropractic educational experience for our students,” said Life West President Gerard W. Clum, DC.
The reaffirmation process was a routine re-evaluation conducted by the agency. Life West has held status with the CCE since 1983 and was last reaffirmed in 1995.
Chiropractic Bill Loses Votes
According to the Associated Press, the South Dakota House turned down a bill that would have raised chiropractors’ reimbursement. The bill required insurance companies to pay chiropractors the same amount as they pay physicians for the same services. Rising insurance premiums were cited as a reason to oppose the bill, which failed to pass with a 30–40 vote.
Patients’ Health Status Disclosed
Recent mishaps in protecting patient information emphasizes the importance of compliance with the Health Insurance Portability and Accountability Act (HIPAA) and ensuring confidentiality of patient records. In Morgantown, WV, three women alleged that their mental health records were taken by University Health Associates (UHA) clerk Timothy Poniewasz, who disclosed the information to others. The jury awarded a total of $2.3 million in damages, declaring UHA negligent, and ordered the hospital to pay roughly $750,000 in compensatory damages to each plaintiff. Poniewasz was fired after one of the women learned of the privacy violations and complained to the hospital. In another occurrence, Washington Hospital Center receptionist Tijuana Goldring was found guilty of divulging protected health information to a janitorial staffer’s coworkers. The DC Superior Court awarded John Doe, as the man had been referred to in court, $250,000 for damages relating to the release his confidential information. Doe claimed coworkers teased him at work upon learning through Goldring he was HIV positive. He also claimed that Medlantic, WHC’s owner, was in breach of confidential relationship and violated his right to privacy. The court found Medlantic liable for the breach of confidentiality claim, but ruled there was no legitimate invasion of privacy claim. Medlantic argued on appeal that Doe waited longer than 1 year to sue after he became aware that Goldring was the probably source of disclosing his information. Lastly, according to the New Orleans Times Picayune, a computer that contained thousands of names of individuals with AIDS and other sexually transmitted diseases was put up for sale as surplus. The computer, one of eight randomly selected from a consignment offered to state agencies, had been awaiting sale at the State of Kentucky’s surplus-property office, but never left the custody of state officials. The computers would have been offered to the public if they had remained unsold, the Times reported. The computer was traced to a health services agency that believed the computer’s hard drive had been erased. |
Timing Effects of HRT
According to a report in the winter issue of Menopausal Medicine, the timing of hormone replacement therapy (HRT) may be a key factor in whether HRT can slow heart vessel disease. Researchers from Wake Forest University Baptist Medical Center and Tufts-New England Medical Center stated that estrogen does help, depending on the right time to start therapy.
“Mounting evidence points to the conclusion that HRT can help prevent heart vessel disease—if the therapy begins around the time that the body stops making its own estrogen,” said Thomas B. Clarkson, DVM, of Wake Forest. “The question may not be if estrogen helps, but when is the optimum time to begin therapy.”
Richard H. Karas, MD, PhD, director of the preventive cardiology center at Tufts, along with Clarkson, a professor of comparative medicine, reviewed numerous studies of postmenopausal women and monkeys that evaluated the cardiovascular effects of HRT. The evaluated studies included the Women’s Health Initiative (WHI), which showed an increased risk of heart attacks in women taking HRT and led to recommendations that women should not begin HRT for the purpose of preventing the disease. They also reviewed trials of postmenopausal monkeys conducted at Wake Forest over the past 12 years.
According to Clarkson, the studies demonstrate that though HRT has beneficial effects in inhibiting the early stages of heart vessel disease, it also can have negative effects if initiated at older ages when some women have already developed the disease.
For years, doctors had prescribed HRT to prevent heart disease in postmenopausal women. Studies such as WHI question doctors’ treatment decisions, which were based on observational studies showing that women who took estrogen had fewer heart attacks.
Several possible explanations exist for the discordant findings between observational studies and WHI. Clarkson and Karas stated that one of main differences is the age of the patients studied—observation studies looked at women who began HRT at a relatively young age; WHI women averaged 63 years old when they began therapy.
Emphasizing that timing of HRT initiation significantly influences its potential for cardiovascular benefits or harm, Clarkson and Karas said the data they reviewed supports their theory that HRT may be able to maintain vessel health when it is initiated in younger women, without an advanced buildup of fatty deposits in their heart vessels. However, the treatment may be either ineffective or potentially harmful when it is given to older women with more advanced vessel disease.
Continuing Education Online
Doctors of chiropractic and other licensed professionals can now pursue continuing education programs and seminars through the Internet on TheCEU.com’s website, www.theceu. com. TheCEU.com is sponsored by National University of Health Sciences. The doctor of chiropractic degree program of National University of Health Sciences is accredited by the Commission on Accreditation of the Council on Chiropractic Education. Many states accept online CE credit hours at this time.
TheCEU.com offers the following four types of programs: 1) certificate courses of general interest that focus on unique and specific topics. Previous experience is not necessary to enroll; 2) certification programs that are adjunct academic online modules that allow students to learn required core material credited toward a 100-hour certification courset; 3) diplomate programs that are also adjunct academic modules that allow participants to acquire required core materials credited toward a more in-depth 300-hour diplomate course; and 4) academic curriculum, which includes classes for academic credit that can be used in bachelors, masters, or doctoral degree programs.
Free sample courses are available at www.theceu.com.
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