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HEALTHBEAT SHOW NOTES .... Episode #21 - Recorded December 2, 2005

In this week’s news:  We’ll Look At -

• Doctors Objecting to Planned Cut in Medicare Fees

• Life Gets CCE Accreditation

• NJ Contacts Aetna

• Senate Passes IT Legislation

• Whiplash Injuries and Patterns of Care

• HIPAA Comment Period Lengthened

• Chiropractic Is Cost-Effective in Treating Chronic Back Pain

• .... and in this edition of HealthBeat’s Health Corner, a very special Interview with Dr. L. John Faye

For HealthBeat, This is Dr. Todd Eglow.

Welcome to HealthBeat Podcast #21, recorded December 2, 2005.  HealthBeat is Chiropractic OnLine Today’s radio program, providing current news and commentary about Chiropractic and Health. 

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RSS Info – In this edition of HealthBeat, we discuss Reduction in Medicare Fees, Life Chiropractic College, Aetna Insurance, US Information Technology Legislation, Whiplash Injuries, HIPAA Comment Period, Cost Effectiveness of Chiropractic Treatment, and a Very Special Chiropractic Corner Interview with Dr. L. John Faye.

For information about adding Personalized HealthBeat Podcasts to your office’s Web Site, to help you attract new patients, please Email us at – healthbeat@chiropracticradio.com

Doctors Objecting to Planned Cut in Medicare Fees

The Bush administration is headed for a clash with the nation's doctors over a federal plan to cut their Medicare fees by 4.4 percent next year, even as the government tries to measure the quality of care they provide.

Doctors say that if the cut occurs, some physicians will be less willing to accept new Medicare patients.

Administration officials said that on Monday they would publish a final rule cutting 4.4 percent from the amount paid to doctors for each service provided to Medicare patients in 2006. They said the cut was required by a formula in the Medicare law. But doctors pointed out that President Bush had not proposed any specific legislation to avert the cut.

In a report to Congress in April, Medicare's trustees said the formula would produce cuts totaling roughly 25 percent from 2006 to 2011, while doctors' costs are expected to rise 15 percent.

For more information, surf to the NYTimes.com - http://www.nytimes.com/2005/11/20/national/20docs.html

Life Gets CCE Accreditation

Life University has received full accreditation from The Council on Chiropractic Education’s (CCE) Commission on Accreditation effective November 21, 2005. An announcement placed on the CCE website stated: The Council on Chiropractic Education Commission on Accreditation held a meeting on November 12, 2005 in Phoenix , Arizona . The following Accreditation actions were taken: Accreditation of Life University College of Chiropractic, Doctor of Chiropractic Program; Marietta , GA.

According to the CCE website, Life University will not have its next regularly scheduled comprehensive evaluation site visit for 7 years until the fall of 2012.  The CCE website also curiously states: "Continuously accredited since: June 1985" in the listing for Life University .

This concludes a saga that has seen many changes at Life University including the removal of it’s founder, Dr. Sid Williams, the loss of 80% of it’s student population, a successful injunction against CCE to retain accreditation, and three presidential changes concluding with the appointment of Dr. Guy Riekeman as the latest president.

The school has been growing over the past year and has just once again gone over the 1000 mark in the DC enrollment. 

For a copy of the CCE’s statement, please surf to our Web Site at www.cce-usa.org

http://www.cce-usa.org/2005-11-21%20COA%20Announcement%20Nov%202005%20Mtg.pdf

NJ Contacts Aetna

According to the NJ Group, the ANJC, Aetna Insurance Company has released to its participating providers an amended fee schedule of reimbursement rates which substantially reduce reimbursement for chiropractic manipulative treatment modalities while increasing reimbursement for other services. 

Aetna ’s new fee schedule is directly linked to 2005 Medicare / Medicaid reimbursement levels.  Though Aetna ’s initial notification regarding the fee schedule amendments indicated that most physicians would see an aggregate net increase in reimbursement rates, chiropractic physicians were not a member of the class of providers who obtained an increase with the amendments.  Rather, reimbursement for chiropractic manipulative treatment services was reduced approximately 20% from the Medicare / Medicaid values.  In contrast, Evaluation and Management Codes which are utilized primarily by allopathic physicians, received significant fee increases, in some instances in excess of 100%.       

The ANJC is taking action by initiating contact with Aetna’s senior vice president of network and provider services to make Aetna aware of the discriminatory reimbursement in its new fee schedule as it applies to chiropractic physicians and demanding a change.  If Aetna is not willing to participate in meaningful conversations with us, the ANJC Board of Directors will determine what further action is warranted to protect the chiropractors of New Jersey .

For more information, contact the ANJC at www.anjc.info

Senate Passes IT Legislation

The U.S. Senate has passed legislation to promote interoperable health care information technology and provide $280 million in financial assistance over two years to providers and regional I.T. networks. The legislation, S. 1418, passed by unanimous consent without a formal floor vote and now moves to the House.

The legislation would authorize in statute the Office of the National Coordinator for Health Information Technology--established under a presidential executive order--and requires federal health I.T. purchases to conform to data standards that promote quality and interoperability. The bill also establishes an advisory body to the Department of Health and Human Services, and procedures to develop data standards and establish an I.T. certification program. In all these areas, the government and/or private sector already have acted, so the bill would essentially endorse and support those efforts.

The legislation also requires a study of the barriers that physician licensure requirements pose to increased use of telemedicine and other I.T. applications.

For more information, surf to the US congressional Web site, http://thomas.loc.gov

For more information about the Health and Human Services effort to promote IT and Healthcare, surf to - http://hhs.gov/healthit/

Whiplash Injuries and Patterns of Care

A study from the October 24, 2005 issue of the Archives of Internal Medicine looked at Initial Patterns of Clinical Care and Recovery From Whiplash Injuries.

Little is known about the most effective pattern of clinical care for acute whiplash. The Authors designed a cohort study to determine whether patterns of early clinical care (involving visits to general practitioners, chiropractors, or specialists) were associated with different rates of recovery.

The study looked at 2486 Saskatchewan adults with whiplash injuries and 8 initial patterns of care that integrated type of provider and number of visits.

The results of the study found that there was an independent association between the type and intensity of initial clinical care and time to recovery.  It was  found that patients in the low-utilization general practitioner group had the fastest recovery, even after controlling for injury severity and other confounders.

Compared with this group, the high-utilization general practitioner group experienced a 1-year rate of recovery that was 27% slower ; for the high-utilization chiropractic group it was 39% slower; for the high-utilization general practitioner plus chiropractic combined group it was 28%; and for those who consulted general practitioners and specialists, it was 31% slower.

The study concluded that the type and intensity of clinical care initiated within the first month after the injury is associated with the rate of recovery from whiplash injuries. The study did not support the hypothesis that early aggressive care promotes faster recovery.

For more information, surf to the October 24th issue of the Archives of Internal Medicine.   October 24, 2005; Vol. 165, No. 19, pp. 2257-2263.

As a follow up, the FCER sent out an eNewsletter with the following commentary from Dr. Anthony L. Rosner, PhD, LLD (Hons):

The implication of this study is that both medical doctors and chiropractors should avoid over-treatment of their whiplash patients in the early stages of therapy. This is deduced by measuring the times to recovery by measuring the number of days between the date of injury and the date which corresponds to the closure of the insurance claim. For those patients experiencing greater than 2 visits to the general practitioner or 6 visits to the chiropractor within the first 30 days following a traffic collision, times to recovery are significantly longer. The implication is that physicians who promote frequent visits may be encouraging patients to cope passively with their pain, promoting illness behavior and leading them to demand still more clinical care.

What remains unanswered is whether the claims closure process truly represents meaningful patient recovery, despite the fact that it is described as a negotiated process between the healthcare provider, insurer, and claimant. Does it truly represent a return to a patient's well-being and functionality with some relationship to how the patient was faring prior to the accident?

Furthermore, there seem to be some variances in severity in the baseline such that patients in the low-utilization chiropractic group clearly reported less severe injuries, while patients in the low-utilization general practitioner cohort had less severe injuries than those in the high-utilization general practitioner group?with or without chiropractic services.

With these initial differences, one could propose a foregone conclusion in that treatments might be expected to be less intensive and less frequent with those patients checking in with the less severe symptoms. Under these circumstances, it would seem premature to assume that the delayed claim closure with extended care is itself a factor which prolongs medical or chiropractic care even further.

HIPAA Comment Period Lengthened

The Centers for Medicare and Medicaid Services, the CMS, granted a 60-day extension on the comment period for the proposed HIPAA claims attachments rule. Published Sept. 23, the rule’s original Nov. 22 deadline for submitting comments is now moved to Jan. 23.

“Due to the very technical nature of this rule, the industry is asking for additional time to conduct a more comprehensive and thorough review in order to provide comments to the standards development organizations as well as to CMS,” the agency said in a notice published Nov. 22 in the Federal Register.

The notice is available at gpoaccess.gov/fr/index.html

Chiropractic Is Cost-Effective in Treating Chronic Back Pain

According to the American Chiropractic Association, the ACA, a new study finds that chiropractic and medical care
have comparable costs for treating chronic low-back pain, with chiropractic care producing significantly better outcomes.

A group of chronic low-back patients who underwent chiropractic treatment showed higher pain relief and satisfaction with the care and lower disability scores than a group that underwent medical care, according to an October 2005 study in the Journal of Manipulative and Physiological Therapeutics (JMPT).

Although several cost-effectiveness studies outside the United States have favorably compared chiropractic to medical care, this new study is one of the first to compare low-back treatment costs and outcomes within the structure of the American health care system.  

In the United States alone, back pain associated costs are estimated to reach $48 billion for 2005, and, at any given time, 80 percent of the U.S. population suffers from back pain – statistics that make this study especially pertinent, according to the authors.

The study involved 2780 patients with mechanical low-back pain who referred themselves to 60 doctors of chiropractic and 111 medical doctors in 64 general practice community clinics in Oregon and one in Vancouver , Wa .

Chiropractic care included spinal manipulation, physical therapies, an exercise plan, and self-care patient education. Medical care consisted of prescription drugs, an exercise plan, self- care advice, and a referral to a physical therapist (in approximately 25 percent of cases). The costs of treatment and patients’ pain, disability, and satisfaction with their health care were assessed at 3 and 12 months after the initial visit to the doctor.

The office costs alone for chiropractic treatment of low-back pain were higher than for medical care. However, when costs of advanced imaging and referral to physical therapists and other providers were added, chiropractic care costs for chronic patients were 16 percent lower than medical care costs. The differences between medical and chiropractic total costs were not statistically significant for acute or chronic patients. The study did not include over-the-counter drug, hospitalization, or surgical costs.

Both acute and chronic patients showed better outcomes in pain and disability reduction and higher satisfaction with their care after undergoing chiropractic treatment. The advantage of chiropractic care was clinically significant in the chronic patient group at 3 months’ follow-up, but smaller in the acute group. Improvements in patients’ physical and mental health were comparable in both the chiropractic and the medical group, with the exception of physical health scores in the acute patients in the chiropractic group, which showed an advantage over the medical group.

The authors of the study concluded that -  “With their mission to increase value and respond to patient preferences, health care organizations and policy makers need to reevaluate the appropriateness of chiropractic as a treatment option for low-back  pain.”

For more information, surf to our Show Notes for a link to the Abstract for this study - http://www2.us.elsevierhealth.com/inst/serve?action=searchDB&searchDBfor=art&artType=abs&id=as0161475405002277&nav=abs

As always, please surf to our Podcast Show Notes at ChiropractiRadio.com for a full listing of web references mentioned in today’s show.

Welcome to Chiropractic OnLine Today’s Healthbeat Podcasts.  This is Dr. Todd Eglow.  HealthBeat is Chiropractic OnLine Today’s radio program, providing current news and commentary about Chiropractic and Health.  HealthBeat Podcasts can be accessed via iTunes or other portable interfaces.  For Subscription information, surf to our web site at www.ChiropracticRadio.com.

In this edition of HealthBeat’s Chiropractic Corner, we interview Dr. L. John Faye.  Dr. Faye has been educating Chiropractors and promoting Chiropractic for over 30 years.  In this interview, we discuss Dr. Faye’s background and his continued desire to promote science within the Chiropractic Profession.
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"A rumor without a leg to stand on will get around some other way."

-  John Tudor

For Chiropractic OnLine Today’s HealthBeat, This is Dr. Todd Eglow.

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