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HEALTHBEAT SHOW NOTES .... Episode #95 - Recorded May 4, 2007

Hello and welcome to this week’s edition of HealthBeat, Chiropractic OnLine Today’s Health, News and informational Podcast.

In this week’s news:  We’ll Look At –  

• Stress and Neurons

• Update to NJ Ruling Against Extremity Adjustments

• Court Decision Effects Durable Medical Equipment

• FCER Publishes Book on Evidence Based Chiropractic Practice

For HealthBeat, This is Dr. Todd Eglow.

Welcome to HealthBeat Podcast #95, recorded May 4, 2007.  HealthBeat is Chiropractic OnLine Today’s radio program, providing current news and commentary about Chiropractic and Health.

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And Now for some news ….

Stress and Neurons

A study recently published in the journal Neuroscience found that in rats, one acute exposure to psychosocial stress reduces both short- and long-term survival of newborn hippocampal neurons.

Stress is a predisposing factor for depression, and animal models have indicated that chronic stress in particular might have a role in the etiology of affective disorders by inhibiting neurogenesis in the hippocampal dentate gyrus.

However, whether acute stress also influences neurogenesis is unclear. The researchers exposed adult rats to the naturalistic experience of social defeat by allowing an intruder rat to enter the territory of a colony of rats including an aggressive dominant male, and determined the effects of a single, acute episode of this psychosocial stressor on the different stages of neurogenesis.

The authors found that this study revealed a temporal aspect to the effect of stress on neuronal survival. The authors speculate that a single exposure to stress may leave proliferation unaffected but render the hippocampal environment less supportive for the subsequent survival of the newborn neurons.

If this is indeed the case, future research may probe the possibility of manipulating the neuronal environment in order to promote the survival of new neurons after stress.

Surf to our Show Notes for a link to this article - http://www.nature.com/nrn/journal/v8/n5/full/nrn2138.html

Update to NJ Ruling Against Extremity Adjustments

As reported in COT HealthBeat Episode #94, a NJ state appellate court held in the case of Bedford v. Riello that extra-spinal adjustment of a joint outside the spinal column is outside of the scope of chiropractic practice in New Jersey. 

The NJ group, the ANJC provided notification of this decision as well as answers to frequently asked questions in a prior communication.  However, numerous questions have been directed to ANJC headquarters which prompted response to some of the most asked questions. 

QUESTION: Doesn’t the Chiropractic Board have to Notify Chiropractors That Extraspinal Adjustments are Outside the Scope of Chiropractic or is the Decision in the Case Enough?

The fact that the Appellate Division opinion in Bedford v. Riello is a "published" opinion provides notice to all chiropractors as well as the public at large as to its holding that extraspinal adjustments are outside the scope of chiropractic in New Jersey.  There is no requirement that the Board of Chiropractic Examiners notify the licensees as the way our system is set up a published court opinion provides that notification. 

QUESTION:  What Specific Services Does the Bedford Decision Preclude Chiropractors From Performing on their Patients? 

In Bedford v. Riello, the Appellate Division concluded that “the scope of chiropractic practice in New Jersey is limited to adjustments of the spinal column and does not include the adjustment of other joints.”   The decision is very broad and most likely precludes the adjustment of any area other than the spine. 

The five spinal regions that can be adjusted are defined in the CPT manual to include 1) cervical region; 2) thoracic region; 3) lumbar region; 4) sacral region; and 5) pelvic region and are billed pursuant to CPT 98940 (one to two region), CPT 98941 (three to four region) and CPT 98942 (five regions). 

The five extra-spinal regions that now cannot be adjusted are reported under CPT 98943 as: 1) head; 2) temporo-mandibular joint (“TMJ”); 3) lower extremities; 4) upper extremities; and 5) abdomen.  The court decision clearly states that these areas cannot receive an “adjustment” by a chiropractor. 

For all intents and purposes, the Bedford court removed, with one fell swoop of its judicial knife, the words “and related structures” from the chiropractic scope of practice regulation, N.J.A.C. 13:44E-1.1(a), which used to permit “adjustment and/or manipulation of the articulations of the spine and related structures.”  Notably, however, the court does not discuss subsection (c) of the scope regulation which permits chiropractors to, in conjunction with a chiropractic adjustment, order and/or administer physical modalities where clinically indicated. 

Thus, guidance from the Board of Chiropractic Examiners or further court interpretation of the decision is required before a more definitive long-term answer can be given.  

Surf to www.anjc.info for more information about this situation.

Court Decision Effects Durable Medical Equipment

In light of a recent appeals court decision, medical suppliers are likely to increase their scrutiny of medical necessity documentation.

As a result, physicians who order durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) should revisit their documentation standards and coordinate with their medical suppliers to ensure that their processes are compliant.

In November, the 11th Circuit Court of Appeals reasoned that a certificate of medical necessity (CMN) — “an optional prepayment tool designed primarily to reduce paperwork” — could not be the “exclusive means for proving medical necessity.” The court found that the Secretary of Health and Human Services could demand that suppliers furnish documentation beyond a CMN to meet the requirement that Medicare-reimbursed DMEPOS be medically necessary.

Generally, durable medical equipment regional carriers (DMERCs) reimburse DMEPOS suppliers for covered items deemed medically necessary by obtaining CMNs from physicians and submitting them to the DMERCs. As physicians who order DMEPOS know, the CMN is a document in which they attest to the following language:

“I certify that I am the treating physician identified in … this form .… Any statement on my letterhead attached hereto has been reviewed and signed by me. I certify that the medical necessity information … is true, accurate and complete, to the best of my knowledge, and I understand that any falsification, omission, or concealment of material fact in that section may subject me to civil or criminal liability.”

Now, orthopedic practices face a new bottom line: They must ensure that their ability to document medical necessity properly improves on the grim Medicare audit statistics that have emerged during some recent court cases.

Surf to our Show Notes for more information - http://www.orthosupersite.com/default.asp?page=view&rid=21504

FCER Publishes Book on Evidence Based Chiropractic Practice

Evidence-based chiropractic (EBC) is a process of actively seeking support for and improvement of clinical practice through the integration of the best available research evidence; combined with the practitioner’s clinical expertise and the patient’s values. Research evidence does not supersede clinical decision making in EBC, rather it enhances the knowledge and skills of the practitioner to produce better patient care.

This new book, entitled - Evidence-based Chiropractic Practice offers valuable information to help healthcare practitioners and students care for their patients as effectively and efficiently as possible.

The book also offers important information on understanding the content of research articles, including the basics of research design and diostatistics.

According to the forward by Dr. John J. Triano – “The future of Chiropractic depends on the ability to articulate its effective role in guiding and managing patients. The toolbox provided in this work is essential to accurate interaction with patients, payers, and policy makers responding to critics and working to keep the system honest for the future. These tools are as valuable as learning the next adjusting technique or examination procedure for casting the success of practice in defensible terms. Each of us now carries that charge.”

Surf to our Show Notes for a link to this new book - https://www.fcerstore.org/sess/utn;jsessionid=15463626c562da7/shopdata/index.shopscript?main_url=https%3A%2F%2Fwww.fcerstore.org%2Fsess%2Futn%3Bjsessionid%3D15463626c562da7%2Fshopdata%2F0005_New%2BItems%2Fproduct_details.shopscript%3Farticle%3D0012_Evidence-Based%252BChiropractic%252BPractice%253D2C%252Bby%252BMichael%252BT%253D252E%252BHaneline%252B%253D28EVIDENCEBK%253D29

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

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

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