Algorithm for the Chiropractic Treatment of Spine Related Pain

>

Source Documents

bull ALGORITHMS FOR THE CHIROPRACTIC MANAGEMENT OF ACUTE AND CHRONIC SPINE-RELATED PAIN GREGORY A BAKER DC RONALD J FARABAUGH DC THOMAS J AUGAT DC MS CCSP FASA CHERYL HAWK DC PHD TOPICS IN INTEGRATIVE HEALTH CARE [ISSN 2158-4222] ndash VOL 3(4) DEC 2012

bull CHIROPRACTIC MANAGEMENT OF LOW BACK DISORDERS REPORT FROM A CONSENSUS PROCESS G Globe MBA DC PhD C Morris DC W Whalen DC R Farabaugh DC and C Hawk DC PhD JMPT NovemberDecember 2008

bull MANAGEMENT OF CHRONIC SPINE-RELATED CONDITIONS CONSENSUS RECOMMENDATIONS OF A MULTIDISCIPLINARY PANEL R Farabaugh DC M Dehen DC and C Hawk DC PhD JMPT Volume 33 Number 7 Sept 2010

>

Algorithm for the Chiropractic Treatment of Spine Related Pain

bull Dictate or recommend the modality of treatmentbull Guide the management of non-painful functional or

structural spinal care (subluxation correction posture correction scoliosis management etc)

bull Apply to wellness carehealth promotion

The scope of this algorithm is for the chiropractic management of spine related

pain

It does not

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope of

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Source Documents

bull ALGORITHMS FOR THE CHIROPRACTIC MANAGEMENT OF ACUTE AND CHRONIC SPINE-RELATED PAIN GREGORY A BAKER DC RONALD J FARABAUGH DC THOMAS J AUGAT DC MS CCSP FASA CHERYL HAWK DC PHD TOPICS IN INTEGRATIVE HEALTH CARE [ISSN 2158-4222] ndash VOL 3(4) DEC 2012

bull CHIROPRACTIC MANAGEMENT OF LOW BACK DISORDERS REPORT FROM A CONSENSUS PROCESS G Globe MBA DC PhD C Morris DC W Whalen DC R Farabaugh DC and C Hawk DC PhD JMPT NovemberDecember 2008

bull MANAGEMENT OF CHRONIC SPINE-RELATED CONDITIONS CONSENSUS RECOMMENDATIONS OF A MULTIDISCIPLINARY PANEL R Farabaugh DC M Dehen DC and C Hawk DC PhD JMPT Volume 33 Number 7 Sept 2010

>

Algorithm for the Chiropractic Treatment of Spine Related Pain

bull Dictate or recommend the modality of treatmentbull Guide the management of non-painful functional or

structural spinal care (subluxation correction posture correction scoliosis management etc)

bull Apply to wellness carehealth promotion

The scope of this algorithm is for the chiropractic management of spine related

pain

It does not

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope of

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Algorithm for the Chiropractic Treatment of Spine Related Pain

bull Dictate or recommend the modality of treatmentbull Guide the management of non-painful functional or

structural spinal care (subluxation correction posture correction scoliosis management etc)

bull Apply to wellness carehealth promotion

The scope of this algorithm is for the chiropractic management of spine related

pain

It does not

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope of

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope of

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope of

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope of

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope of

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope of

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Patient presents with acute spine related pain

Is ConditionOutside of Scope of

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg