ISCA Spring Report 2014

19
SPRING 2014 PRESIDENT'S MESSAGE: OUR PROFESSIONAL HOME The idea of creating a “professional home” for the chiropractic profession is one that has been taking shape at the Indiana State Chiropractic Association for some time. We want you to feel more than an obligation to be a part of the ISCA; we want you to feel welcome here and to find the camaraderie of other chiropractic physicians who, like you, want most of all to provide the best care possible to their patients and to advance this great profession. As your professional home, ISCA offers the tools and information to take your practice to a new level, to thrive even in these tough economic times. A review of this special ISCA Report should assure our members and potential members alike that we have been successful in creating a state association worthy of being called your home. Our understanding of the public’s interest in wellness is skyrocketing, and there is no better provider than today’s doctor of chiropractic to help show them the way to optimal health. Our members are trained to more effectively apply their skills and knowledge as wellness coaches to better the health of their patients and their families. Later this year, we will launch a new program to train DCs to conduct Department of Transportation (DOT) physicals for commercial vehicle drivers. DOT expects to need 40,000 medical examiners to meet the demands in this country. It is also anticipated that many of the MDs who currently conduct these physicals will not elect to undergo the new training and certification required for the program. This means that the chiropractic profession has a tremendous opportunity to meet an important need within our communities and earn additional income for our practices. A strong showing of chiropractic participation in this program will also raise the profile of DCs as expert health care providers who care about the public’s safety. No matter how you choose to practice, ISCA is a fit. Our webinars and seminars, for example, provide proven strategies for improving the efficiency and profitability of any practice. This is just one of an ever-expanding array of education programs available through ISCA—many of which offer CEUs to help you stay current with your license. If you’re interested in a specialty committee, ISCA offers many where you can network with other DCs who share your interests. For some of you, this information may be new. If so, please take the time to read this Report and see what you’ve been missing. Learn about all the ways that you can come home to ISCA and leave with new ideas, new opportunities and new perspective on the value of your state association membership. All the Best, Robert W. Tennant, D.C., F.I.C.C. President Indiana State Chiropractic Association

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Transcript of ISCA Spring Report 2014

Page 1: ISCA Spring Report 2014

spring 2014

Presidents Message OUr PrOfessiOnal hOMe

The idea of creating a ldquoprofessional homerdquo for the chiropractic profession is one that has been taking shape at the Indiana State Chiropractic Association for some time We want you to feel more than an obligation to be a part of the ISCA we want you to feel welcome here and to find the camaraderie of other chiropractic physicians who like you want most of all to provide the best care possible to their patients and to advance this great profession

As your professional home ISCA offers the tools and information to take your practice to a new level to thrive even in these tough economic times A review of this special isCa report should assure our members and potential members alike that we have been successful in creating a state association worthy of being called your home

Our understanding of the publicrsquos interest in wellness is skyrocketing and there is no better provider than todayrsquos doctor of chiropractic to help show them the way to optimal health Our members are trained to more effectively apply their skills and knowledge as wellness coaches to better the health of their patients and their families

Later this year we will launch a new program to train DCs to conduct Department of Transportation (DOT) physicals for commercial vehicle drivers DOT expects to need 40000 medical examiners to meet the demands in this country It is also anticipated that many of the MDs who currently conduct these physicals will not elect to undergo the new training and certification required for the program This means that the chiropractic profession has a tremendous opportunity to meet an important need within our communities and earn additional income for our practices A strong showing of chiropractic participation in this program will also raise the profile of DCs as expert health care providers who care about the publicrsquos safety

No matter how you choose to practice ISCA is a fit Our webinars and seminars for example provide proven strategies for improving the efficiency and profitability of any practice This is just one of an ever-expanding array of education programs available through ISCAmdashmany of which offer CEUs to help you stay current with your license If yoursquore interested in a specialty committee ISCA offers many where you can network with other DCs who share your interests

For some of you this information may be new If so please take the time to read this Report and see what yoursquove been missing Learn about all the ways that you can come home to ISCA and leave with new ideas new opportunities and new perspective on the value of your state association membership

All the Best

robert W tennant dC fiCCPresident indiana state Chiropractic association

spring 20142

PresidentRobert Tennant DC FICCShirley IN7657371117docthrtcnet

Second Vice-PresidentMichael Toney DCTerre Haute IN8122321464flopper1968hotmailcom

SecretaryMichael Phelps DCMartinsville IN7653422208mikephelps55attnet

TreasurerChristopher Paprocki DC FICCGreenwood IN3178817759jpaprocki1aolcom

Immediate Past PresidentAnthony Wolf DC FICCIndianapolis IN3178981100dranthonywolfgmailcom

Past President RepresentativeRobert Clements DCKokomo IN 7654521330raclements99aolcom

DIRecToRS aT LaRge

Toby Harmon DCJasper IN8126346363harmonfminsightbbcom

Douglas Breger DCNew Albany IN5023227411doctorbregeryahoocom

aLTeRnaTe DIRecToR aT LaRge

Keith Bartley DCJasper IN8124826600brtchirofullnetcom

Joseph Paun DCHighland IN2192274033drjoepaunwellnesscom

DISTRIcT DIRecToRS

District TwoGerard Hofferth DCSouth Bend IN5742561008drhofaolcom

District ThreeJason Russell DCFort Wayne IN2606371000teamoptimumperformancefortwaynecom

District FourPeter Furno DCZionsville IN3173749966pgfindyrrcom

District FiveDiane Vuotto DCIndianapolis IN3178986989vuottojdcomcastnet

District SixRichard Hilton DCNew Palestine IN3178614300drhiltonsbcglobalnet

District Seven Kristen Hartwell DCIndianapolis IN3177849311 iuchiroyahoocomt

District eightShaun Tymchak DCNewburgh IN8128581008drshaunnewburghchirocom

District nineE Curtis Harris DCFranklin IN3177367088drcurtisharriscichcccomcom

aLTeRnaTe DISTRIcT DIRecToRS

District oneRobert Hall DCMerrillville IN2198843250krackbabyaolcom

District TwoWilliam Garl DCBremen IN5745464111wgarlmchsicom

District ThreeTroy Byall DCFort Wayne IN2604144257troybyalldcgmailcom

District FourAdam Cline DCWest Lafayette IN7654633000drclineclinecliniccom

District FiveJoseph Fortunato DCIndianapolis IN3172572225josephfortunatodccomcastnet

District SixDavid Davis DCWinchester IN 7655843665drdddaolcom

District Seven

District eight

District nineScott Auton DCFranklin IN3173460799scottautonyahoocom

indiana state ChirOPraCtiC assOCiatiOn BOard Of direCtOrs

inside this issUePRESIDEnTS MESSAgE1

ISCA BOARD OF DIRECTORS2

ExECUTIvE DIRECTORS MESSAgE3

ThAnk yOU TO ThE 2014 DCS OF ThE DAy4

UPDATE COnTACT InFO4

CISCA LEgISLATIvE REPORT5

ISCA hIghLIghTS MEMBERShIP AnD LOCAL InvOLvEMEnT AT SPRIng

COnFEREnCE6-7

CLOSIng yOUR PRACTICE DOnT jUST ShUT yOUR DOORS8

SPRIng MEAnS TIME FOR ISCA MEMBERS AnD nOnMEMBERS TO MEET In DISTRICTS 9

CERTIFIED MEDICAL ExAMInER TRAInIng REgISTRATIOn 10

ISCA REgIOnAL vIDEO vIEWIngS 11

MEDICAIDMEDICARE UPDATE12-13

InSURAnCE COMMITTEE UPDATE14

TRUST BUT vERIFy15

WERE ALREADy ThERE ndashChIROPRACTIC AnD PUBLIC hEALTh hAnD-In- hAnD16-18

ISCA CLASSIFIEDS19

the isCa rePOrt Will Be distriBUted Online fOr yOUr COnvenienCe Please keeP the assOCiatiOn OffiCe UPdated On yOUr MOst CUrrent eMail address as Well as PraCtiCe

and hOMe addresses sO that We Can PrOvide yOU the MOst tiMely COMMUniCatiOnsUPdate yOUr infOrMatiOn On Page 4

AlternAtes the IsCA by-laws allow for the Directors at large and the District Directors to have Alternate Directors the Alternate At large Directors may reside anywhere in the state the Alternate District Directors must reside within their district there are 9 districts and their boundaries are the same as per the national census this is done to keep the Districts in line on a proportional basis When the Directors are not present the Alternate Directors have the full voting powers as the Directors and may take their place at any meetings this system was initiated to involve more people in the associationrsquos decision-making process and to serve as a training ground for future board members the Alternate Directors at large are nominated by the Directors at large and then must be approved by the Board of Directors the District Director Alternates are recommended by the District Directors and approved by the board

spring 20143

exeCUtive direCtOrs Message PatriCia MCgUffey esq

greetings tO OUr WOnderfUl isCa faMily

Thanks to you the ISCA had a record attendance and a record number of exhibitors at our ISCA Spring Conference that will be highlighted later in this newsletter

Thanks to you the ISCA had one of the most successful DC of the Day Programs at the Legislature ever

Thanks to you the ISCA had a fantastic year at the 2014 Indiana General Assembly Session We passed legislation to allow you to get the training to do physical exams for school bus drivers In addition we defeated legislation that would have reduced the time you could collect for a patientrsquos bill in small claims court from six to two years (This would have created an insurmountable problem for DCs) Dedicated ISCA volunteers braved the tough winter elements for the best attended most successful ISCA visit to the Statehouse ever I am so pleased to tell you that I continue to hear from legislators about how much they appreciate what you do and your service in their communities A full report on our activities is highlighted later in the newsletter

Thanks to you our Insurance Committee answered more insurance Medicaid and Medicare questions than ever before

Thanks to you the ISCA is recognized as one of the strongest chiropractic membership organizations in the country You have the strongest laws and most protective regulations for the chiropractic profession and are the envy of your colleagues in other states

Thanks to you chiropractic patients in Indiana understand the value of chiropractic treatment They read about the benefits in the press receive recognition by the Governorrsquos Proclamation and are pleased to see endorsements in local and national publications that football stars and numerous celebrities tout the benefits of chiropractic

There would be no ISCA story without you We feel truly blessed to have the best and most supportive members anywhere Please let us know how we can serve you to make your practice even more successful

Please let us know how you would like to become more involved in the ISCA by serving on a committee or being considered for a Board member position in the elections at our fall meeting

The ISCA is You Thanks for making 2013 the best year yet and for the many exciting things yet in store for us in 2014

Yours in Chiropractic

Patricia McGuffey EsqExecutive Director

spring 20144

thank yOU tO the 2014 dCs Of the day

We thank all the Chiropractors listed below who volunteered to serve as DC of the Day for the 2014 Indiana General Assembly Session Your participation in the ISCArsquos program promotes the benefits of chiropractic to lawmakers and educates them on the cost effectiveness and efficiency of chiropractic treatment THANK YOU FOR REPRESENTING THE ISCA AND MAKING THIS PROGRAM THE SUCCESS THAT IT IS

Dr Clements Dr Doyle Dr S harmon Dr harris Dr hilton Dr hushower Dr kielur Dr Phelps Dr S Roberts Dr Rusk Dr Schulke Dr vuotto Dr Williams and Dr Wolf

Special thanks to DC of the Day Chairwoman Dr Kristen Hartwell for spearheading this effort

thank yOU tO OUr 2014 PaC COntriBUtOrs

Drs Berseth Chalfant Cochran Cripe Daffron Denis Elliott Fulller Furno garl golden hall hartwell hofferth Molin Phelps Rohleder Ruckel Riggle Schaub Spruch Stulc Unterseher and Wolf

as Well as OUr 2014 legislative assessMent COntriBUtOrs

Drs Frishman Garl Hall Hartwell Wolf and Zajac

Your Donations Allow Us to Continue to Have a Strong Voice at the Statehouse on Your Behalf

UPDaTe YoUR conTacT InFoRMaTIon ndash return to IsCA 200 s Meridian suite 410 Indianapolis In 46225 or Fax it to (317) 686-2672 or email infoindianastatechirosorg

Clinic Name Contact Name

Clinic Address

City State Zip

Home Address

City State Zip

e-mail Clinic Phone ( ) Fax ( )

Home Phone ( ) Mobile Phone ( )

the IsCA report will be distributed online for your convenience Please keep the Association office updated on your most current email address as well as practice and home addresses so that we can provide you the most timely and cost effective communications

UPdate yOUr reCOrds

spring 20145

CisCa legislative rePOrt By Dr Anthony Wolf DC FICC Immediate Past President and Chairman Legislative Committee

The 2013 Legislative session began with a review of all bills introduced to the Indiana General Assembly in early January Our lobbyists Pat McGuffey and Jessaca Turner Stulz reviewed nearly 1000 bills to determine if they would have any impact on the chiropractic profession and our ability to practice in Indiana

The Legislative Committee comprised of Dr Anthony Wolf (Chair) Dr Robert Tennant Dr Frank Laux Dr Mike Toney Dr David Davis Dr Mike Phelps Dr Peter Furno Dr Jared Himsel and Dr Justin Gilmore held weekly conference calls on Friday afternoons lasting 1-3 hours to discuss all bills pertinent to the chiropractic profession in Indiana The bills are summarized and e-mailed to the committee members by Pat McGuffey to be reviewed prior to our conference call The bills are discussed in detail with input by all committee members to decide if any action by the ISCA should be taken Pat and Jessaca will follow-up with the committeersquos recommendations and attend all legislative hearings on these bills The following week the ISCA Legislative Committee is updated on any movement of a bill any action needed on any new bills pertinent to our profession This process continues until the end of the legislative session

This year we were able to retain language in the occupational therapistrsquos scope expansion bill that prohibits them from performing spinal manipulation Our lobbying team was also able to coordinate legislators to table a bill to a summer study session that would have reduced the time to collect a bill from a patient in small claims court from 6 years to 2 years The Legislative Committee felt this would impact our ability to collect on delayed accounts such as Personal Injury cases and insurance delays in payment Pat McGuffey will be actively involved in the summer study session regarding this bill

Through the sole efforts of the ISCA lobbying team we were able to revive a bill with language that will allow Doctors of Chiropractic to be included as a provider that can perform school bus driver physicals All eligible providers must be certified The ISCA will be offering certification courses this year to our membership

GOALS FOR 2014-2015The ISCA Legislative Committee will be reviewing our current scope of practice to expand to more of an ldquoopenrdquo scope to allow future graduates the ability to practice to the full extent of their education obtained at a CCE and US Department of Education accredited institution Emphasis will be added that the education must be a part of the core curriculum National Board Tested and must be taught in a majority of chiropractic schools in the United States

Be sure to complete your insurance survey and return to the ISCA within 10 days When preparing your insurance issue be sure to create a ldquosanitizedrdquo paper trail with your correspondence with the insurance company The ISCA Insurance Committee will review the problems and concerns our membership is experiencing The committee will then formulate a list of concerns to present to the Indiana Department of Insurance to attempt to resolve our issues If this proves unsuccessful the ISCA Legislative Committee will determine if legislation will be appropriate and introduce a bill for the 2015 Legislative session

Remember Lawsuits are expensive and usually require an additional assessment to our membership Legislation requires a large BackPAC fund and intense grassroots efforts by our membership The ISCA Insurance and Legislative Committees will always attempt to resolve issues in the most effective and least costly manner for our membership

To protect and move this profession forward to its proper placement in our healthcare system it requires full active participation of our entire membership

Maintain your highest level of Membership in the ISCA

Contribute to BackPAC

Answer to the ldquocallrdquo

ndash Act on Grassroots efforts

ndash Complete Surveys and Requests

Attend ISCA Sponsored CE Seminars

Become ACTIVE on a committee

Encourage a non-member to become an active member

Every insurance check they cash and the very ability to practice Chiropractic in Indiana is a direct result of the ISCArsquos past present and future efforts

Being involved at the state level for more than 20 years and now at the national level as the ACA Delegate for Indiana I have realized without a doubt that the profession would cease to exist without the continued effort of the ISCA and ACA

Thank you for the privilege to serve as your Immediate Past President Legislative Chair and ACA Delegate

As we all look in the mirror we must consider the quote by Russell Wilson (Seattle Seahawks Quarterback)

Why nOt Me

spring 20146

isCa highlights MeMBershiP and lOCal invOlveMent at sPring COnferenCe

Indianapolis ndash The Indiana State Chiropractic Association (ISCA) spoke of the importance of association membership and involvement during the 2014 Spring Conference February 21-23 2014 at the Hilton Indianapolis North

ldquoMembership does the work of the Associationrdquo said Dr Robert Tennant President of ISCA ldquoIt is this work that is vital to the advancement of the chiropractic profession and strengthening our local legislative effortsrdquo

Foot Levelers presenter Dr Kevin Wong discussed the importance of involvement in your State Association to support the profession ldquoWe will not advance without our membersrdquo said Dr Wong ldquoThey are the messengers that keep our mission movingrdquo

Dr Kevin Wong Dr Miles Bodzin and Dr Tim Maggs presented at the conference Dr Wong presented on understanding and treating the feet and extremities to understand why they are vital to whole body health Dr Bodzinrsquos course discussed the methods systems and strategies for freeing yourself from the shackles of insurance dependence Dr Maggsrsquo course described the current medical model care for high school athletes and discussed the need for the biomechanical model

ldquoThis is a time of great opportunity for the chiropractic profession We must work as a team communicate a consistent message to decision makers and engage more of our doctors to improve health and that is what the ISCA works to dordquo said Dr Tennant

ISCA Executive Director Pat McGuffey said the Association organizes two educational conferences each calendar year for Doctors of Chiropractic in Indiana More than 135 Doctors of Chiropractic attended the 2014 ISCA Spring Conference

Mark your calendar for The ISCA Fall Conference October 10-12 2014 at the Indianapolis Marriott East

1 Welcome to the 2014 ISCA Spring Conference

2 President Dr Robert Tennant discusses the importance of involvement with the Association

3 Executive Director Pat McGuffey reviews the work going on during the 2014 Legislative Session

2

1

2

11

3

spring 20147

4 Dr Kevin Wong speaks on Supporting Your Body

5 Dr Toby Harmon Board Member and Conference Committee Chairman energizes the group while describing his committees goals

6 DrPeterFurnocollectsfortheBackPACraffleduringthemembership luncheon

7 ThankstoallwhomadetheBackPACraffleasuccess

8 Dr Miles Bodzin Founder and CEO of Cash Practice Systems addresses the group at the Membership Luncheon and presents during seminar sessions

9 Attendees at the Membership Luncheon

10 Attendees listen to speakers during the Saturday Membership Luncheon

11 Conference attendees enjoyed the sounds of NEXUS during the attendee reception and mixed and mingled with their colleagues

12 Vendors greeted conference attendees through the event

13 Dr Diane Vuotto Board Member and Membership Committee Chairwoman

4

4

45

6

78

8

99

1010

11

12 1212 13

1111 11

spring 20148

ClOsing yOUr PraCtiCe dOnrsquot JUst shUt yOUr dOOrsBy Stephanie T Eckerle Esq Plews Shadley Racher amp Braun

Many chiropractors need to close their practice whether it is due to retirement relocation or a career change In other cases you may not need to close

your practice but you may want to discontinue the chiropractor-patient relationship with a certain patient Regardless of the scenario there are certain regulations that you need to be aware of in order to close your practice or terminate the patient relationship in compliance with all applicable laws

Closing Your Practice you must notify all of your active patients if you plan on retiring discontinuing your practice or moving from the community Generally active patients would be any patients that you have seen in the past two years The notice that you send to the patients should first state the date that your practice will close This date should be at least thirty days after you send the patients the notice Second the notice should provide directions on how the patients can obtain their medical records or transfer those to another chiropractor If you are going to charge patients any fees for copying medical records this should also be included in the notice In addition you may also include a release form for the medical records that is compliant with HIPAA and all applicable state laws which will further protect you when transferring medical records As a chiropractor you have a duty to promptly release a patients records to any other chiropractor or any other health discipline practitioner designated by the patient upon written request of the patient Lastly the letter should encourage your patients to seek the services of another chiropractor If you do refer your clients to a specific chiropractor you cannot receive any compensation for the referral of that patient under Indiana law

Terminating a Patient Relationship as a chiropractor you cannot abandon a patient under indiana law If you desire to terminate the patient relationship you must give due notice to a patient or those responsible for a patientrsquos care when you are withdrawing from a case Generally we recommend that you provide a patient or their caregiver with written notice of the termination at least thirty days in advance In addition you may want to provide the patient with a referral to another chiropractor Lastly you should always ensure that the patient knows how to obtain and transfer their medical records

The Indiana Chiropractic Board does enforce provisions applicable to closing or selling your practice or terminating the patient relationship For example in 2011 the Chiropractic Board brought a complaint against a chiropractor that refused to release a patientrsquos medical records unless that patient signed a general waiver of liability Therefore ensuring compliance with all applicable laws and regulations is critical In addition to regulatory compliance issues there are many other issues that you may want to consider when selling or closing your practice such as transferring your equipment terminating a lease or selling real estate terminating your employees terminating or assigning any contracts with vendors and allocating liability among you and the seller or purchaser as applicable

Stephanie Eckerle is the chair of the health Care and Life Sciences practice group at Plews Shadley Racher amp Braun LLP She represents various types of medical professionals including chiropractors physicians mid-level providers and pharmacists She also represents practice groups pharmacies laboratories and other health care entities If you have any questions about health care matters including how to close or sell your practice please contact Stephanie at (317) 637-0700 or seckerlepsrbcom

spring 20149

sPring Means tiMe fOr isCa MeMBers and nOnMeMBers tO Meet in distriCts By Cathy Orosz Membership Director and ISCA Association Manager

Spring is here and the ISCA is ready to recruit

ldquoThe snow is cleared and we are ready to hit the ground runningrdquo says Dr Diane Vuotto Membership Chairwoman and District 5 Director ldquoISCA District Directors are ready to engage current and potential members in their area and they need your input

Each of the nine District Directors are currently planning special meetings throughout April and May to recruit new members as well as learn from current members on how the ISCA can serve them better

Dr Hilton will be taking to the road in District 6 for one-on-one meetings If you are interested in scheduling a meeting with Dr Hilton please contact him at drhiltonsbcglobalnet

District 9 will be meeting on Tuesday April 29 at 630 pm at Dr Scott Autonrsquos office at 1551 N Main St in Franklin To attend this meeting and learn more about efforts in District 9 please contact Dr Auton at scottautonyahoocom or (317) 346-0799

If you would like to be more involved the ISCA asks that you please consider volunteering your time and talents Please contact Cathy Orosz at (317) 673-4245 (800) 572-8002 or infoindianastatechirosorg to learn how you can become more involved in the Association

WELCOME NEW MEMBERS 2014

Dr Nancy Elwartowski-Cooper Carmel

Dr Kevin Forrest Indianapolis

Dr Anthony Forrest Indianapolis

Dr Julie Carleton Fishers

INDIANA STATECHIROPRACTICASSOCIATIONwwwindianastatechirosorg

spring 201410

Certified Medical Examiner Training WE NEED 20 PAID REGISTRANTS BY APRIL 10 IN ORDER

TO HOST THIS TRAINING Saturday May 3 and Sunday May 4 2014 Indianapolis Location TBD 800 AM to 6 pm Saturday May 3 and 8 AM to noon Sunday May 4 YOU CANNOT DO PHYSICAL EXAMS FOR TRUCK AND BUS DRIVERS ANY LONGER UNLESS YOU OBTAIN THIS CERTIFICATION Interested in becoming a Certified Medical Examiner (CME) and be listed on the National Reg-istry YOU MUST COMPLETE THIS TRAINING AND TESTING on Federal Motor Carrier Safety Ad-ministrationrsquos (FMCSA) physical qualification standards and guidelines If you intend to perform physical examinations and issue medical certificates for commercial motor vehicle (CMV) drivers to meet the requirements of Section 39141 of the Federal Motor Carrier Safety Regulations (FMCSRs) you must be certified and listed on the FMCSArsquos National Registry by May 21 2014 Upon completion of this program you will be eligible to take the Certification Test for $79 at an Indiana testing site The ISCA will provide you with info regarding multiple testing sites Program presented for the ISCA by Michael Megehee DC National Registry Certified Medical Examiner and President TeamCME LLC

Registration Name Clinic Address CityStateZip Phone Email Address Payment Method (Credit Card or Check) Credit Card Type Credit Card Expiration 3 Digit Code Name on Card Signature Questions Contact Cathy Orosz at infoindianastatechirosorg or call 317-673-4245 or toll-free at 800-572-8002 The ISCA needs a minimum of 20 registrants by Friday April 10 for this program to be offered Payment is needed upon regis-tration and no refunds will be granted

Mail Registrations to Indiana State Chiropractic Association 200 S Meridian St Ste 410 Indianapolis IN 46225 Or Fax to 317-686-2672 or email to infoindianastatechirosorg

The Cost of the 12-hour training is $400 for ISCA Members and $450 for Non Members

Because we have to pay for TeamCME in Advance we must have 20 paid registrants by April 10 in order to host this training MAKE YOUR RESERVATIONS TODAY

spring 201411

CONTACT INFORMATION

NAME_____________________________________________________________________

COMPANY __________________________________________________________________

MAILING ADDRESS__________________________________________________________

CITY STATE ZIP_____________________________________________________________

PHONE ________________________________ FAX________________________________

EMAIL_____________________________________________________________________

ADDITIONAL ATTENDEE NAMES________________________________________________

___________________________________________________________________________

PAYMENT OPTIONS

AMEX VISA MASTERCARD CHECK (MAKE PAYABLE TO ISCA BACKPAC)

CARDHOLDER_______________________________________________________________

CARD ____________________________________________________________________

EXP__________________________ 3 DIGIT SECURITY ___________________________

SIGNATURE_________________________________________________________________

MAIL ISCA 200 S Meridian St Suite 410 Indianapolis IN 46225FAX 3176862672 ATTN Cathy Orosz

ISCA REGIONAL VIDEO VIEWINGSNEED CONTINUING EDUCATION HOURS THERErsquoS STILL TIME

Donrsquot miss your opportunity to get your required continuing education credits prior to June 30 2014 Indiana Statute dictates that every Licensed Chiropractor in Indiana gets four hours of risk management each year by attending one of the ISCArsquos Regional Video Viewings

There are a limited number of seats at some locations so pre-registration is necessaryIf you choose to pay at the door Pre-Registration is REQUIRED Non-prior notice of attendance will be subject to the Non-Member rate above Call the ISCA office for availability at your location (317) 673-4245 If you need directions to a location please call the ISCA for host contact information

Proceeds of the viewings are contributed to the ISCA Political Action Committee and are non-business deductible

QUESTIONS Contact Cathy Orosz at 8005728002 3176734245 or email infoindianastatechirosorg Proceeds of the viewings are contributed to the ISCA Political Action Committee and are non-business deductible

Contributions to the ISCA Political Action Committee are non-business deductible

REGIONAL VIDEO RATES

$185 Member In Good Standing $250 Non-Member $165 GoldSilver Member Free Of Charge - Platinum Member

VIEWING DATES amp LOCATIONS

WEDNESDAY MAY 7 830 AM - 1230PM Dr Patrick Case 3027 Mishawa Ave South Bend IN

TUESDAY MAY 8 830 AM - 1230PM Dr Douglas Breger 2652 Charlestown Rd New Albany IN

SATURDAY MAY 10 830 AM - 1230PM Dr John Kostidis Call 2199244456 for location and availability Valparaiso IN

WEDNESDAY MAY 13 7 AM - 11 AM Dr Toby Harmon 2602 Newton St Jasper IN

THURSDAY MAY 15 9 AM - 1PM Dr Michael Hartle 3835 W Jefferson Blvd Fort Wayne IN

spring 201412

MediCaidMediCare UPdateBy Michael Phelps DC Secretary ISCA Board of Directors MedicaidMedicare Advising Committee

2013 saw yet another attempt to take chiropractic care out of Medicaid The ISCA amp its Legislative Committee was successful in stopping this attack on the chiropractic profession Thanks to the hard work of the ISCA Indiana remains one of the limited states where Medicaid covers all chiropractic services under our states scope of practice

January 1 2014 also saw the reinstatement of the 5 reduction in imbursement that we accepted several years ago

The ISCA is able to keep chiropractors in the Medicaid Program as well as other insurance as a paid provider through the hard work and dedication of volunteers If you are able to donate some time there are a number of committees and positions that need to be filled by doctors that want to make a difference If you know of DCs that are not members of the ISCA tell them about the good work we do for the profession and that we need all Doctors of Chiropractic in this state to be members Remember if youre not part of the solution youre part of the problem

As you know with the changes in health care coverage there are changes with respect to Medicare All chiropractors should be reporting PQRS for incentive payment eligibility Those who report satisfactorily for the 2013 amp 2014 program years may avoid the 2015 PQRS payment adjustment Additional information on how to avoid future PQRS payment adjustments can be found through supporting documentation available on the CMS website at httpwwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-InstructionsPQRS Chiropractors are fortunate as they only have to report on three measures

Measure 131 - Pain Assessment and Follow upMeasure 182 - Functional Outcome AssessmentMeasure 317 - Preventive Care and Screening (Screening for High Blood Pressure)

January 1 2014 saw an increase of approximately 9 in the reimbursement for chiropractic adjustments (98940 98941 amp 98942) This increase was due to a reassessment of the RVUs for CMT

The latest CERT report saw a decrease in the percentage of errors for chiropractors Chiropractic physicians need to continue to improve their documentation and coding of services in order to maintain this downward decline of errors

The Wisconsin Physicians Service (WPS) periodically analyzes provider coding patterns to identify deviations within a peer group For the J8 (Indiana and Michigan) Jurisdiction there has been a significantly higher than normal usage of the Code 98942 (CMT of five regions of the spine) There are approximately 35 DCs in the state of Michigan that are on the radar I am happy to report that there are no chiropractors in the state of Indiana under review

All that needs to happen for Chiropractic to fail is for good doctors to do nothing If you know of a chiropractor that is not a member of the ISCA urge them to join

MedicaidMedicare Update (contd on page 13)

spring 201413

MedicaidMedicare Update (contd from page 12)

SGR BILL PASSES HOUSE GOES TO SENATE FOR CONSIDERATIONWe learned that the United States House of Representatives passed House Bill 4302 The bill proposes to extend Medicarersquos Sustainable Growth Rate (SGR) current rate to April 15 2015 and would delay other Medicare deadlines The bill as currently drafted would postpone ICD-10-CM implementation until after October 1 2015 and restrict the Centers for Medicare amp Medicaid Services (CMS) from acting without congressional approval The bill now goes to the US Senate for debate and vote If it passes the Senate it would then be sent to President Obamarsquos desk to be signed or vetoed The ISCA will continue to monitor this situation and recommends preparing for ICD-10 implementation

PLEASE ALSO MARK YOUR CALENDAR WITH THESE DATES Medicare Secondary Payer (MSP) Seminar April 17 2014 from 100 pm to 400 pm Hilton Garden Inn Fort Wayne 8615 US Hwy 24 West Fort Wayne IN Click here to register

There is a Chiropractic Medicare Seminar on April 26 2014 in Mishawaka IN Click here for more information

HELPFUL LINKSNeed help in the transition to ICD-10 Go to the Road to 10 website by clicking here This site is primarily for the MD but has general information that pertains to all health care specialties

Stay up-to-date on changes in Medicare at the WPS Medicare website by clicking here This website is for all providers but sometimes offers information specific to chiropractors

INFORMATION REGARDING THE HOLDING OF APRIL 2014 CLAIMS FOR SERvICES PAID UNDER THE 2014 MEDICARE PHYSICIAN FEE SCHEDULE The 2014 Medicare Physician Fee Schedule (MPFS) final rule stipulated a negative update to the MPFS that was to be effective January 1 2014 That reduction was averted for three months with the passage of the Pathway for SGR Reform Act of 2013 which provided for a 05 percent update for services paid under the MPFS through March 31 2014 CMS is hopeful that there will be congressional action to prevent the negative update from taking effect on April 1 2014 CMS has instructed the Medicare Administrative Contractors to hold claims containing services paid under the MPFS for the first 10 business days of April (ie through April 14 2014) This hold would only affect MPFS claims with dates of service of April 1 2014 and later The hold should have minimal impact on provider cash flow because under current law clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt All claims for services delivered on or before March 31 2014 will be processed and paid under normal procedures regardless of any Congressional actions

spring 201414

insUranCe COMMittee UPdateBy Peter Furno DC ISCA Board of Directors District 4 Director and Insurance Committee Chairman

During 2013 the ISCA Insurance Committee addressed many issues and questions from its members with regard to insurance legalities of advertising and proposed associations with third party vendors offering incentives contrary to our practice statues Doctors with definitively legal questions were referred to their legal counsel for liability reasons Most questions directed to the insurance committee are answered within 24 hours

Because the ISCA continues to receive anecdotal complaints from the field claiming insurer reimbursement discrimination and other transgressions the insurance committee as a part of the ISCArsquos proactive efforts to address this problem has developed a survey to obtain information on various insurance problems or concerns impacting chiropractors in the field The ISCA is aggressively attempting to determine problems that are affecting large numbers of doctors and which may be indicating the development of a trend requiring attention by the ISCA and then the IDOI However although it is the intent to meet with the IDOI once the survey information is correlated so that the contentions of our doctors may be addressed officially without firm evidence of wrong doing by the insurance industry the ISCA cannot go forward Consequently it is imperative that all members who are having trouble submit their complaints to the ISCA together with supportive documentation so that this issue may be addressed

Now that the PPACA is law and will require ldquoevidence-basedrdquo treatment procedures to be utilized before reimbursements are made the intent of the Insurance Committee to make at least one presentation to decision-makers of an employer group regarding the cost-effectiveness and efficacy of chiropractic in the management of work related uncomplicated spine injuries in comparison to traditional medical care Heretofore the majority of employers had no idea of the cost-effectiveness of chiropractic care when compared to traditional medicine and simply allowed their work nurses and medical providers to direct care ndash which the research shows is one of the main reasons costs are so high

The Insurance Committee in an attempt to keep the ISCA membership updated will attempt to address at least two insurance queries weekly and present answers to the membership via the ISCA monthly eNews and Newsletter

Insurance Pearl Medicare and Chiropractic Billing Misconceptions It is worthwhile to address a few of the prevailing misconceptions Here are the nine truisms regarding Medicare and chiropractic

1 There is not a 12-visit limit to Medicare for chiropractic services The limits of care are based on the specific medical necessity of the primary subluxation and its secondary neuromusculoskeletal diagnosis

2 Medicare will pay for both acute and chronic conditions as long as there is documentation or expectation of functional improvement

3 Nonparticipating (nonpar) providers are required to bill for services All covered services under chiropractic (spinal manipulation) must be billed to Medicare

4 Nonpar providers are audited just as par providers are There is no protection from a Medicare audit by being nonpar

5 Nonpar providers must document services in the same manner as any provider of Medicare services Being par or nonpar is irrelevant in reference to documentation of chiropractic services

6 Chiropractors may not opt out of Medicare This is simply not an option for doctors of chiropractic Being nonpar is not opting out but designating oneself as a Medicare provider nonpar In simple terms chiropractors must belong to Medicare to treat Medicare patients

7 Advance Beneficiary Notices (ABNs) should not be used as routine documents for patients to sign on their initial visit However they must be used when there is a genuine belief or reasonable expectation that Medicare will deny or not pay for the service on a specific visit or series of visits In other words a blanket ABN at the beginning of care is not sufficient or compliant

8 Medicare claims are not difficult they are simply different from health insurance claims When not done in Medicares format claims are denied

9 Medicare payment is what it is I will refrain from stating it is good While we all would want higher reimbursements (Who doesnt) the average fees for chiropractic services for manipulation are $30-$36 per visit This is far better reimbursement than under many of the managed care plans chiropractors routinely fight to join Furthermore that dollar amount is for spinal manipulation only other services may be billed to the patient or covered by a secondary insurance plan

spring 201415

trUst BUt verifyBy Dr R A Foxworth FICC MCS-P

I was speaking with a doctor recently who was venting her frustration about not knowing who to believe or trust as an authority when it comes to being in practice today She goes to different seminars because she wants to improve herself personally and professionally She also wants to improve her practice by learning more about her productivity effectiveness documentation compliance and billing She shared that she doesnt simply attend the CEU required hours for her license she puts in seminar hours to improve her practice her clinical skills her compliance and her business insight

Her problem The conflicting information she receives from various experts at each seminar How she asked can they all be right if they all say different things As a result of her experience she wanted to know why a Discount Medical Plan Organization (DMPO) like ChiroHealthUSA was of value in todayrsquos practices Why she asked is this even necessary What are my resources

I passed her third-degree with flying colors by the way

I could appreciate her position because I am a bit of a skeptic myself In fact thats how all this started for me I was a chiropractor in practice just like you trying to maximize my insurance payments so I wasnt leaving money on the table while still working to come up with a way my uninsured patients could afford those fees

Because of my activity within my state (as a governor-appointed health expert as an active participant in my State Chiropractic Association and the state representative for the American Chiropractic Association) I knew there were rules to follow to avoid compliance issues when creating our fee schedule I did my research and initially started a Discount Medical Plan Organization (DMPO) for my state alone I knew this would legally protect my practice and my colleagues and that at the time was my only goal

And as skeptic I wouldnrsquot even take my own word for it when it came to believing that a Discount Medical Plan Organization (DMPO) was the simplest way to keep my fee schedules compliant legal and safe Thatrsquos why I became a Certified Medical Compliance Specialist (MCS-P) so skeptics like me could get a breath and feel at ease As an MCS-P Irsquom quite simply held to a higher standard I have to be able to quote chapter and verse about why any possible fee or activity is or isnrsquot compliant

We know therersquos a plethora of inaccurate information that gets disseminated in our profession Im sad to say that I had to agree with my frustrated colleague when she was venting about all the conflicting advice she was receiving Thatrsquos why ChiroHealthUSA has relationships with many MCS-Ps to help get accurate reliable information out there Many of the brightest minds in our profession agree with and recommend ChiroHealthUSA to their chiropractic colleagues

Looking back when I set up my first DMPO within my state I can see how shortsighted I was I now know that taking ChiroHealthUSA to a national audience to protect all chiropractic practices in the country was the vision I shouldve had at the start Im glad I had an encounter with one of my fellow MCS-Ps who gave me this bigger vision

Learn more about how ChiroHealthUSA can help your practice be more compliant You can attend a free webinar this Tuesday April 1 Register at wwwChiroHealthUSAcom today to find out more

Dr Foxworth is a certified Medical Compliance Specialist and President of ChirohealthUSA A practicing Chiropractor he remains ldquoin the trenchesrdquo facing challenges with billing coding documentation and compliance he has served as president of the Mississippi Chiropractic Association former Staff Chiropractor at

the gv Sonny Montgomery vA Medical Center and is a Fellow of the International College of Chiropractic you can contact Dr Foxworth at 1 (888) 719-9990 infochirohealthusacom or visit the ChirohealthUSA website at wwwchirohealthusacom join us for a free webinar that will give you all the details about how a DMPO can help you practice with more peace of mind go to wwwchirohealthusacom to register today

spring 201416

Were already there ndash ChirOPraCtiC and PUBliC health hand-in-handBy Caitlin Lukacs from the March 2014 issue of ACA news

Public health is a popular buzz phrase in the healthcare arena but what exactly is it and how does chiropractic fit into it ldquoPublic health describes the overall wellbeing of the populacerdquo explains Richard Bruns DC past chairman of the American Chiropractic Associationrsquos (ACA) Wellness and Health Promotion Committee and ACA chairman of the Board of Governors ldquoAll public health issues have future implications for individuals as well as the publicrdquo

Public health encompasses habits and social norms such as smoking alcohol consumption obesity and the use of seatbelts as well as environmental issues such as clean water air quality and how livestock and agricultural practices affect the environment adds Will Evans DC PhD MCHES provost of the University of Western States Public health also includes health education and health promotion

ldquoPublic health and chiropractic go hand-in-handrdquo explains Karen Konarski-Hart DC DABCO FACO vice president of ACArsquos Council of Delegates and chairman of the American Public Health Association (APHA)Wellness and Health Promotion Committee ldquoDCs donrsquot practice in a vacuum they are interested in all aspects of a patientrsquos life that affect his or her health and wellbeing as well as how that person interacts in the healthcare community at largerdquo

Whether they identify it as public health or not all chiropractic physicians address public health issues when dealing with their patients For example when a new patient comes into your office you begin with a detailed history and an initial examination that includes not only taking vital signs but discussing tobacco and alcohol use and other behaviors that affect that patientrsquos health explains Dr Evans ldquoThis allows you to create an individual health-risk assessment based on his or her environment family history lifestyle etc and address public health issues such as tobacco use at the same timerdquo he says

BROACHING THE SUBjECTIt can sometimes be difficult to initiate conversations with patients about issues such as smoking or weight loss ldquoThe best place to address such topics is in your initial report of findings to the patientrdquo suggests Dr Evans ldquoYoursquove examined the patient and determined the cause of the pain or complaint that brought him or her into your office in the first place and now yoursquove got an opportunity to say lsquoI see some lifestyle-related issues that could be contributing to your pain or that could lead to other complaints down the roadrsquordquo

Yoursquore in a position to identify potential problems for your

patients says Dr Konarski-Hart ldquoThey may be setting themselves up for diabetes or cardiovascular disease or maybe they arenrsquot getting enough exercise mdash all of these things should be discussed as part of good primary carerdquo

You never want to force patients to make changes so yoursquoll need to assess their openness to addressing lifestyle changes first Simply ask them if theyrsquod be willing to discuss a healthier weight for example If they are you can let them know that you have multiple resources and partners in place to help them move forward

Dr Evans determines his patientsrsquo willingness to make lifestyle modifications by using the Stages of Change a common model of health behavior change The Stages of Change are

Pre-contemplator stage ndash Patient has no intention of making any changes in the next six months

Contemplator stage ndash Patient is considering a change within the next six months

Preparation stage ndash Patient has decided on a change and is preparing to take some kind of action

Action stage ndash Patient has begun implementing the change

Maintenance stage ndash Patient has made a change and is now working to maintain it

Take the example of an overweight patient Because the average weight of an individual in the United States has increased over the past few years some people who are overweight or borderline overweight donrsquot even realize it says Dr Evans Broach the subject gently and suggest a few small goals such as parking farther away from the office or shopping center or wearing a pedometer and working to increase the number of steps taken in a day You could also teach that patient how to read food labels and discuss healthier meal options Itrsquos about identifying the risk communicating the risk determining where your patient falls in the Stages of Change and then prescribing appropriate modifications explains Dr Evans ldquoAnd donrsquot forget to follow up with that patient at his or her next appointment Itrsquos important that he or she doesnrsquot lose confidence in your recommendations or in you as a healthcare providerrdquo he adds

GET INvOLvEDIn addition to discussions with patients in the treatment

Were Already There ndash Chiropractic and Public health hand-in-hand(contd on page 17)

spring 201417

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 16)

room there are many ways to incorporate public health into your practice One of the easiest ways to get involved is to participate in an observance that already exists such as the APHArsquos Public Health Week held the first week of every April (wwwaphaorgprogramshealthweek) or ACArsquos National Chiropractic Health Month (NCHM) celebrated every October These organizations come up with a new theme each year and gather all of the resources you need to participate ldquoIt takes the thinking and planning aspect off of the individual doctorrdquo says Dr Konarski-Hart ldquoAll you need to do is follow the instructions laid out by the parent organizationrdquo Additionally when you throw your hat into the ring on a larger issue or observance you know that the public health community is focused on that issue at that time so you can reach out to your county or state health department or other local healthcare associations and join in their efforts which will help you to build mutually beneficial long-term relationships says Dr Konarski-Hart ldquoMany state groups are underfunded and understaffed and they welcome participation particularly from physiciansrdquo she notes

DCs can also create their own observances ldquoACA offers webinars teleseminars and patient handouts on a variety of public health issuesmdashperuse the offerings and pick a topic to focus on for a week or a monthrdquo says Dr Konarski-Hart She suggests having your clinic sponsor a wellness competition or challenge You could partner with a local exercise facility or health foods store as well as a school or senior center and make it a community event You could also organize an eat well exercise club in which members meet for a walk or bike ride and then share a healthy breakfast or lunch Your practice could sponsor a poster contest at a local school or community center ldquoHave the kids create posters focused on healthy lifestyle choices and then give out prizes of fun healthy exercise such as a day of horseback riding or ice skatingrdquo Dr Konarski-Hart says Additionally your practice could sponsor a marathon participant or a local amateur sports team to show that you support healthy activities and active lifestyles

Similarly be informed about the public health issues in your community Maybe you live in an area with a high population of smokers or perhaps there have been numerous injuries due to not wearing a seatbelt in recent years Do some background research on these topics and then get involved whether that means simply providing patient handouts in your waiting room giving a community health talk participating in health fairs or working with your local health department (and other relevant organizations) to pass pertinent legislation

Look for organizations in your area that are already offering public health resources or programs and set up

a partnership with them For example for the topic of overweightobesity you could offer your clinic as a weigh-in site for participants in Weight Watchers programs suggests Dr Evans or partner with a local gym to give discounts to chiropractic patients Dr Bruns recommends getting involved with the school lunch program to advocate for healthy options for students For smoking cessation work with the American Lung Association to put on an informational presentation at a local hospital or sponsor a 5k or a stair run to raise awareness (and funds) for lung cancer research For drug addiction set up a referral network with psychologists or addiction centers and either offer acupuncture in your office or refer out to an acupuncturist as it has been shown to help patients through the detox process You can also use your knowledge of nutrition and exercise to facilitate the journey through detox says Dr Bruns

Additionally you should make a point to support these other organizations when they host local events (even if yoursquore not an official partner) or reach out for financial support ldquoI always participate in the American Cancer Societyrsquos golf tournament and I display their materials in my office as wellrdquo says Dr Bruns He also participates in the fundraising efforts of the American Heart Association and the American Lung Association on a regular basis ldquoItrsquos good for your patients and your community to see that you care about and support other healthcare organizationsrdquo he says

Another option for public health involvement is to join the APHArsquos Chiropractic Health Care Section Yoursquoll be informed on public health happenings have access to the latest information and research see what DCs are doing nationally and in other states on particular issues and even have the chance to give input and be involved in decision-making

CONCUSSIONConcussion prevention and treatment is one public health topic that is relevant to every patient population in every region of the United States ldquoWersquore seeing more concussions lately due in part to the number of children participating in contact sports the excessive training involved in these sports and the fact that most people arenrsquot aware of the symptoms and long-term risks of concussionsrdquo says Dr Konarski-Hart Helmets donrsquot actually provide protection against concussions either ldquoThe padding will protect the skull from fracture but because your brain is loose inside your skull it is not protected from impact or traumardquo she explains And with todayrsquos cultural emphasis on pushing through the pain wersquore starting to see more and more professional athletes coming forward with serious emotional psychological and neurological issues that are linked to multiple concussions in their past

spring 201418

As an EMT herself Dr Konarski-Hart attended an EMT convention in the summer of 2013 and heard a presentation from the Childrenrsquos Hospital of Arkansas on injury prevention After speaking with the presenters she discovered that they were having trouble getting buy-in from the allopathic community and she offered her services as a DC Since then Dr Konarski-Hart and the Arkansas Chiropractic Physicians Association (ACPA) have been working with the childrenrsquos hospital on various statewide projects dealing with all aspects of injury prevention One such program focuses on concussions

ldquoThrough this partnership we learned that Arkansas has not finalized its concussion protocols yet and we were able to get someone from our ACPA legislative team involved in that process to ensure chiropracticrsquos inclusion as an involved professionrdquo says Dr Konarski-Hart

Because of DCsrsquo knowledge and training itrsquos important for them to get involved with the concussion issue says Dr Bruns ldquoKnowing what we know about concussions we are doing a tremendous service to athletes and their families by completing pre-participation physicals and screenings and watching for signs and symptoms during participation as wellrdquo he says And itrsquos not just athletes who are suffering from concussions mdash itrsquos children who fall off a bike or a swing set or an older adult who slips on the ice

Itrsquos crucial for DCs to help disseminate information about concussions Whether you see concussion symptoms in a patient in your office or work with local sports teams you have the knowledge to serve as a local expert on the topic DCs can assess injured parties work with school administrators to create concussion protocols and push for legislation on standard concussion treatment says Dr Bruns

Kids parents coaches trainers and doctors all need to be aware of concussions and the potential risks involved with sustaining one or more ldquoItrsquos a matter of understanding the potential risks before making a decision to play in a game or to have a player sit out a game for examplerdquo says Dr Konarski-Hart

WErsquoRE ALREADY THEREAs DCs we focus on the biomechanics structure and function of the human body and we have a unique approach in that we look at the whole person in terms of nutrition flexibility blood flow and muscle and nervous tissue function says Dr Bruns ldquoThe chiropractic profession recognizes the importance of healthful eating nutritional support avoiding the bad habits of smoking and drinking alcohol and has been counseling patients on healthy lifestyles since long before it was fashionablerdquo

According to Dr Konarski-Hart simply choosing to be a doctor of chiropractic means that yoursquore involved in public health on some level because your goal is to make your patient healthier and therefore make your community healthier In other words DCs are already an integral part of public health

With the new health care emphasis on wellness and prevention many healthcare providers legislators insurance companies and government policy developers are focusing on how to offer access to these services especially in medically underserved rural areas or small towns Chiropractic representatives need to be part of those discussions to point out that in many of these communities DCs are already there providing that assessment counseling and care This representation is one of the functions of the ACA and state chiropractic associations and why your membership and involvement with these organizations is so critical says Dr Konarski-Hart

aCa neWs extraCERTIFIED CHIROPRACTIC WELLNESS SPECIALIST PROGRAMIn 2011 ACA began a partnership with the National Wellness Institute (NWI) a well respected organization recognized both inside and outside the chiropractic profession to offer a wellness certification program for DCs The 40-hour program will enable students to integrate principles of wellness coaching health promotion and disease prevention to their current practices Once the program is completed DCs will become Certified Chiropractic Wellness Specialists ldquoThe program was developed and launched by Dr Evans Cheryl Hawk DC PhD CHES and Mike Perko PhDmdashdoctors who are at the forefront of health promotion illness prevention and wellnessrdquo says Dr Bruns Originally the certification consisted of four different modules and DCs had to travel to select cities to participate in the weekend seminars However ACA quickly realized that it was difficult for DCs to get to these courses and decided to turn the program into an online certification NWI has taken the lead on this conversion

ACA RESOURCES Bookmark wwwacatoday orgpublichealth on your computer for quick and easy access to patient handouts references and research for presentations a calendar of national public health observances and other resources that have all been vetted by the ACA APHAWellness and Health Promotion Committee for use in your office Published in the March 2014 ACA news

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 17)

spring 201419

ASSOCIATES WANTED

Associate Wanted Starting base annual salary range is 50-60K plus additional monthly $500-2K in productivity compensation Benefits include MalpracticeMedical insurance CE Our care model uses the latest in Chiropractic Massage Physical Therapy Acupuncture and Nutritional medicine services South Bend is home to Notre Dame and a short drive to Chicago and Lake Michigan This is a good place to raise a family with good schools and a low cost of living Sendfax a letter of interest and resume to apintodcyahoocom or fax (574) 254-1652 Posted 11514

Chicagoland Associate Doctor Needed Busy office with multiple long term associates Family practice Thirty minutes to downtown Chicago Full timepart time paid vacation $26hour starting pay with periodic raises Proficient in the Thompson leg-check technique We are looking for someone who is ready and willing to blend with a very upbeat fun and positive staff Interested applicants should email their resume to infotrimbolichironet or fax to (219) 836-2344 wwwtrimbolichironet Posted 12914

Opportunity for Doctor to grow own practice with buyout of 40 year family practice in 2-5 years Located in North Central Indiana with easy access to Indianapolis and Chicago Wonderful area to raise a family good schools low crime slower pace of life Contact pdyer4hotmailcom Posted 2614

Associate Needed We are currently searching for an associate doctor to help us at the Osmon Chiropractic Center in Bloomington IN This would be a tremendous opportunity for a new graduate or anyone considering a possible change of location You will be working in a beautiful 2500 square foot state of the art clinic with 1 other doctor and a professional staff of 8 to assist you There will be only a small amount of practice building activities on your part because we will provide you with a practice representative who will do that for you You will enjoy the security of a known income and practice without the stress of practice overhead and staff management All you need to do is learn our system of patient managementmdashthe same system we all use in the office and work together as a team to get and keep our community under chiropractic care It is an exciting place to practice Send resume and cover letter to drosmonhotmailcom and please feel free to visit our website at wwwDrOsmoncom Posted 3314

EQUIPMENT FOR SALE

For SalemdashFutura 3000GT automatic X-ray film processor two 8x10 cassettes two 7x14 cassettes two 14x17 cassettes Xray film cabinet new film xray I D Imprinter amp infra red light for sale $80000 Mikephelps55attnet or call (765) 345-0224 Posted 92413

PRACTICES FOR SALE

Free North Manchester practice Collected gt$300000 in 2012 Drs Kelsey giving practice records and X-ray to DC who buys their building 302 W MainHwy 114 Appraised for $165000 last monthmdashyou can buy it for $145000 Closing office on 103013 so you must act soon for this opportunity (260) 568-4419 or office 260-982-4646 Posted 100213

DCS WANTED

Kauffman Chiropractic PC is looking for a full-time position to be filled October 2013 Successful 25+ years established company with physical therapy massage therapy and rehabilitation Enthusiastic ambitious doctor who is willing to learn is a must Must be proficient in Diversified Thompson and Distraction techniques Nice salary is offered Email resume to chirodancomcastnet Posted 82713

Fantastic opportunity for energetic success-oriented doctor excited to grow with us professionally Comes with ownership possibilities Learn to share chiropractic in your community Train in an established practice run on outstanding systems Great training and support for you with focus on exceptiional patient communication and care including chiropractic rehab and massage Send CV or resume to clarksvillespineandrehabinsightbbcom Contact Joseph Rogers Lousville Kentucky (812) 282-7500 Posted 1714

Career Opportunity ndash URGENT ASSOCIATE WANTED ndash PEORIA IL Work in a state of the art wellness center with upbeat and professional staff ready to support you Utilize chiropractic clinical nutrition and rehabilitation to manage a wide range of conditions Doctor must be bright outgoing enthusiastic and must have excellent clinical skills This is an opportunity you dont want to miss Designed for someone looking for a career not simply another job Extensive training and great income potential Invest in your future Send a resume to lfulleralignlifecom Posted 12414

Part Time DC needed for Gary IN office for DOT Certified Medical Exams and some Chiropractic beginning March 15 2014 NO STRESS NO BILLING No Overhead ndash No Headaches Easy hours (8 am - 5 pm - 2 dayswk) Continue in your own practice and make extra cash in our office or just work part-time for us Will tutor you and pay for your DOT Certification - work 2 daysweek ($25000) Will tutor you and pay for your DOT Certification ($50hr = $25000year for 2 daysweek) Contact Lynn Biese -Carroll DC at lbiesewirrcom or call (262) 515-2168 Posted 2614

Associate Needed ndash Bloomington Indiana Expanding practice in Bloomington Indiana is looking for full-time position to be filled Enthusiastic ambitious doctor is a must Must be proficient in Diversified and Low Force techniques rehab and physical therapy Practice is a very strong stable consistent referral based practice Salary and profit share of clinic are offered We will train and mentor in technique and all areas of patient compliance and success Send resume to Dr Fox 1710 West Third St Bloomington Indiana 47404 or email to jbfprodigynet Posted 21814

vACATION DOCTORS

Mobile Moje Chiropractic Dr Moje is available for vacation relief and office coverage Licensed in IN OH MI WI MN amp PA Specializing in maternity leave injuries and vacations Call or email for CV availability rates references and further information Contact Dr Moje at stephanmojegmailcom or (218) 205-6141 Posted 81613

indiana state ChirOPraCtiC assOCiatiOn Classifieds

Page 2: ISCA Spring Report 2014

spring 20142

PresidentRobert Tennant DC FICCShirley IN7657371117docthrtcnet

Second Vice-PresidentMichael Toney DCTerre Haute IN8122321464flopper1968hotmailcom

SecretaryMichael Phelps DCMartinsville IN7653422208mikephelps55attnet

TreasurerChristopher Paprocki DC FICCGreenwood IN3178817759jpaprocki1aolcom

Immediate Past PresidentAnthony Wolf DC FICCIndianapolis IN3178981100dranthonywolfgmailcom

Past President RepresentativeRobert Clements DCKokomo IN 7654521330raclements99aolcom

DIRecToRS aT LaRge

Toby Harmon DCJasper IN8126346363harmonfminsightbbcom

Douglas Breger DCNew Albany IN5023227411doctorbregeryahoocom

aLTeRnaTe DIRecToR aT LaRge

Keith Bartley DCJasper IN8124826600brtchirofullnetcom

Joseph Paun DCHighland IN2192274033drjoepaunwellnesscom

DISTRIcT DIRecToRS

District TwoGerard Hofferth DCSouth Bend IN5742561008drhofaolcom

District ThreeJason Russell DCFort Wayne IN2606371000teamoptimumperformancefortwaynecom

District FourPeter Furno DCZionsville IN3173749966pgfindyrrcom

District FiveDiane Vuotto DCIndianapolis IN3178986989vuottojdcomcastnet

District SixRichard Hilton DCNew Palestine IN3178614300drhiltonsbcglobalnet

District Seven Kristen Hartwell DCIndianapolis IN3177849311 iuchiroyahoocomt

District eightShaun Tymchak DCNewburgh IN8128581008drshaunnewburghchirocom

District nineE Curtis Harris DCFranklin IN3177367088drcurtisharriscichcccomcom

aLTeRnaTe DISTRIcT DIRecToRS

District oneRobert Hall DCMerrillville IN2198843250krackbabyaolcom

District TwoWilliam Garl DCBremen IN5745464111wgarlmchsicom

District ThreeTroy Byall DCFort Wayne IN2604144257troybyalldcgmailcom

District FourAdam Cline DCWest Lafayette IN7654633000drclineclinecliniccom

District FiveJoseph Fortunato DCIndianapolis IN3172572225josephfortunatodccomcastnet

District SixDavid Davis DCWinchester IN 7655843665drdddaolcom

District Seven

District eight

District nineScott Auton DCFranklin IN3173460799scottautonyahoocom

indiana state ChirOPraCtiC assOCiatiOn BOard Of direCtOrs

inside this issUePRESIDEnTS MESSAgE1

ISCA BOARD OF DIRECTORS2

ExECUTIvE DIRECTORS MESSAgE3

ThAnk yOU TO ThE 2014 DCS OF ThE DAy4

UPDATE COnTACT InFO4

CISCA LEgISLATIvE REPORT5

ISCA hIghLIghTS MEMBERShIP AnD LOCAL InvOLvEMEnT AT SPRIng

COnFEREnCE6-7

CLOSIng yOUR PRACTICE DOnT jUST ShUT yOUR DOORS8

SPRIng MEAnS TIME FOR ISCA MEMBERS AnD nOnMEMBERS TO MEET In DISTRICTS 9

CERTIFIED MEDICAL ExAMInER TRAInIng REgISTRATIOn 10

ISCA REgIOnAL vIDEO vIEWIngS 11

MEDICAIDMEDICARE UPDATE12-13

InSURAnCE COMMITTEE UPDATE14

TRUST BUT vERIFy15

WERE ALREADy ThERE ndashChIROPRACTIC AnD PUBLIC hEALTh hAnD-In- hAnD16-18

ISCA CLASSIFIEDS19

the isCa rePOrt Will Be distriBUted Online fOr yOUr COnvenienCe Please keeP the assOCiatiOn OffiCe UPdated On yOUr MOst CUrrent eMail address as Well as PraCtiCe

and hOMe addresses sO that We Can PrOvide yOU the MOst tiMely COMMUniCatiOnsUPdate yOUr infOrMatiOn On Page 4

AlternAtes the IsCA by-laws allow for the Directors at large and the District Directors to have Alternate Directors the Alternate At large Directors may reside anywhere in the state the Alternate District Directors must reside within their district there are 9 districts and their boundaries are the same as per the national census this is done to keep the Districts in line on a proportional basis When the Directors are not present the Alternate Directors have the full voting powers as the Directors and may take their place at any meetings this system was initiated to involve more people in the associationrsquos decision-making process and to serve as a training ground for future board members the Alternate Directors at large are nominated by the Directors at large and then must be approved by the Board of Directors the District Director Alternates are recommended by the District Directors and approved by the board

spring 20143

exeCUtive direCtOrs Message PatriCia MCgUffey esq

greetings tO OUr WOnderfUl isCa faMily

Thanks to you the ISCA had a record attendance and a record number of exhibitors at our ISCA Spring Conference that will be highlighted later in this newsletter

Thanks to you the ISCA had one of the most successful DC of the Day Programs at the Legislature ever

Thanks to you the ISCA had a fantastic year at the 2014 Indiana General Assembly Session We passed legislation to allow you to get the training to do physical exams for school bus drivers In addition we defeated legislation that would have reduced the time you could collect for a patientrsquos bill in small claims court from six to two years (This would have created an insurmountable problem for DCs) Dedicated ISCA volunteers braved the tough winter elements for the best attended most successful ISCA visit to the Statehouse ever I am so pleased to tell you that I continue to hear from legislators about how much they appreciate what you do and your service in their communities A full report on our activities is highlighted later in the newsletter

Thanks to you our Insurance Committee answered more insurance Medicaid and Medicare questions than ever before

Thanks to you the ISCA is recognized as one of the strongest chiropractic membership organizations in the country You have the strongest laws and most protective regulations for the chiropractic profession and are the envy of your colleagues in other states

Thanks to you chiropractic patients in Indiana understand the value of chiropractic treatment They read about the benefits in the press receive recognition by the Governorrsquos Proclamation and are pleased to see endorsements in local and national publications that football stars and numerous celebrities tout the benefits of chiropractic

There would be no ISCA story without you We feel truly blessed to have the best and most supportive members anywhere Please let us know how we can serve you to make your practice even more successful

Please let us know how you would like to become more involved in the ISCA by serving on a committee or being considered for a Board member position in the elections at our fall meeting

The ISCA is You Thanks for making 2013 the best year yet and for the many exciting things yet in store for us in 2014

Yours in Chiropractic

Patricia McGuffey EsqExecutive Director

spring 20144

thank yOU tO the 2014 dCs Of the day

We thank all the Chiropractors listed below who volunteered to serve as DC of the Day for the 2014 Indiana General Assembly Session Your participation in the ISCArsquos program promotes the benefits of chiropractic to lawmakers and educates them on the cost effectiveness and efficiency of chiropractic treatment THANK YOU FOR REPRESENTING THE ISCA AND MAKING THIS PROGRAM THE SUCCESS THAT IT IS

Dr Clements Dr Doyle Dr S harmon Dr harris Dr hilton Dr hushower Dr kielur Dr Phelps Dr S Roberts Dr Rusk Dr Schulke Dr vuotto Dr Williams and Dr Wolf

Special thanks to DC of the Day Chairwoman Dr Kristen Hartwell for spearheading this effort

thank yOU tO OUr 2014 PaC COntriBUtOrs

Drs Berseth Chalfant Cochran Cripe Daffron Denis Elliott Fulller Furno garl golden hall hartwell hofferth Molin Phelps Rohleder Ruckel Riggle Schaub Spruch Stulc Unterseher and Wolf

as Well as OUr 2014 legislative assessMent COntriBUtOrs

Drs Frishman Garl Hall Hartwell Wolf and Zajac

Your Donations Allow Us to Continue to Have a Strong Voice at the Statehouse on Your Behalf

UPDaTe YoUR conTacT InFoRMaTIon ndash return to IsCA 200 s Meridian suite 410 Indianapolis In 46225 or Fax it to (317) 686-2672 or email infoindianastatechirosorg

Clinic Name Contact Name

Clinic Address

City State Zip

Home Address

City State Zip

e-mail Clinic Phone ( ) Fax ( )

Home Phone ( ) Mobile Phone ( )

the IsCA report will be distributed online for your convenience Please keep the Association office updated on your most current email address as well as practice and home addresses so that we can provide you the most timely and cost effective communications

UPdate yOUr reCOrds

spring 20145

CisCa legislative rePOrt By Dr Anthony Wolf DC FICC Immediate Past President and Chairman Legislative Committee

The 2013 Legislative session began with a review of all bills introduced to the Indiana General Assembly in early January Our lobbyists Pat McGuffey and Jessaca Turner Stulz reviewed nearly 1000 bills to determine if they would have any impact on the chiropractic profession and our ability to practice in Indiana

The Legislative Committee comprised of Dr Anthony Wolf (Chair) Dr Robert Tennant Dr Frank Laux Dr Mike Toney Dr David Davis Dr Mike Phelps Dr Peter Furno Dr Jared Himsel and Dr Justin Gilmore held weekly conference calls on Friday afternoons lasting 1-3 hours to discuss all bills pertinent to the chiropractic profession in Indiana The bills are summarized and e-mailed to the committee members by Pat McGuffey to be reviewed prior to our conference call The bills are discussed in detail with input by all committee members to decide if any action by the ISCA should be taken Pat and Jessaca will follow-up with the committeersquos recommendations and attend all legislative hearings on these bills The following week the ISCA Legislative Committee is updated on any movement of a bill any action needed on any new bills pertinent to our profession This process continues until the end of the legislative session

This year we were able to retain language in the occupational therapistrsquos scope expansion bill that prohibits them from performing spinal manipulation Our lobbying team was also able to coordinate legislators to table a bill to a summer study session that would have reduced the time to collect a bill from a patient in small claims court from 6 years to 2 years The Legislative Committee felt this would impact our ability to collect on delayed accounts such as Personal Injury cases and insurance delays in payment Pat McGuffey will be actively involved in the summer study session regarding this bill

Through the sole efforts of the ISCA lobbying team we were able to revive a bill with language that will allow Doctors of Chiropractic to be included as a provider that can perform school bus driver physicals All eligible providers must be certified The ISCA will be offering certification courses this year to our membership

GOALS FOR 2014-2015The ISCA Legislative Committee will be reviewing our current scope of practice to expand to more of an ldquoopenrdquo scope to allow future graduates the ability to practice to the full extent of their education obtained at a CCE and US Department of Education accredited institution Emphasis will be added that the education must be a part of the core curriculum National Board Tested and must be taught in a majority of chiropractic schools in the United States

Be sure to complete your insurance survey and return to the ISCA within 10 days When preparing your insurance issue be sure to create a ldquosanitizedrdquo paper trail with your correspondence with the insurance company The ISCA Insurance Committee will review the problems and concerns our membership is experiencing The committee will then formulate a list of concerns to present to the Indiana Department of Insurance to attempt to resolve our issues If this proves unsuccessful the ISCA Legislative Committee will determine if legislation will be appropriate and introduce a bill for the 2015 Legislative session

Remember Lawsuits are expensive and usually require an additional assessment to our membership Legislation requires a large BackPAC fund and intense grassroots efforts by our membership The ISCA Insurance and Legislative Committees will always attempt to resolve issues in the most effective and least costly manner for our membership

To protect and move this profession forward to its proper placement in our healthcare system it requires full active participation of our entire membership

Maintain your highest level of Membership in the ISCA

Contribute to BackPAC

Answer to the ldquocallrdquo

ndash Act on Grassroots efforts

ndash Complete Surveys and Requests

Attend ISCA Sponsored CE Seminars

Become ACTIVE on a committee

Encourage a non-member to become an active member

Every insurance check they cash and the very ability to practice Chiropractic in Indiana is a direct result of the ISCArsquos past present and future efforts

Being involved at the state level for more than 20 years and now at the national level as the ACA Delegate for Indiana I have realized without a doubt that the profession would cease to exist without the continued effort of the ISCA and ACA

Thank you for the privilege to serve as your Immediate Past President Legislative Chair and ACA Delegate

As we all look in the mirror we must consider the quote by Russell Wilson (Seattle Seahawks Quarterback)

Why nOt Me

spring 20146

isCa highlights MeMBershiP and lOCal invOlveMent at sPring COnferenCe

Indianapolis ndash The Indiana State Chiropractic Association (ISCA) spoke of the importance of association membership and involvement during the 2014 Spring Conference February 21-23 2014 at the Hilton Indianapolis North

ldquoMembership does the work of the Associationrdquo said Dr Robert Tennant President of ISCA ldquoIt is this work that is vital to the advancement of the chiropractic profession and strengthening our local legislative effortsrdquo

Foot Levelers presenter Dr Kevin Wong discussed the importance of involvement in your State Association to support the profession ldquoWe will not advance without our membersrdquo said Dr Wong ldquoThey are the messengers that keep our mission movingrdquo

Dr Kevin Wong Dr Miles Bodzin and Dr Tim Maggs presented at the conference Dr Wong presented on understanding and treating the feet and extremities to understand why they are vital to whole body health Dr Bodzinrsquos course discussed the methods systems and strategies for freeing yourself from the shackles of insurance dependence Dr Maggsrsquo course described the current medical model care for high school athletes and discussed the need for the biomechanical model

ldquoThis is a time of great opportunity for the chiropractic profession We must work as a team communicate a consistent message to decision makers and engage more of our doctors to improve health and that is what the ISCA works to dordquo said Dr Tennant

ISCA Executive Director Pat McGuffey said the Association organizes two educational conferences each calendar year for Doctors of Chiropractic in Indiana More than 135 Doctors of Chiropractic attended the 2014 ISCA Spring Conference

Mark your calendar for The ISCA Fall Conference October 10-12 2014 at the Indianapolis Marriott East

1 Welcome to the 2014 ISCA Spring Conference

2 President Dr Robert Tennant discusses the importance of involvement with the Association

3 Executive Director Pat McGuffey reviews the work going on during the 2014 Legislative Session

2

1

2

11

3

spring 20147

4 Dr Kevin Wong speaks on Supporting Your Body

5 Dr Toby Harmon Board Member and Conference Committee Chairman energizes the group while describing his committees goals

6 DrPeterFurnocollectsfortheBackPACraffleduringthemembership luncheon

7 ThankstoallwhomadetheBackPACraffleasuccess

8 Dr Miles Bodzin Founder and CEO of Cash Practice Systems addresses the group at the Membership Luncheon and presents during seminar sessions

9 Attendees at the Membership Luncheon

10 Attendees listen to speakers during the Saturday Membership Luncheon

11 Conference attendees enjoyed the sounds of NEXUS during the attendee reception and mixed and mingled with their colleagues

12 Vendors greeted conference attendees through the event

13 Dr Diane Vuotto Board Member and Membership Committee Chairwoman

4

4

45

6

78

8

99

1010

11

12 1212 13

1111 11

spring 20148

ClOsing yOUr PraCtiCe dOnrsquot JUst shUt yOUr dOOrsBy Stephanie T Eckerle Esq Plews Shadley Racher amp Braun

Many chiropractors need to close their practice whether it is due to retirement relocation or a career change In other cases you may not need to close

your practice but you may want to discontinue the chiropractor-patient relationship with a certain patient Regardless of the scenario there are certain regulations that you need to be aware of in order to close your practice or terminate the patient relationship in compliance with all applicable laws

Closing Your Practice you must notify all of your active patients if you plan on retiring discontinuing your practice or moving from the community Generally active patients would be any patients that you have seen in the past two years The notice that you send to the patients should first state the date that your practice will close This date should be at least thirty days after you send the patients the notice Second the notice should provide directions on how the patients can obtain their medical records or transfer those to another chiropractor If you are going to charge patients any fees for copying medical records this should also be included in the notice In addition you may also include a release form for the medical records that is compliant with HIPAA and all applicable state laws which will further protect you when transferring medical records As a chiropractor you have a duty to promptly release a patients records to any other chiropractor or any other health discipline practitioner designated by the patient upon written request of the patient Lastly the letter should encourage your patients to seek the services of another chiropractor If you do refer your clients to a specific chiropractor you cannot receive any compensation for the referral of that patient under Indiana law

Terminating a Patient Relationship as a chiropractor you cannot abandon a patient under indiana law If you desire to terminate the patient relationship you must give due notice to a patient or those responsible for a patientrsquos care when you are withdrawing from a case Generally we recommend that you provide a patient or their caregiver with written notice of the termination at least thirty days in advance In addition you may want to provide the patient with a referral to another chiropractor Lastly you should always ensure that the patient knows how to obtain and transfer their medical records

The Indiana Chiropractic Board does enforce provisions applicable to closing or selling your practice or terminating the patient relationship For example in 2011 the Chiropractic Board brought a complaint against a chiropractor that refused to release a patientrsquos medical records unless that patient signed a general waiver of liability Therefore ensuring compliance with all applicable laws and regulations is critical In addition to regulatory compliance issues there are many other issues that you may want to consider when selling or closing your practice such as transferring your equipment terminating a lease or selling real estate terminating your employees terminating or assigning any contracts with vendors and allocating liability among you and the seller or purchaser as applicable

Stephanie Eckerle is the chair of the health Care and Life Sciences practice group at Plews Shadley Racher amp Braun LLP She represents various types of medical professionals including chiropractors physicians mid-level providers and pharmacists She also represents practice groups pharmacies laboratories and other health care entities If you have any questions about health care matters including how to close or sell your practice please contact Stephanie at (317) 637-0700 or seckerlepsrbcom

spring 20149

sPring Means tiMe fOr isCa MeMBers and nOnMeMBers tO Meet in distriCts By Cathy Orosz Membership Director and ISCA Association Manager

Spring is here and the ISCA is ready to recruit

ldquoThe snow is cleared and we are ready to hit the ground runningrdquo says Dr Diane Vuotto Membership Chairwoman and District 5 Director ldquoISCA District Directors are ready to engage current and potential members in their area and they need your input

Each of the nine District Directors are currently planning special meetings throughout April and May to recruit new members as well as learn from current members on how the ISCA can serve them better

Dr Hilton will be taking to the road in District 6 for one-on-one meetings If you are interested in scheduling a meeting with Dr Hilton please contact him at drhiltonsbcglobalnet

District 9 will be meeting on Tuesday April 29 at 630 pm at Dr Scott Autonrsquos office at 1551 N Main St in Franklin To attend this meeting and learn more about efforts in District 9 please contact Dr Auton at scottautonyahoocom or (317) 346-0799

If you would like to be more involved the ISCA asks that you please consider volunteering your time and talents Please contact Cathy Orosz at (317) 673-4245 (800) 572-8002 or infoindianastatechirosorg to learn how you can become more involved in the Association

WELCOME NEW MEMBERS 2014

Dr Nancy Elwartowski-Cooper Carmel

Dr Kevin Forrest Indianapolis

Dr Anthony Forrest Indianapolis

Dr Julie Carleton Fishers

INDIANA STATECHIROPRACTICASSOCIATIONwwwindianastatechirosorg

spring 201410

Certified Medical Examiner Training WE NEED 20 PAID REGISTRANTS BY APRIL 10 IN ORDER

TO HOST THIS TRAINING Saturday May 3 and Sunday May 4 2014 Indianapolis Location TBD 800 AM to 6 pm Saturday May 3 and 8 AM to noon Sunday May 4 YOU CANNOT DO PHYSICAL EXAMS FOR TRUCK AND BUS DRIVERS ANY LONGER UNLESS YOU OBTAIN THIS CERTIFICATION Interested in becoming a Certified Medical Examiner (CME) and be listed on the National Reg-istry YOU MUST COMPLETE THIS TRAINING AND TESTING on Federal Motor Carrier Safety Ad-ministrationrsquos (FMCSA) physical qualification standards and guidelines If you intend to perform physical examinations and issue medical certificates for commercial motor vehicle (CMV) drivers to meet the requirements of Section 39141 of the Federal Motor Carrier Safety Regulations (FMCSRs) you must be certified and listed on the FMCSArsquos National Registry by May 21 2014 Upon completion of this program you will be eligible to take the Certification Test for $79 at an Indiana testing site The ISCA will provide you with info regarding multiple testing sites Program presented for the ISCA by Michael Megehee DC National Registry Certified Medical Examiner and President TeamCME LLC

Registration Name Clinic Address CityStateZip Phone Email Address Payment Method (Credit Card or Check) Credit Card Type Credit Card Expiration 3 Digit Code Name on Card Signature Questions Contact Cathy Orosz at infoindianastatechirosorg or call 317-673-4245 or toll-free at 800-572-8002 The ISCA needs a minimum of 20 registrants by Friday April 10 for this program to be offered Payment is needed upon regis-tration and no refunds will be granted

Mail Registrations to Indiana State Chiropractic Association 200 S Meridian St Ste 410 Indianapolis IN 46225 Or Fax to 317-686-2672 or email to infoindianastatechirosorg

The Cost of the 12-hour training is $400 for ISCA Members and $450 for Non Members

Because we have to pay for TeamCME in Advance we must have 20 paid registrants by April 10 in order to host this training MAKE YOUR RESERVATIONS TODAY

spring 201411

CONTACT INFORMATION

NAME_____________________________________________________________________

COMPANY __________________________________________________________________

MAILING ADDRESS__________________________________________________________

CITY STATE ZIP_____________________________________________________________

PHONE ________________________________ FAX________________________________

EMAIL_____________________________________________________________________

ADDITIONAL ATTENDEE NAMES________________________________________________

___________________________________________________________________________

PAYMENT OPTIONS

AMEX VISA MASTERCARD CHECK (MAKE PAYABLE TO ISCA BACKPAC)

CARDHOLDER_______________________________________________________________

CARD ____________________________________________________________________

EXP__________________________ 3 DIGIT SECURITY ___________________________

SIGNATURE_________________________________________________________________

MAIL ISCA 200 S Meridian St Suite 410 Indianapolis IN 46225FAX 3176862672 ATTN Cathy Orosz

ISCA REGIONAL VIDEO VIEWINGSNEED CONTINUING EDUCATION HOURS THERErsquoS STILL TIME

Donrsquot miss your opportunity to get your required continuing education credits prior to June 30 2014 Indiana Statute dictates that every Licensed Chiropractor in Indiana gets four hours of risk management each year by attending one of the ISCArsquos Regional Video Viewings

There are a limited number of seats at some locations so pre-registration is necessaryIf you choose to pay at the door Pre-Registration is REQUIRED Non-prior notice of attendance will be subject to the Non-Member rate above Call the ISCA office for availability at your location (317) 673-4245 If you need directions to a location please call the ISCA for host contact information

Proceeds of the viewings are contributed to the ISCA Political Action Committee and are non-business deductible

QUESTIONS Contact Cathy Orosz at 8005728002 3176734245 or email infoindianastatechirosorg Proceeds of the viewings are contributed to the ISCA Political Action Committee and are non-business deductible

Contributions to the ISCA Political Action Committee are non-business deductible

REGIONAL VIDEO RATES

$185 Member In Good Standing $250 Non-Member $165 GoldSilver Member Free Of Charge - Platinum Member

VIEWING DATES amp LOCATIONS

WEDNESDAY MAY 7 830 AM - 1230PM Dr Patrick Case 3027 Mishawa Ave South Bend IN

TUESDAY MAY 8 830 AM - 1230PM Dr Douglas Breger 2652 Charlestown Rd New Albany IN

SATURDAY MAY 10 830 AM - 1230PM Dr John Kostidis Call 2199244456 for location and availability Valparaiso IN

WEDNESDAY MAY 13 7 AM - 11 AM Dr Toby Harmon 2602 Newton St Jasper IN

THURSDAY MAY 15 9 AM - 1PM Dr Michael Hartle 3835 W Jefferson Blvd Fort Wayne IN

spring 201412

MediCaidMediCare UPdateBy Michael Phelps DC Secretary ISCA Board of Directors MedicaidMedicare Advising Committee

2013 saw yet another attempt to take chiropractic care out of Medicaid The ISCA amp its Legislative Committee was successful in stopping this attack on the chiropractic profession Thanks to the hard work of the ISCA Indiana remains one of the limited states where Medicaid covers all chiropractic services under our states scope of practice

January 1 2014 also saw the reinstatement of the 5 reduction in imbursement that we accepted several years ago

The ISCA is able to keep chiropractors in the Medicaid Program as well as other insurance as a paid provider through the hard work and dedication of volunteers If you are able to donate some time there are a number of committees and positions that need to be filled by doctors that want to make a difference If you know of DCs that are not members of the ISCA tell them about the good work we do for the profession and that we need all Doctors of Chiropractic in this state to be members Remember if youre not part of the solution youre part of the problem

As you know with the changes in health care coverage there are changes with respect to Medicare All chiropractors should be reporting PQRS for incentive payment eligibility Those who report satisfactorily for the 2013 amp 2014 program years may avoid the 2015 PQRS payment adjustment Additional information on how to avoid future PQRS payment adjustments can be found through supporting documentation available on the CMS website at httpwwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-InstructionsPQRS Chiropractors are fortunate as they only have to report on three measures

Measure 131 - Pain Assessment and Follow upMeasure 182 - Functional Outcome AssessmentMeasure 317 - Preventive Care and Screening (Screening for High Blood Pressure)

January 1 2014 saw an increase of approximately 9 in the reimbursement for chiropractic adjustments (98940 98941 amp 98942) This increase was due to a reassessment of the RVUs for CMT

The latest CERT report saw a decrease in the percentage of errors for chiropractors Chiropractic physicians need to continue to improve their documentation and coding of services in order to maintain this downward decline of errors

The Wisconsin Physicians Service (WPS) periodically analyzes provider coding patterns to identify deviations within a peer group For the J8 (Indiana and Michigan) Jurisdiction there has been a significantly higher than normal usage of the Code 98942 (CMT of five regions of the spine) There are approximately 35 DCs in the state of Michigan that are on the radar I am happy to report that there are no chiropractors in the state of Indiana under review

All that needs to happen for Chiropractic to fail is for good doctors to do nothing If you know of a chiropractor that is not a member of the ISCA urge them to join

MedicaidMedicare Update (contd on page 13)

spring 201413

MedicaidMedicare Update (contd from page 12)

SGR BILL PASSES HOUSE GOES TO SENATE FOR CONSIDERATIONWe learned that the United States House of Representatives passed House Bill 4302 The bill proposes to extend Medicarersquos Sustainable Growth Rate (SGR) current rate to April 15 2015 and would delay other Medicare deadlines The bill as currently drafted would postpone ICD-10-CM implementation until after October 1 2015 and restrict the Centers for Medicare amp Medicaid Services (CMS) from acting without congressional approval The bill now goes to the US Senate for debate and vote If it passes the Senate it would then be sent to President Obamarsquos desk to be signed or vetoed The ISCA will continue to monitor this situation and recommends preparing for ICD-10 implementation

PLEASE ALSO MARK YOUR CALENDAR WITH THESE DATES Medicare Secondary Payer (MSP) Seminar April 17 2014 from 100 pm to 400 pm Hilton Garden Inn Fort Wayne 8615 US Hwy 24 West Fort Wayne IN Click here to register

There is a Chiropractic Medicare Seminar on April 26 2014 in Mishawaka IN Click here for more information

HELPFUL LINKSNeed help in the transition to ICD-10 Go to the Road to 10 website by clicking here This site is primarily for the MD but has general information that pertains to all health care specialties

Stay up-to-date on changes in Medicare at the WPS Medicare website by clicking here This website is for all providers but sometimes offers information specific to chiropractors

INFORMATION REGARDING THE HOLDING OF APRIL 2014 CLAIMS FOR SERvICES PAID UNDER THE 2014 MEDICARE PHYSICIAN FEE SCHEDULE The 2014 Medicare Physician Fee Schedule (MPFS) final rule stipulated a negative update to the MPFS that was to be effective January 1 2014 That reduction was averted for three months with the passage of the Pathway for SGR Reform Act of 2013 which provided for a 05 percent update for services paid under the MPFS through March 31 2014 CMS is hopeful that there will be congressional action to prevent the negative update from taking effect on April 1 2014 CMS has instructed the Medicare Administrative Contractors to hold claims containing services paid under the MPFS for the first 10 business days of April (ie through April 14 2014) This hold would only affect MPFS claims with dates of service of April 1 2014 and later The hold should have minimal impact on provider cash flow because under current law clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt All claims for services delivered on or before March 31 2014 will be processed and paid under normal procedures regardless of any Congressional actions

spring 201414

insUranCe COMMittee UPdateBy Peter Furno DC ISCA Board of Directors District 4 Director and Insurance Committee Chairman

During 2013 the ISCA Insurance Committee addressed many issues and questions from its members with regard to insurance legalities of advertising and proposed associations with third party vendors offering incentives contrary to our practice statues Doctors with definitively legal questions were referred to their legal counsel for liability reasons Most questions directed to the insurance committee are answered within 24 hours

Because the ISCA continues to receive anecdotal complaints from the field claiming insurer reimbursement discrimination and other transgressions the insurance committee as a part of the ISCArsquos proactive efforts to address this problem has developed a survey to obtain information on various insurance problems or concerns impacting chiropractors in the field The ISCA is aggressively attempting to determine problems that are affecting large numbers of doctors and which may be indicating the development of a trend requiring attention by the ISCA and then the IDOI However although it is the intent to meet with the IDOI once the survey information is correlated so that the contentions of our doctors may be addressed officially without firm evidence of wrong doing by the insurance industry the ISCA cannot go forward Consequently it is imperative that all members who are having trouble submit their complaints to the ISCA together with supportive documentation so that this issue may be addressed

Now that the PPACA is law and will require ldquoevidence-basedrdquo treatment procedures to be utilized before reimbursements are made the intent of the Insurance Committee to make at least one presentation to decision-makers of an employer group regarding the cost-effectiveness and efficacy of chiropractic in the management of work related uncomplicated spine injuries in comparison to traditional medical care Heretofore the majority of employers had no idea of the cost-effectiveness of chiropractic care when compared to traditional medicine and simply allowed their work nurses and medical providers to direct care ndash which the research shows is one of the main reasons costs are so high

The Insurance Committee in an attempt to keep the ISCA membership updated will attempt to address at least two insurance queries weekly and present answers to the membership via the ISCA monthly eNews and Newsletter

Insurance Pearl Medicare and Chiropractic Billing Misconceptions It is worthwhile to address a few of the prevailing misconceptions Here are the nine truisms regarding Medicare and chiropractic

1 There is not a 12-visit limit to Medicare for chiropractic services The limits of care are based on the specific medical necessity of the primary subluxation and its secondary neuromusculoskeletal diagnosis

2 Medicare will pay for both acute and chronic conditions as long as there is documentation or expectation of functional improvement

3 Nonparticipating (nonpar) providers are required to bill for services All covered services under chiropractic (spinal manipulation) must be billed to Medicare

4 Nonpar providers are audited just as par providers are There is no protection from a Medicare audit by being nonpar

5 Nonpar providers must document services in the same manner as any provider of Medicare services Being par or nonpar is irrelevant in reference to documentation of chiropractic services

6 Chiropractors may not opt out of Medicare This is simply not an option for doctors of chiropractic Being nonpar is not opting out but designating oneself as a Medicare provider nonpar In simple terms chiropractors must belong to Medicare to treat Medicare patients

7 Advance Beneficiary Notices (ABNs) should not be used as routine documents for patients to sign on their initial visit However they must be used when there is a genuine belief or reasonable expectation that Medicare will deny or not pay for the service on a specific visit or series of visits In other words a blanket ABN at the beginning of care is not sufficient or compliant

8 Medicare claims are not difficult they are simply different from health insurance claims When not done in Medicares format claims are denied

9 Medicare payment is what it is I will refrain from stating it is good While we all would want higher reimbursements (Who doesnt) the average fees for chiropractic services for manipulation are $30-$36 per visit This is far better reimbursement than under many of the managed care plans chiropractors routinely fight to join Furthermore that dollar amount is for spinal manipulation only other services may be billed to the patient or covered by a secondary insurance plan

spring 201415

trUst BUt verifyBy Dr R A Foxworth FICC MCS-P

I was speaking with a doctor recently who was venting her frustration about not knowing who to believe or trust as an authority when it comes to being in practice today She goes to different seminars because she wants to improve herself personally and professionally She also wants to improve her practice by learning more about her productivity effectiveness documentation compliance and billing She shared that she doesnt simply attend the CEU required hours for her license she puts in seminar hours to improve her practice her clinical skills her compliance and her business insight

Her problem The conflicting information she receives from various experts at each seminar How she asked can they all be right if they all say different things As a result of her experience she wanted to know why a Discount Medical Plan Organization (DMPO) like ChiroHealthUSA was of value in todayrsquos practices Why she asked is this even necessary What are my resources

I passed her third-degree with flying colors by the way

I could appreciate her position because I am a bit of a skeptic myself In fact thats how all this started for me I was a chiropractor in practice just like you trying to maximize my insurance payments so I wasnt leaving money on the table while still working to come up with a way my uninsured patients could afford those fees

Because of my activity within my state (as a governor-appointed health expert as an active participant in my State Chiropractic Association and the state representative for the American Chiropractic Association) I knew there were rules to follow to avoid compliance issues when creating our fee schedule I did my research and initially started a Discount Medical Plan Organization (DMPO) for my state alone I knew this would legally protect my practice and my colleagues and that at the time was my only goal

And as skeptic I wouldnrsquot even take my own word for it when it came to believing that a Discount Medical Plan Organization (DMPO) was the simplest way to keep my fee schedules compliant legal and safe Thatrsquos why I became a Certified Medical Compliance Specialist (MCS-P) so skeptics like me could get a breath and feel at ease As an MCS-P Irsquom quite simply held to a higher standard I have to be able to quote chapter and verse about why any possible fee or activity is or isnrsquot compliant

We know therersquos a plethora of inaccurate information that gets disseminated in our profession Im sad to say that I had to agree with my frustrated colleague when she was venting about all the conflicting advice she was receiving Thatrsquos why ChiroHealthUSA has relationships with many MCS-Ps to help get accurate reliable information out there Many of the brightest minds in our profession agree with and recommend ChiroHealthUSA to their chiropractic colleagues

Looking back when I set up my first DMPO within my state I can see how shortsighted I was I now know that taking ChiroHealthUSA to a national audience to protect all chiropractic practices in the country was the vision I shouldve had at the start Im glad I had an encounter with one of my fellow MCS-Ps who gave me this bigger vision

Learn more about how ChiroHealthUSA can help your practice be more compliant You can attend a free webinar this Tuesday April 1 Register at wwwChiroHealthUSAcom today to find out more

Dr Foxworth is a certified Medical Compliance Specialist and President of ChirohealthUSA A practicing Chiropractor he remains ldquoin the trenchesrdquo facing challenges with billing coding documentation and compliance he has served as president of the Mississippi Chiropractic Association former Staff Chiropractor at

the gv Sonny Montgomery vA Medical Center and is a Fellow of the International College of Chiropractic you can contact Dr Foxworth at 1 (888) 719-9990 infochirohealthusacom or visit the ChirohealthUSA website at wwwchirohealthusacom join us for a free webinar that will give you all the details about how a DMPO can help you practice with more peace of mind go to wwwchirohealthusacom to register today

spring 201416

Were already there ndash ChirOPraCtiC and PUBliC health hand-in-handBy Caitlin Lukacs from the March 2014 issue of ACA news

Public health is a popular buzz phrase in the healthcare arena but what exactly is it and how does chiropractic fit into it ldquoPublic health describes the overall wellbeing of the populacerdquo explains Richard Bruns DC past chairman of the American Chiropractic Associationrsquos (ACA) Wellness and Health Promotion Committee and ACA chairman of the Board of Governors ldquoAll public health issues have future implications for individuals as well as the publicrdquo

Public health encompasses habits and social norms such as smoking alcohol consumption obesity and the use of seatbelts as well as environmental issues such as clean water air quality and how livestock and agricultural practices affect the environment adds Will Evans DC PhD MCHES provost of the University of Western States Public health also includes health education and health promotion

ldquoPublic health and chiropractic go hand-in-handrdquo explains Karen Konarski-Hart DC DABCO FACO vice president of ACArsquos Council of Delegates and chairman of the American Public Health Association (APHA)Wellness and Health Promotion Committee ldquoDCs donrsquot practice in a vacuum they are interested in all aspects of a patientrsquos life that affect his or her health and wellbeing as well as how that person interacts in the healthcare community at largerdquo

Whether they identify it as public health or not all chiropractic physicians address public health issues when dealing with their patients For example when a new patient comes into your office you begin with a detailed history and an initial examination that includes not only taking vital signs but discussing tobacco and alcohol use and other behaviors that affect that patientrsquos health explains Dr Evans ldquoThis allows you to create an individual health-risk assessment based on his or her environment family history lifestyle etc and address public health issues such as tobacco use at the same timerdquo he says

BROACHING THE SUBjECTIt can sometimes be difficult to initiate conversations with patients about issues such as smoking or weight loss ldquoThe best place to address such topics is in your initial report of findings to the patientrdquo suggests Dr Evans ldquoYoursquove examined the patient and determined the cause of the pain or complaint that brought him or her into your office in the first place and now yoursquove got an opportunity to say lsquoI see some lifestyle-related issues that could be contributing to your pain or that could lead to other complaints down the roadrsquordquo

Yoursquore in a position to identify potential problems for your

patients says Dr Konarski-Hart ldquoThey may be setting themselves up for diabetes or cardiovascular disease or maybe they arenrsquot getting enough exercise mdash all of these things should be discussed as part of good primary carerdquo

You never want to force patients to make changes so yoursquoll need to assess their openness to addressing lifestyle changes first Simply ask them if theyrsquod be willing to discuss a healthier weight for example If they are you can let them know that you have multiple resources and partners in place to help them move forward

Dr Evans determines his patientsrsquo willingness to make lifestyle modifications by using the Stages of Change a common model of health behavior change The Stages of Change are

Pre-contemplator stage ndash Patient has no intention of making any changes in the next six months

Contemplator stage ndash Patient is considering a change within the next six months

Preparation stage ndash Patient has decided on a change and is preparing to take some kind of action

Action stage ndash Patient has begun implementing the change

Maintenance stage ndash Patient has made a change and is now working to maintain it

Take the example of an overweight patient Because the average weight of an individual in the United States has increased over the past few years some people who are overweight or borderline overweight donrsquot even realize it says Dr Evans Broach the subject gently and suggest a few small goals such as parking farther away from the office or shopping center or wearing a pedometer and working to increase the number of steps taken in a day You could also teach that patient how to read food labels and discuss healthier meal options Itrsquos about identifying the risk communicating the risk determining where your patient falls in the Stages of Change and then prescribing appropriate modifications explains Dr Evans ldquoAnd donrsquot forget to follow up with that patient at his or her next appointment Itrsquos important that he or she doesnrsquot lose confidence in your recommendations or in you as a healthcare providerrdquo he adds

GET INvOLvEDIn addition to discussions with patients in the treatment

Were Already There ndash Chiropractic and Public health hand-in-hand(contd on page 17)

spring 201417

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 16)

room there are many ways to incorporate public health into your practice One of the easiest ways to get involved is to participate in an observance that already exists such as the APHArsquos Public Health Week held the first week of every April (wwwaphaorgprogramshealthweek) or ACArsquos National Chiropractic Health Month (NCHM) celebrated every October These organizations come up with a new theme each year and gather all of the resources you need to participate ldquoIt takes the thinking and planning aspect off of the individual doctorrdquo says Dr Konarski-Hart ldquoAll you need to do is follow the instructions laid out by the parent organizationrdquo Additionally when you throw your hat into the ring on a larger issue or observance you know that the public health community is focused on that issue at that time so you can reach out to your county or state health department or other local healthcare associations and join in their efforts which will help you to build mutually beneficial long-term relationships says Dr Konarski-Hart ldquoMany state groups are underfunded and understaffed and they welcome participation particularly from physiciansrdquo she notes

DCs can also create their own observances ldquoACA offers webinars teleseminars and patient handouts on a variety of public health issuesmdashperuse the offerings and pick a topic to focus on for a week or a monthrdquo says Dr Konarski-Hart She suggests having your clinic sponsor a wellness competition or challenge You could partner with a local exercise facility or health foods store as well as a school or senior center and make it a community event You could also organize an eat well exercise club in which members meet for a walk or bike ride and then share a healthy breakfast or lunch Your practice could sponsor a poster contest at a local school or community center ldquoHave the kids create posters focused on healthy lifestyle choices and then give out prizes of fun healthy exercise such as a day of horseback riding or ice skatingrdquo Dr Konarski-Hart says Additionally your practice could sponsor a marathon participant or a local amateur sports team to show that you support healthy activities and active lifestyles

Similarly be informed about the public health issues in your community Maybe you live in an area with a high population of smokers or perhaps there have been numerous injuries due to not wearing a seatbelt in recent years Do some background research on these topics and then get involved whether that means simply providing patient handouts in your waiting room giving a community health talk participating in health fairs or working with your local health department (and other relevant organizations) to pass pertinent legislation

Look for organizations in your area that are already offering public health resources or programs and set up

a partnership with them For example for the topic of overweightobesity you could offer your clinic as a weigh-in site for participants in Weight Watchers programs suggests Dr Evans or partner with a local gym to give discounts to chiropractic patients Dr Bruns recommends getting involved with the school lunch program to advocate for healthy options for students For smoking cessation work with the American Lung Association to put on an informational presentation at a local hospital or sponsor a 5k or a stair run to raise awareness (and funds) for lung cancer research For drug addiction set up a referral network with psychologists or addiction centers and either offer acupuncture in your office or refer out to an acupuncturist as it has been shown to help patients through the detox process You can also use your knowledge of nutrition and exercise to facilitate the journey through detox says Dr Bruns

Additionally you should make a point to support these other organizations when they host local events (even if yoursquore not an official partner) or reach out for financial support ldquoI always participate in the American Cancer Societyrsquos golf tournament and I display their materials in my office as wellrdquo says Dr Bruns He also participates in the fundraising efforts of the American Heart Association and the American Lung Association on a regular basis ldquoItrsquos good for your patients and your community to see that you care about and support other healthcare organizationsrdquo he says

Another option for public health involvement is to join the APHArsquos Chiropractic Health Care Section Yoursquoll be informed on public health happenings have access to the latest information and research see what DCs are doing nationally and in other states on particular issues and even have the chance to give input and be involved in decision-making

CONCUSSIONConcussion prevention and treatment is one public health topic that is relevant to every patient population in every region of the United States ldquoWersquore seeing more concussions lately due in part to the number of children participating in contact sports the excessive training involved in these sports and the fact that most people arenrsquot aware of the symptoms and long-term risks of concussionsrdquo says Dr Konarski-Hart Helmets donrsquot actually provide protection against concussions either ldquoThe padding will protect the skull from fracture but because your brain is loose inside your skull it is not protected from impact or traumardquo she explains And with todayrsquos cultural emphasis on pushing through the pain wersquore starting to see more and more professional athletes coming forward with serious emotional psychological and neurological issues that are linked to multiple concussions in their past

spring 201418

As an EMT herself Dr Konarski-Hart attended an EMT convention in the summer of 2013 and heard a presentation from the Childrenrsquos Hospital of Arkansas on injury prevention After speaking with the presenters she discovered that they were having trouble getting buy-in from the allopathic community and she offered her services as a DC Since then Dr Konarski-Hart and the Arkansas Chiropractic Physicians Association (ACPA) have been working with the childrenrsquos hospital on various statewide projects dealing with all aspects of injury prevention One such program focuses on concussions

ldquoThrough this partnership we learned that Arkansas has not finalized its concussion protocols yet and we were able to get someone from our ACPA legislative team involved in that process to ensure chiropracticrsquos inclusion as an involved professionrdquo says Dr Konarski-Hart

Because of DCsrsquo knowledge and training itrsquos important for them to get involved with the concussion issue says Dr Bruns ldquoKnowing what we know about concussions we are doing a tremendous service to athletes and their families by completing pre-participation physicals and screenings and watching for signs and symptoms during participation as wellrdquo he says And itrsquos not just athletes who are suffering from concussions mdash itrsquos children who fall off a bike or a swing set or an older adult who slips on the ice

Itrsquos crucial for DCs to help disseminate information about concussions Whether you see concussion symptoms in a patient in your office or work with local sports teams you have the knowledge to serve as a local expert on the topic DCs can assess injured parties work with school administrators to create concussion protocols and push for legislation on standard concussion treatment says Dr Bruns

Kids parents coaches trainers and doctors all need to be aware of concussions and the potential risks involved with sustaining one or more ldquoItrsquos a matter of understanding the potential risks before making a decision to play in a game or to have a player sit out a game for examplerdquo says Dr Konarski-Hart

WErsquoRE ALREADY THEREAs DCs we focus on the biomechanics structure and function of the human body and we have a unique approach in that we look at the whole person in terms of nutrition flexibility blood flow and muscle and nervous tissue function says Dr Bruns ldquoThe chiropractic profession recognizes the importance of healthful eating nutritional support avoiding the bad habits of smoking and drinking alcohol and has been counseling patients on healthy lifestyles since long before it was fashionablerdquo

According to Dr Konarski-Hart simply choosing to be a doctor of chiropractic means that yoursquore involved in public health on some level because your goal is to make your patient healthier and therefore make your community healthier In other words DCs are already an integral part of public health

With the new health care emphasis on wellness and prevention many healthcare providers legislators insurance companies and government policy developers are focusing on how to offer access to these services especially in medically underserved rural areas or small towns Chiropractic representatives need to be part of those discussions to point out that in many of these communities DCs are already there providing that assessment counseling and care This representation is one of the functions of the ACA and state chiropractic associations and why your membership and involvement with these organizations is so critical says Dr Konarski-Hart

aCa neWs extraCERTIFIED CHIROPRACTIC WELLNESS SPECIALIST PROGRAMIn 2011 ACA began a partnership with the National Wellness Institute (NWI) a well respected organization recognized both inside and outside the chiropractic profession to offer a wellness certification program for DCs The 40-hour program will enable students to integrate principles of wellness coaching health promotion and disease prevention to their current practices Once the program is completed DCs will become Certified Chiropractic Wellness Specialists ldquoThe program was developed and launched by Dr Evans Cheryl Hawk DC PhD CHES and Mike Perko PhDmdashdoctors who are at the forefront of health promotion illness prevention and wellnessrdquo says Dr Bruns Originally the certification consisted of four different modules and DCs had to travel to select cities to participate in the weekend seminars However ACA quickly realized that it was difficult for DCs to get to these courses and decided to turn the program into an online certification NWI has taken the lead on this conversion

ACA RESOURCES Bookmark wwwacatoday orgpublichealth on your computer for quick and easy access to patient handouts references and research for presentations a calendar of national public health observances and other resources that have all been vetted by the ACA APHAWellness and Health Promotion Committee for use in your office Published in the March 2014 ACA news

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 17)

spring 201419

ASSOCIATES WANTED

Associate Wanted Starting base annual salary range is 50-60K plus additional monthly $500-2K in productivity compensation Benefits include MalpracticeMedical insurance CE Our care model uses the latest in Chiropractic Massage Physical Therapy Acupuncture and Nutritional medicine services South Bend is home to Notre Dame and a short drive to Chicago and Lake Michigan This is a good place to raise a family with good schools and a low cost of living Sendfax a letter of interest and resume to apintodcyahoocom or fax (574) 254-1652 Posted 11514

Chicagoland Associate Doctor Needed Busy office with multiple long term associates Family practice Thirty minutes to downtown Chicago Full timepart time paid vacation $26hour starting pay with periodic raises Proficient in the Thompson leg-check technique We are looking for someone who is ready and willing to blend with a very upbeat fun and positive staff Interested applicants should email their resume to infotrimbolichironet or fax to (219) 836-2344 wwwtrimbolichironet Posted 12914

Opportunity for Doctor to grow own practice with buyout of 40 year family practice in 2-5 years Located in North Central Indiana with easy access to Indianapolis and Chicago Wonderful area to raise a family good schools low crime slower pace of life Contact pdyer4hotmailcom Posted 2614

Associate Needed We are currently searching for an associate doctor to help us at the Osmon Chiropractic Center in Bloomington IN This would be a tremendous opportunity for a new graduate or anyone considering a possible change of location You will be working in a beautiful 2500 square foot state of the art clinic with 1 other doctor and a professional staff of 8 to assist you There will be only a small amount of practice building activities on your part because we will provide you with a practice representative who will do that for you You will enjoy the security of a known income and practice without the stress of practice overhead and staff management All you need to do is learn our system of patient managementmdashthe same system we all use in the office and work together as a team to get and keep our community under chiropractic care It is an exciting place to practice Send resume and cover letter to drosmonhotmailcom and please feel free to visit our website at wwwDrOsmoncom Posted 3314

EQUIPMENT FOR SALE

For SalemdashFutura 3000GT automatic X-ray film processor two 8x10 cassettes two 7x14 cassettes two 14x17 cassettes Xray film cabinet new film xray I D Imprinter amp infra red light for sale $80000 Mikephelps55attnet or call (765) 345-0224 Posted 92413

PRACTICES FOR SALE

Free North Manchester practice Collected gt$300000 in 2012 Drs Kelsey giving practice records and X-ray to DC who buys their building 302 W MainHwy 114 Appraised for $165000 last monthmdashyou can buy it for $145000 Closing office on 103013 so you must act soon for this opportunity (260) 568-4419 or office 260-982-4646 Posted 100213

DCS WANTED

Kauffman Chiropractic PC is looking for a full-time position to be filled October 2013 Successful 25+ years established company with physical therapy massage therapy and rehabilitation Enthusiastic ambitious doctor who is willing to learn is a must Must be proficient in Diversified Thompson and Distraction techniques Nice salary is offered Email resume to chirodancomcastnet Posted 82713

Fantastic opportunity for energetic success-oriented doctor excited to grow with us professionally Comes with ownership possibilities Learn to share chiropractic in your community Train in an established practice run on outstanding systems Great training and support for you with focus on exceptiional patient communication and care including chiropractic rehab and massage Send CV or resume to clarksvillespineandrehabinsightbbcom Contact Joseph Rogers Lousville Kentucky (812) 282-7500 Posted 1714

Career Opportunity ndash URGENT ASSOCIATE WANTED ndash PEORIA IL Work in a state of the art wellness center with upbeat and professional staff ready to support you Utilize chiropractic clinical nutrition and rehabilitation to manage a wide range of conditions Doctor must be bright outgoing enthusiastic and must have excellent clinical skills This is an opportunity you dont want to miss Designed for someone looking for a career not simply another job Extensive training and great income potential Invest in your future Send a resume to lfulleralignlifecom Posted 12414

Part Time DC needed for Gary IN office for DOT Certified Medical Exams and some Chiropractic beginning March 15 2014 NO STRESS NO BILLING No Overhead ndash No Headaches Easy hours (8 am - 5 pm - 2 dayswk) Continue in your own practice and make extra cash in our office or just work part-time for us Will tutor you and pay for your DOT Certification - work 2 daysweek ($25000) Will tutor you and pay for your DOT Certification ($50hr = $25000year for 2 daysweek) Contact Lynn Biese -Carroll DC at lbiesewirrcom or call (262) 515-2168 Posted 2614

Associate Needed ndash Bloomington Indiana Expanding practice in Bloomington Indiana is looking for full-time position to be filled Enthusiastic ambitious doctor is a must Must be proficient in Diversified and Low Force techniques rehab and physical therapy Practice is a very strong stable consistent referral based practice Salary and profit share of clinic are offered We will train and mentor in technique and all areas of patient compliance and success Send resume to Dr Fox 1710 West Third St Bloomington Indiana 47404 or email to jbfprodigynet Posted 21814

vACATION DOCTORS

Mobile Moje Chiropractic Dr Moje is available for vacation relief and office coverage Licensed in IN OH MI WI MN amp PA Specializing in maternity leave injuries and vacations Call or email for CV availability rates references and further information Contact Dr Moje at stephanmojegmailcom or (218) 205-6141 Posted 81613

indiana state ChirOPraCtiC assOCiatiOn Classifieds

Page 3: ISCA Spring Report 2014

spring 20143

exeCUtive direCtOrs Message PatriCia MCgUffey esq

greetings tO OUr WOnderfUl isCa faMily

Thanks to you the ISCA had a record attendance and a record number of exhibitors at our ISCA Spring Conference that will be highlighted later in this newsletter

Thanks to you the ISCA had one of the most successful DC of the Day Programs at the Legislature ever

Thanks to you the ISCA had a fantastic year at the 2014 Indiana General Assembly Session We passed legislation to allow you to get the training to do physical exams for school bus drivers In addition we defeated legislation that would have reduced the time you could collect for a patientrsquos bill in small claims court from six to two years (This would have created an insurmountable problem for DCs) Dedicated ISCA volunteers braved the tough winter elements for the best attended most successful ISCA visit to the Statehouse ever I am so pleased to tell you that I continue to hear from legislators about how much they appreciate what you do and your service in their communities A full report on our activities is highlighted later in the newsletter

Thanks to you our Insurance Committee answered more insurance Medicaid and Medicare questions than ever before

Thanks to you the ISCA is recognized as one of the strongest chiropractic membership organizations in the country You have the strongest laws and most protective regulations for the chiropractic profession and are the envy of your colleagues in other states

Thanks to you chiropractic patients in Indiana understand the value of chiropractic treatment They read about the benefits in the press receive recognition by the Governorrsquos Proclamation and are pleased to see endorsements in local and national publications that football stars and numerous celebrities tout the benefits of chiropractic

There would be no ISCA story without you We feel truly blessed to have the best and most supportive members anywhere Please let us know how we can serve you to make your practice even more successful

Please let us know how you would like to become more involved in the ISCA by serving on a committee or being considered for a Board member position in the elections at our fall meeting

The ISCA is You Thanks for making 2013 the best year yet and for the many exciting things yet in store for us in 2014

Yours in Chiropractic

Patricia McGuffey EsqExecutive Director

spring 20144

thank yOU tO the 2014 dCs Of the day

We thank all the Chiropractors listed below who volunteered to serve as DC of the Day for the 2014 Indiana General Assembly Session Your participation in the ISCArsquos program promotes the benefits of chiropractic to lawmakers and educates them on the cost effectiveness and efficiency of chiropractic treatment THANK YOU FOR REPRESENTING THE ISCA AND MAKING THIS PROGRAM THE SUCCESS THAT IT IS

Dr Clements Dr Doyle Dr S harmon Dr harris Dr hilton Dr hushower Dr kielur Dr Phelps Dr S Roberts Dr Rusk Dr Schulke Dr vuotto Dr Williams and Dr Wolf

Special thanks to DC of the Day Chairwoman Dr Kristen Hartwell for spearheading this effort

thank yOU tO OUr 2014 PaC COntriBUtOrs

Drs Berseth Chalfant Cochran Cripe Daffron Denis Elliott Fulller Furno garl golden hall hartwell hofferth Molin Phelps Rohleder Ruckel Riggle Schaub Spruch Stulc Unterseher and Wolf

as Well as OUr 2014 legislative assessMent COntriBUtOrs

Drs Frishman Garl Hall Hartwell Wolf and Zajac

Your Donations Allow Us to Continue to Have a Strong Voice at the Statehouse on Your Behalf

UPDaTe YoUR conTacT InFoRMaTIon ndash return to IsCA 200 s Meridian suite 410 Indianapolis In 46225 or Fax it to (317) 686-2672 or email infoindianastatechirosorg

Clinic Name Contact Name

Clinic Address

City State Zip

Home Address

City State Zip

e-mail Clinic Phone ( ) Fax ( )

Home Phone ( ) Mobile Phone ( )

the IsCA report will be distributed online for your convenience Please keep the Association office updated on your most current email address as well as practice and home addresses so that we can provide you the most timely and cost effective communications

UPdate yOUr reCOrds

spring 20145

CisCa legislative rePOrt By Dr Anthony Wolf DC FICC Immediate Past President and Chairman Legislative Committee

The 2013 Legislative session began with a review of all bills introduced to the Indiana General Assembly in early January Our lobbyists Pat McGuffey and Jessaca Turner Stulz reviewed nearly 1000 bills to determine if they would have any impact on the chiropractic profession and our ability to practice in Indiana

The Legislative Committee comprised of Dr Anthony Wolf (Chair) Dr Robert Tennant Dr Frank Laux Dr Mike Toney Dr David Davis Dr Mike Phelps Dr Peter Furno Dr Jared Himsel and Dr Justin Gilmore held weekly conference calls on Friday afternoons lasting 1-3 hours to discuss all bills pertinent to the chiropractic profession in Indiana The bills are summarized and e-mailed to the committee members by Pat McGuffey to be reviewed prior to our conference call The bills are discussed in detail with input by all committee members to decide if any action by the ISCA should be taken Pat and Jessaca will follow-up with the committeersquos recommendations and attend all legislative hearings on these bills The following week the ISCA Legislative Committee is updated on any movement of a bill any action needed on any new bills pertinent to our profession This process continues until the end of the legislative session

This year we were able to retain language in the occupational therapistrsquos scope expansion bill that prohibits them from performing spinal manipulation Our lobbying team was also able to coordinate legislators to table a bill to a summer study session that would have reduced the time to collect a bill from a patient in small claims court from 6 years to 2 years The Legislative Committee felt this would impact our ability to collect on delayed accounts such as Personal Injury cases and insurance delays in payment Pat McGuffey will be actively involved in the summer study session regarding this bill

Through the sole efforts of the ISCA lobbying team we were able to revive a bill with language that will allow Doctors of Chiropractic to be included as a provider that can perform school bus driver physicals All eligible providers must be certified The ISCA will be offering certification courses this year to our membership

GOALS FOR 2014-2015The ISCA Legislative Committee will be reviewing our current scope of practice to expand to more of an ldquoopenrdquo scope to allow future graduates the ability to practice to the full extent of their education obtained at a CCE and US Department of Education accredited institution Emphasis will be added that the education must be a part of the core curriculum National Board Tested and must be taught in a majority of chiropractic schools in the United States

Be sure to complete your insurance survey and return to the ISCA within 10 days When preparing your insurance issue be sure to create a ldquosanitizedrdquo paper trail with your correspondence with the insurance company The ISCA Insurance Committee will review the problems and concerns our membership is experiencing The committee will then formulate a list of concerns to present to the Indiana Department of Insurance to attempt to resolve our issues If this proves unsuccessful the ISCA Legislative Committee will determine if legislation will be appropriate and introduce a bill for the 2015 Legislative session

Remember Lawsuits are expensive and usually require an additional assessment to our membership Legislation requires a large BackPAC fund and intense grassroots efforts by our membership The ISCA Insurance and Legislative Committees will always attempt to resolve issues in the most effective and least costly manner for our membership

To protect and move this profession forward to its proper placement in our healthcare system it requires full active participation of our entire membership

Maintain your highest level of Membership in the ISCA

Contribute to BackPAC

Answer to the ldquocallrdquo

ndash Act on Grassroots efforts

ndash Complete Surveys and Requests

Attend ISCA Sponsored CE Seminars

Become ACTIVE on a committee

Encourage a non-member to become an active member

Every insurance check they cash and the very ability to practice Chiropractic in Indiana is a direct result of the ISCArsquos past present and future efforts

Being involved at the state level for more than 20 years and now at the national level as the ACA Delegate for Indiana I have realized without a doubt that the profession would cease to exist without the continued effort of the ISCA and ACA

Thank you for the privilege to serve as your Immediate Past President Legislative Chair and ACA Delegate

As we all look in the mirror we must consider the quote by Russell Wilson (Seattle Seahawks Quarterback)

Why nOt Me

spring 20146

isCa highlights MeMBershiP and lOCal invOlveMent at sPring COnferenCe

Indianapolis ndash The Indiana State Chiropractic Association (ISCA) spoke of the importance of association membership and involvement during the 2014 Spring Conference February 21-23 2014 at the Hilton Indianapolis North

ldquoMembership does the work of the Associationrdquo said Dr Robert Tennant President of ISCA ldquoIt is this work that is vital to the advancement of the chiropractic profession and strengthening our local legislative effortsrdquo

Foot Levelers presenter Dr Kevin Wong discussed the importance of involvement in your State Association to support the profession ldquoWe will not advance without our membersrdquo said Dr Wong ldquoThey are the messengers that keep our mission movingrdquo

Dr Kevin Wong Dr Miles Bodzin and Dr Tim Maggs presented at the conference Dr Wong presented on understanding and treating the feet and extremities to understand why they are vital to whole body health Dr Bodzinrsquos course discussed the methods systems and strategies for freeing yourself from the shackles of insurance dependence Dr Maggsrsquo course described the current medical model care for high school athletes and discussed the need for the biomechanical model

ldquoThis is a time of great opportunity for the chiropractic profession We must work as a team communicate a consistent message to decision makers and engage more of our doctors to improve health and that is what the ISCA works to dordquo said Dr Tennant

ISCA Executive Director Pat McGuffey said the Association organizes two educational conferences each calendar year for Doctors of Chiropractic in Indiana More than 135 Doctors of Chiropractic attended the 2014 ISCA Spring Conference

Mark your calendar for The ISCA Fall Conference October 10-12 2014 at the Indianapolis Marriott East

1 Welcome to the 2014 ISCA Spring Conference

2 President Dr Robert Tennant discusses the importance of involvement with the Association

3 Executive Director Pat McGuffey reviews the work going on during the 2014 Legislative Session

2

1

2

11

3

spring 20147

4 Dr Kevin Wong speaks on Supporting Your Body

5 Dr Toby Harmon Board Member and Conference Committee Chairman energizes the group while describing his committees goals

6 DrPeterFurnocollectsfortheBackPACraffleduringthemembership luncheon

7 ThankstoallwhomadetheBackPACraffleasuccess

8 Dr Miles Bodzin Founder and CEO of Cash Practice Systems addresses the group at the Membership Luncheon and presents during seminar sessions

9 Attendees at the Membership Luncheon

10 Attendees listen to speakers during the Saturday Membership Luncheon

11 Conference attendees enjoyed the sounds of NEXUS during the attendee reception and mixed and mingled with their colleagues

12 Vendors greeted conference attendees through the event

13 Dr Diane Vuotto Board Member and Membership Committee Chairwoman

4

4

45

6

78

8

99

1010

11

12 1212 13

1111 11

spring 20148

ClOsing yOUr PraCtiCe dOnrsquot JUst shUt yOUr dOOrsBy Stephanie T Eckerle Esq Plews Shadley Racher amp Braun

Many chiropractors need to close their practice whether it is due to retirement relocation or a career change In other cases you may not need to close

your practice but you may want to discontinue the chiropractor-patient relationship with a certain patient Regardless of the scenario there are certain regulations that you need to be aware of in order to close your practice or terminate the patient relationship in compliance with all applicable laws

Closing Your Practice you must notify all of your active patients if you plan on retiring discontinuing your practice or moving from the community Generally active patients would be any patients that you have seen in the past two years The notice that you send to the patients should first state the date that your practice will close This date should be at least thirty days after you send the patients the notice Second the notice should provide directions on how the patients can obtain their medical records or transfer those to another chiropractor If you are going to charge patients any fees for copying medical records this should also be included in the notice In addition you may also include a release form for the medical records that is compliant with HIPAA and all applicable state laws which will further protect you when transferring medical records As a chiropractor you have a duty to promptly release a patients records to any other chiropractor or any other health discipline practitioner designated by the patient upon written request of the patient Lastly the letter should encourage your patients to seek the services of another chiropractor If you do refer your clients to a specific chiropractor you cannot receive any compensation for the referral of that patient under Indiana law

Terminating a Patient Relationship as a chiropractor you cannot abandon a patient under indiana law If you desire to terminate the patient relationship you must give due notice to a patient or those responsible for a patientrsquos care when you are withdrawing from a case Generally we recommend that you provide a patient or their caregiver with written notice of the termination at least thirty days in advance In addition you may want to provide the patient with a referral to another chiropractor Lastly you should always ensure that the patient knows how to obtain and transfer their medical records

The Indiana Chiropractic Board does enforce provisions applicable to closing or selling your practice or terminating the patient relationship For example in 2011 the Chiropractic Board brought a complaint against a chiropractor that refused to release a patientrsquos medical records unless that patient signed a general waiver of liability Therefore ensuring compliance with all applicable laws and regulations is critical In addition to regulatory compliance issues there are many other issues that you may want to consider when selling or closing your practice such as transferring your equipment terminating a lease or selling real estate terminating your employees terminating or assigning any contracts with vendors and allocating liability among you and the seller or purchaser as applicable

Stephanie Eckerle is the chair of the health Care and Life Sciences practice group at Plews Shadley Racher amp Braun LLP She represents various types of medical professionals including chiropractors physicians mid-level providers and pharmacists She also represents practice groups pharmacies laboratories and other health care entities If you have any questions about health care matters including how to close or sell your practice please contact Stephanie at (317) 637-0700 or seckerlepsrbcom

spring 20149

sPring Means tiMe fOr isCa MeMBers and nOnMeMBers tO Meet in distriCts By Cathy Orosz Membership Director and ISCA Association Manager

Spring is here and the ISCA is ready to recruit

ldquoThe snow is cleared and we are ready to hit the ground runningrdquo says Dr Diane Vuotto Membership Chairwoman and District 5 Director ldquoISCA District Directors are ready to engage current and potential members in their area and they need your input

Each of the nine District Directors are currently planning special meetings throughout April and May to recruit new members as well as learn from current members on how the ISCA can serve them better

Dr Hilton will be taking to the road in District 6 for one-on-one meetings If you are interested in scheduling a meeting with Dr Hilton please contact him at drhiltonsbcglobalnet

District 9 will be meeting on Tuesday April 29 at 630 pm at Dr Scott Autonrsquos office at 1551 N Main St in Franklin To attend this meeting and learn more about efforts in District 9 please contact Dr Auton at scottautonyahoocom or (317) 346-0799

If you would like to be more involved the ISCA asks that you please consider volunteering your time and talents Please contact Cathy Orosz at (317) 673-4245 (800) 572-8002 or infoindianastatechirosorg to learn how you can become more involved in the Association

WELCOME NEW MEMBERS 2014

Dr Nancy Elwartowski-Cooper Carmel

Dr Kevin Forrest Indianapolis

Dr Anthony Forrest Indianapolis

Dr Julie Carleton Fishers

INDIANA STATECHIROPRACTICASSOCIATIONwwwindianastatechirosorg

spring 201410

Certified Medical Examiner Training WE NEED 20 PAID REGISTRANTS BY APRIL 10 IN ORDER

TO HOST THIS TRAINING Saturday May 3 and Sunday May 4 2014 Indianapolis Location TBD 800 AM to 6 pm Saturday May 3 and 8 AM to noon Sunday May 4 YOU CANNOT DO PHYSICAL EXAMS FOR TRUCK AND BUS DRIVERS ANY LONGER UNLESS YOU OBTAIN THIS CERTIFICATION Interested in becoming a Certified Medical Examiner (CME) and be listed on the National Reg-istry YOU MUST COMPLETE THIS TRAINING AND TESTING on Federal Motor Carrier Safety Ad-ministrationrsquos (FMCSA) physical qualification standards and guidelines If you intend to perform physical examinations and issue medical certificates for commercial motor vehicle (CMV) drivers to meet the requirements of Section 39141 of the Federal Motor Carrier Safety Regulations (FMCSRs) you must be certified and listed on the FMCSArsquos National Registry by May 21 2014 Upon completion of this program you will be eligible to take the Certification Test for $79 at an Indiana testing site The ISCA will provide you with info regarding multiple testing sites Program presented for the ISCA by Michael Megehee DC National Registry Certified Medical Examiner and President TeamCME LLC

Registration Name Clinic Address CityStateZip Phone Email Address Payment Method (Credit Card or Check) Credit Card Type Credit Card Expiration 3 Digit Code Name on Card Signature Questions Contact Cathy Orosz at infoindianastatechirosorg or call 317-673-4245 or toll-free at 800-572-8002 The ISCA needs a minimum of 20 registrants by Friday April 10 for this program to be offered Payment is needed upon regis-tration and no refunds will be granted

Mail Registrations to Indiana State Chiropractic Association 200 S Meridian St Ste 410 Indianapolis IN 46225 Or Fax to 317-686-2672 or email to infoindianastatechirosorg

The Cost of the 12-hour training is $400 for ISCA Members and $450 for Non Members

Because we have to pay for TeamCME in Advance we must have 20 paid registrants by April 10 in order to host this training MAKE YOUR RESERVATIONS TODAY

spring 201411

CONTACT INFORMATION

NAME_____________________________________________________________________

COMPANY __________________________________________________________________

MAILING ADDRESS__________________________________________________________

CITY STATE ZIP_____________________________________________________________

PHONE ________________________________ FAX________________________________

EMAIL_____________________________________________________________________

ADDITIONAL ATTENDEE NAMES________________________________________________

___________________________________________________________________________

PAYMENT OPTIONS

AMEX VISA MASTERCARD CHECK (MAKE PAYABLE TO ISCA BACKPAC)

CARDHOLDER_______________________________________________________________

CARD ____________________________________________________________________

EXP__________________________ 3 DIGIT SECURITY ___________________________

SIGNATURE_________________________________________________________________

MAIL ISCA 200 S Meridian St Suite 410 Indianapolis IN 46225FAX 3176862672 ATTN Cathy Orosz

ISCA REGIONAL VIDEO VIEWINGSNEED CONTINUING EDUCATION HOURS THERErsquoS STILL TIME

Donrsquot miss your opportunity to get your required continuing education credits prior to June 30 2014 Indiana Statute dictates that every Licensed Chiropractor in Indiana gets four hours of risk management each year by attending one of the ISCArsquos Regional Video Viewings

There are a limited number of seats at some locations so pre-registration is necessaryIf you choose to pay at the door Pre-Registration is REQUIRED Non-prior notice of attendance will be subject to the Non-Member rate above Call the ISCA office for availability at your location (317) 673-4245 If you need directions to a location please call the ISCA for host contact information

Proceeds of the viewings are contributed to the ISCA Political Action Committee and are non-business deductible

QUESTIONS Contact Cathy Orosz at 8005728002 3176734245 or email infoindianastatechirosorg Proceeds of the viewings are contributed to the ISCA Political Action Committee and are non-business deductible

Contributions to the ISCA Political Action Committee are non-business deductible

REGIONAL VIDEO RATES

$185 Member In Good Standing $250 Non-Member $165 GoldSilver Member Free Of Charge - Platinum Member

VIEWING DATES amp LOCATIONS

WEDNESDAY MAY 7 830 AM - 1230PM Dr Patrick Case 3027 Mishawa Ave South Bend IN

TUESDAY MAY 8 830 AM - 1230PM Dr Douglas Breger 2652 Charlestown Rd New Albany IN

SATURDAY MAY 10 830 AM - 1230PM Dr John Kostidis Call 2199244456 for location and availability Valparaiso IN

WEDNESDAY MAY 13 7 AM - 11 AM Dr Toby Harmon 2602 Newton St Jasper IN

THURSDAY MAY 15 9 AM - 1PM Dr Michael Hartle 3835 W Jefferson Blvd Fort Wayne IN

spring 201412

MediCaidMediCare UPdateBy Michael Phelps DC Secretary ISCA Board of Directors MedicaidMedicare Advising Committee

2013 saw yet another attempt to take chiropractic care out of Medicaid The ISCA amp its Legislative Committee was successful in stopping this attack on the chiropractic profession Thanks to the hard work of the ISCA Indiana remains one of the limited states where Medicaid covers all chiropractic services under our states scope of practice

January 1 2014 also saw the reinstatement of the 5 reduction in imbursement that we accepted several years ago

The ISCA is able to keep chiropractors in the Medicaid Program as well as other insurance as a paid provider through the hard work and dedication of volunteers If you are able to donate some time there are a number of committees and positions that need to be filled by doctors that want to make a difference If you know of DCs that are not members of the ISCA tell them about the good work we do for the profession and that we need all Doctors of Chiropractic in this state to be members Remember if youre not part of the solution youre part of the problem

As you know with the changes in health care coverage there are changes with respect to Medicare All chiropractors should be reporting PQRS for incentive payment eligibility Those who report satisfactorily for the 2013 amp 2014 program years may avoid the 2015 PQRS payment adjustment Additional information on how to avoid future PQRS payment adjustments can be found through supporting documentation available on the CMS website at httpwwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-InstructionsPQRS Chiropractors are fortunate as they only have to report on three measures

Measure 131 - Pain Assessment and Follow upMeasure 182 - Functional Outcome AssessmentMeasure 317 - Preventive Care and Screening (Screening for High Blood Pressure)

January 1 2014 saw an increase of approximately 9 in the reimbursement for chiropractic adjustments (98940 98941 amp 98942) This increase was due to a reassessment of the RVUs for CMT

The latest CERT report saw a decrease in the percentage of errors for chiropractors Chiropractic physicians need to continue to improve their documentation and coding of services in order to maintain this downward decline of errors

The Wisconsin Physicians Service (WPS) periodically analyzes provider coding patterns to identify deviations within a peer group For the J8 (Indiana and Michigan) Jurisdiction there has been a significantly higher than normal usage of the Code 98942 (CMT of five regions of the spine) There are approximately 35 DCs in the state of Michigan that are on the radar I am happy to report that there are no chiropractors in the state of Indiana under review

All that needs to happen for Chiropractic to fail is for good doctors to do nothing If you know of a chiropractor that is not a member of the ISCA urge them to join

MedicaidMedicare Update (contd on page 13)

spring 201413

MedicaidMedicare Update (contd from page 12)

SGR BILL PASSES HOUSE GOES TO SENATE FOR CONSIDERATIONWe learned that the United States House of Representatives passed House Bill 4302 The bill proposes to extend Medicarersquos Sustainable Growth Rate (SGR) current rate to April 15 2015 and would delay other Medicare deadlines The bill as currently drafted would postpone ICD-10-CM implementation until after October 1 2015 and restrict the Centers for Medicare amp Medicaid Services (CMS) from acting without congressional approval The bill now goes to the US Senate for debate and vote If it passes the Senate it would then be sent to President Obamarsquos desk to be signed or vetoed The ISCA will continue to monitor this situation and recommends preparing for ICD-10 implementation

PLEASE ALSO MARK YOUR CALENDAR WITH THESE DATES Medicare Secondary Payer (MSP) Seminar April 17 2014 from 100 pm to 400 pm Hilton Garden Inn Fort Wayne 8615 US Hwy 24 West Fort Wayne IN Click here to register

There is a Chiropractic Medicare Seminar on April 26 2014 in Mishawaka IN Click here for more information

HELPFUL LINKSNeed help in the transition to ICD-10 Go to the Road to 10 website by clicking here This site is primarily for the MD but has general information that pertains to all health care specialties

Stay up-to-date on changes in Medicare at the WPS Medicare website by clicking here This website is for all providers but sometimes offers information specific to chiropractors

INFORMATION REGARDING THE HOLDING OF APRIL 2014 CLAIMS FOR SERvICES PAID UNDER THE 2014 MEDICARE PHYSICIAN FEE SCHEDULE The 2014 Medicare Physician Fee Schedule (MPFS) final rule stipulated a negative update to the MPFS that was to be effective January 1 2014 That reduction was averted for three months with the passage of the Pathway for SGR Reform Act of 2013 which provided for a 05 percent update for services paid under the MPFS through March 31 2014 CMS is hopeful that there will be congressional action to prevent the negative update from taking effect on April 1 2014 CMS has instructed the Medicare Administrative Contractors to hold claims containing services paid under the MPFS for the first 10 business days of April (ie through April 14 2014) This hold would only affect MPFS claims with dates of service of April 1 2014 and later The hold should have minimal impact on provider cash flow because under current law clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt All claims for services delivered on or before March 31 2014 will be processed and paid under normal procedures regardless of any Congressional actions

spring 201414

insUranCe COMMittee UPdateBy Peter Furno DC ISCA Board of Directors District 4 Director and Insurance Committee Chairman

During 2013 the ISCA Insurance Committee addressed many issues and questions from its members with regard to insurance legalities of advertising and proposed associations with third party vendors offering incentives contrary to our practice statues Doctors with definitively legal questions were referred to their legal counsel for liability reasons Most questions directed to the insurance committee are answered within 24 hours

Because the ISCA continues to receive anecdotal complaints from the field claiming insurer reimbursement discrimination and other transgressions the insurance committee as a part of the ISCArsquos proactive efforts to address this problem has developed a survey to obtain information on various insurance problems or concerns impacting chiropractors in the field The ISCA is aggressively attempting to determine problems that are affecting large numbers of doctors and which may be indicating the development of a trend requiring attention by the ISCA and then the IDOI However although it is the intent to meet with the IDOI once the survey information is correlated so that the contentions of our doctors may be addressed officially without firm evidence of wrong doing by the insurance industry the ISCA cannot go forward Consequently it is imperative that all members who are having trouble submit their complaints to the ISCA together with supportive documentation so that this issue may be addressed

Now that the PPACA is law and will require ldquoevidence-basedrdquo treatment procedures to be utilized before reimbursements are made the intent of the Insurance Committee to make at least one presentation to decision-makers of an employer group regarding the cost-effectiveness and efficacy of chiropractic in the management of work related uncomplicated spine injuries in comparison to traditional medical care Heretofore the majority of employers had no idea of the cost-effectiveness of chiropractic care when compared to traditional medicine and simply allowed their work nurses and medical providers to direct care ndash which the research shows is one of the main reasons costs are so high

The Insurance Committee in an attempt to keep the ISCA membership updated will attempt to address at least two insurance queries weekly and present answers to the membership via the ISCA monthly eNews and Newsletter

Insurance Pearl Medicare and Chiropractic Billing Misconceptions It is worthwhile to address a few of the prevailing misconceptions Here are the nine truisms regarding Medicare and chiropractic

1 There is not a 12-visit limit to Medicare for chiropractic services The limits of care are based on the specific medical necessity of the primary subluxation and its secondary neuromusculoskeletal diagnosis

2 Medicare will pay for both acute and chronic conditions as long as there is documentation or expectation of functional improvement

3 Nonparticipating (nonpar) providers are required to bill for services All covered services under chiropractic (spinal manipulation) must be billed to Medicare

4 Nonpar providers are audited just as par providers are There is no protection from a Medicare audit by being nonpar

5 Nonpar providers must document services in the same manner as any provider of Medicare services Being par or nonpar is irrelevant in reference to documentation of chiropractic services

6 Chiropractors may not opt out of Medicare This is simply not an option for doctors of chiropractic Being nonpar is not opting out but designating oneself as a Medicare provider nonpar In simple terms chiropractors must belong to Medicare to treat Medicare patients

7 Advance Beneficiary Notices (ABNs) should not be used as routine documents for patients to sign on their initial visit However they must be used when there is a genuine belief or reasonable expectation that Medicare will deny or not pay for the service on a specific visit or series of visits In other words a blanket ABN at the beginning of care is not sufficient or compliant

8 Medicare claims are not difficult they are simply different from health insurance claims When not done in Medicares format claims are denied

9 Medicare payment is what it is I will refrain from stating it is good While we all would want higher reimbursements (Who doesnt) the average fees for chiropractic services for manipulation are $30-$36 per visit This is far better reimbursement than under many of the managed care plans chiropractors routinely fight to join Furthermore that dollar amount is for spinal manipulation only other services may be billed to the patient or covered by a secondary insurance plan

spring 201415

trUst BUt verifyBy Dr R A Foxworth FICC MCS-P

I was speaking with a doctor recently who was venting her frustration about not knowing who to believe or trust as an authority when it comes to being in practice today She goes to different seminars because she wants to improve herself personally and professionally She also wants to improve her practice by learning more about her productivity effectiveness documentation compliance and billing She shared that she doesnt simply attend the CEU required hours for her license she puts in seminar hours to improve her practice her clinical skills her compliance and her business insight

Her problem The conflicting information she receives from various experts at each seminar How she asked can they all be right if they all say different things As a result of her experience she wanted to know why a Discount Medical Plan Organization (DMPO) like ChiroHealthUSA was of value in todayrsquos practices Why she asked is this even necessary What are my resources

I passed her third-degree with flying colors by the way

I could appreciate her position because I am a bit of a skeptic myself In fact thats how all this started for me I was a chiropractor in practice just like you trying to maximize my insurance payments so I wasnt leaving money on the table while still working to come up with a way my uninsured patients could afford those fees

Because of my activity within my state (as a governor-appointed health expert as an active participant in my State Chiropractic Association and the state representative for the American Chiropractic Association) I knew there were rules to follow to avoid compliance issues when creating our fee schedule I did my research and initially started a Discount Medical Plan Organization (DMPO) for my state alone I knew this would legally protect my practice and my colleagues and that at the time was my only goal

And as skeptic I wouldnrsquot even take my own word for it when it came to believing that a Discount Medical Plan Organization (DMPO) was the simplest way to keep my fee schedules compliant legal and safe Thatrsquos why I became a Certified Medical Compliance Specialist (MCS-P) so skeptics like me could get a breath and feel at ease As an MCS-P Irsquom quite simply held to a higher standard I have to be able to quote chapter and verse about why any possible fee or activity is or isnrsquot compliant

We know therersquos a plethora of inaccurate information that gets disseminated in our profession Im sad to say that I had to agree with my frustrated colleague when she was venting about all the conflicting advice she was receiving Thatrsquos why ChiroHealthUSA has relationships with many MCS-Ps to help get accurate reliable information out there Many of the brightest minds in our profession agree with and recommend ChiroHealthUSA to their chiropractic colleagues

Looking back when I set up my first DMPO within my state I can see how shortsighted I was I now know that taking ChiroHealthUSA to a national audience to protect all chiropractic practices in the country was the vision I shouldve had at the start Im glad I had an encounter with one of my fellow MCS-Ps who gave me this bigger vision

Learn more about how ChiroHealthUSA can help your practice be more compliant You can attend a free webinar this Tuesday April 1 Register at wwwChiroHealthUSAcom today to find out more

Dr Foxworth is a certified Medical Compliance Specialist and President of ChirohealthUSA A practicing Chiropractor he remains ldquoin the trenchesrdquo facing challenges with billing coding documentation and compliance he has served as president of the Mississippi Chiropractic Association former Staff Chiropractor at

the gv Sonny Montgomery vA Medical Center and is a Fellow of the International College of Chiropractic you can contact Dr Foxworth at 1 (888) 719-9990 infochirohealthusacom or visit the ChirohealthUSA website at wwwchirohealthusacom join us for a free webinar that will give you all the details about how a DMPO can help you practice with more peace of mind go to wwwchirohealthusacom to register today

spring 201416

Were already there ndash ChirOPraCtiC and PUBliC health hand-in-handBy Caitlin Lukacs from the March 2014 issue of ACA news

Public health is a popular buzz phrase in the healthcare arena but what exactly is it and how does chiropractic fit into it ldquoPublic health describes the overall wellbeing of the populacerdquo explains Richard Bruns DC past chairman of the American Chiropractic Associationrsquos (ACA) Wellness and Health Promotion Committee and ACA chairman of the Board of Governors ldquoAll public health issues have future implications for individuals as well as the publicrdquo

Public health encompasses habits and social norms such as smoking alcohol consumption obesity and the use of seatbelts as well as environmental issues such as clean water air quality and how livestock and agricultural practices affect the environment adds Will Evans DC PhD MCHES provost of the University of Western States Public health also includes health education and health promotion

ldquoPublic health and chiropractic go hand-in-handrdquo explains Karen Konarski-Hart DC DABCO FACO vice president of ACArsquos Council of Delegates and chairman of the American Public Health Association (APHA)Wellness and Health Promotion Committee ldquoDCs donrsquot practice in a vacuum they are interested in all aspects of a patientrsquos life that affect his or her health and wellbeing as well as how that person interacts in the healthcare community at largerdquo

Whether they identify it as public health or not all chiropractic physicians address public health issues when dealing with their patients For example when a new patient comes into your office you begin with a detailed history and an initial examination that includes not only taking vital signs but discussing tobacco and alcohol use and other behaviors that affect that patientrsquos health explains Dr Evans ldquoThis allows you to create an individual health-risk assessment based on his or her environment family history lifestyle etc and address public health issues such as tobacco use at the same timerdquo he says

BROACHING THE SUBjECTIt can sometimes be difficult to initiate conversations with patients about issues such as smoking or weight loss ldquoThe best place to address such topics is in your initial report of findings to the patientrdquo suggests Dr Evans ldquoYoursquove examined the patient and determined the cause of the pain or complaint that brought him or her into your office in the first place and now yoursquove got an opportunity to say lsquoI see some lifestyle-related issues that could be contributing to your pain or that could lead to other complaints down the roadrsquordquo

Yoursquore in a position to identify potential problems for your

patients says Dr Konarski-Hart ldquoThey may be setting themselves up for diabetes or cardiovascular disease or maybe they arenrsquot getting enough exercise mdash all of these things should be discussed as part of good primary carerdquo

You never want to force patients to make changes so yoursquoll need to assess their openness to addressing lifestyle changes first Simply ask them if theyrsquod be willing to discuss a healthier weight for example If they are you can let them know that you have multiple resources and partners in place to help them move forward

Dr Evans determines his patientsrsquo willingness to make lifestyle modifications by using the Stages of Change a common model of health behavior change The Stages of Change are

Pre-contemplator stage ndash Patient has no intention of making any changes in the next six months

Contemplator stage ndash Patient is considering a change within the next six months

Preparation stage ndash Patient has decided on a change and is preparing to take some kind of action

Action stage ndash Patient has begun implementing the change

Maintenance stage ndash Patient has made a change and is now working to maintain it

Take the example of an overweight patient Because the average weight of an individual in the United States has increased over the past few years some people who are overweight or borderline overweight donrsquot even realize it says Dr Evans Broach the subject gently and suggest a few small goals such as parking farther away from the office or shopping center or wearing a pedometer and working to increase the number of steps taken in a day You could also teach that patient how to read food labels and discuss healthier meal options Itrsquos about identifying the risk communicating the risk determining where your patient falls in the Stages of Change and then prescribing appropriate modifications explains Dr Evans ldquoAnd donrsquot forget to follow up with that patient at his or her next appointment Itrsquos important that he or she doesnrsquot lose confidence in your recommendations or in you as a healthcare providerrdquo he adds

GET INvOLvEDIn addition to discussions with patients in the treatment

Were Already There ndash Chiropractic and Public health hand-in-hand(contd on page 17)

spring 201417

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 16)

room there are many ways to incorporate public health into your practice One of the easiest ways to get involved is to participate in an observance that already exists such as the APHArsquos Public Health Week held the first week of every April (wwwaphaorgprogramshealthweek) or ACArsquos National Chiropractic Health Month (NCHM) celebrated every October These organizations come up with a new theme each year and gather all of the resources you need to participate ldquoIt takes the thinking and planning aspect off of the individual doctorrdquo says Dr Konarski-Hart ldquoAll you need to do is follow the instructions laid out by the parent organizationrdquo Additionally when you throw your hat into the ring on a larger issue or observance you know that the public health community is focused on that issue at that time so you can reach out to your county or state health department or other local healthcare associations and join in their efforts which will help you to build mutually beneficial long-term relationships says Dr Konarski-Hart ldquoMany state groups are underfunded and understaffed and they welcome participation particularly from physiciansrdquo she notes

DCs can also create their own observances ldquoACA offers webinars teleseminars and patient handouts on a variety of public health issuesmdashperuse the offerings and pick a topic to focus on for a week or a monthrdquo says Dr Konarski-Hart She suggests having your clinic sponsor a wellness competition or challenge You could partner with a local exercise facility or health foods store as well as a school or senior center and make it a community event You could also organize an eat well exercise club in which members meet for a walk or bike ride and then share a healthy breakfast or lunch Your practice could sponsor a poster contest at a local school or community center ldquoHave the kids create posters focused on healthy lifestyle choices and then give out prizes of fun healthy exercise such as a day of horseback riding or ice skatingrdquo Dr Konarski-Hart says Additionally your practice could sponsor a marathon participant or a local amateur sports team to show that you support healthy activities and active lifestyles

Similarly be informed about the public health issues in your community Maybe you live in an area with a high population of smokers or perhaps there have been numerous injuries due to not wearing a seatbelt in recent years Do some background research on these topics and then get involved whether that means simply providing patient handouts in your waiting room giving a community health talk participating in health fairs or working with your local health department (and other relevant organizations) to pass pertinent legislation

Look for organizations in your area that are already offering public health resources or programs and set up

a partnership with them For example for the topic of overweightobesity you could offer your clinic as a weigh-in site for participants in Weight Watchers programs suggests Dr Evans or partner with a local gym to give discounts to chiropractic patients Dr Bruns recommends getting involved with the school lunch program to advocate for healthy options for students For smoking cessation work with the American Lung Association to put on an informational presentation at a local hospital or sponsor a 5k or a stair run to raise awareness (and funds) for lung cancer research For drug addiction set up a referral network with psychologists or addiction centers and either offer acupuncture in your office or refer out to an acupuncturist as it has been shown to help patients through the detox process You can also use your knowledge of nutrition and exercise to facilitate the journey through detox says Dr Bruns

Additionally you should make a point to support these other organizations when they host local events (even if yoursquore not an official partner) or reach out for financial support ldquoI always participate in the American Cancer Societyrsquos golf tournament and I display their materials in my office as wellrdquo says Dr Bruns He also participates in the fundraising efforts of the American Heart Association and the American Lung Association on a regular basis ldquoItrsquos good for your patients and your community to see that you care about and support other healthcare organizationsrdquo he says

Another option for public health involvement is to join the APHArsquos Chiropractic Health Care Section Yoursquoll be informed on public health happenings have access to the latest information and research see what DCs are doing nationally and in other states on particular issues and even have the chance to give input and be involved in decision-making

CONCUSSIONConcussion prevention and treatment is one public health topic that is relevant to every patient population in every region of the United States ldquoWersquore seeing more concussions lately due in part to the number of children participating in contact sports the excessive training involved in these sports and the fact that most people arenrsquot aware of the symptoms and long-term risks of concussionsrdquo says Dr Konarski-Hart Helmets donrsquot actually provide protection against concussions either ldquoThe padding will protect the skull from fracture but because your brain is loose inside your skull it is not protected from impact or traumardquo she explains And with todayrsquos cultural emphasis on pushing through the pain wersquore starting to see more and more professional athletes coming forward with serious emotional psychological and neurological issues that are linked to multiple concussions in their past

spring 201418

As an EMT herself Dr Konarski-Hart attended an EMT convention in the summer of 2013 and heard a presentation from the Childrenrsquos Hospital of Arkansas on injury prevention After speaking with the presenters she discovered that they were having trouble getting buy-in from the allopathic community and she offered her services as a DC Since then Dr Konarski-Hart and the Arkansas Chiropractic Physicians Association (ACPA) have been working with the childrenrsquos hospital on various statewide projects dealing with all aspects of injury prevention One such program focuses on concussions

ldquoThrough this partnership we learned that Arkansas has not finalized its concussion protocols yet and we were able to get someone from our ACPA legislative team involved in that process to ensure chiropracticrsquos inclusion as an involved professionrdquo says Dr Konarski-Hart

Because of DCsrsquo knowledge and training itrsquos important for them to get involved with the concussion issue says Dr Bruns ldquoKnowing what we know about concussions we are doing a tremendous service to athletes and their families by completing pre-participation physicals and screenings and watching for signs and symptoms during participation as wellrdquo he says And itrsquos not just athletes who are suffering from concussions mdash itrsquos children who fall off a bike or a swing set or an older adult who slips on the ice

Itrsquos crucial for DCs to help disseminate information about concussions Whether you see concussion symptoms in a patient in your office or work with local sports teams you have the knowledge to serve as a local expert on the topic DCs can assess injured parties work with school administrators to create concussion protocols and push for legislation on standard concussion treatment says Dr Bruns

Kids parents coaches trainers and doctors all need to be aware of concussions and the potential risks involved with sustaining one or more ldquoItrsquos a matter of understanding the potential risks before making a decision to play in a game or to have a player sit out a game for examplerdquo says Dr Konarski-Hart

WErsquoRE ALREADY THEREAs DCs we focus on the biomechanics structure and function of the human body and we have a unique approach in that we look at the whole person in terms of nutrition flexibility blood flow and muscle and nervous tissue function says Dr Bruns ldquoThe chiropractic profession recognizes the importance of healthful eating nutritional support avoiding the bad habits of smoking and drinking alcohol and has been counseling patients on healthy lifestyles since long before it was fashionablerdquo

According to Dr Konarski-Hart simply choosing to be a doctor of chiropractic means that yoursquore involved in public health on some level because your goal is to make your patient healthier and therefore make your community healthier In other words DCs are already an integral part of public health

With the new health care emphasis on wellness and prevention many healthcare providers legislators insurance companies and government policy developers are focusing on how to offer access to these services especially in medically underserved rural areas or small towns Chiropractic representatives need to be part of those discussions to point out that in many of these communities DCs are already there providing that assessment counseling and care This representation is one of the functions of the ACA and state chiropractic associations and why your membership and involvement with these organizations is so critical says Dr Konarski-Hart

aCa neWs extraCERTIFIED CHIROPRACTIC WELLNESS SPECIALIST PROGRAMIn 2011 ACA began a partnership with the National Wellness Institute (NWI) a well respected organization recognized both inside and outside the chiropractic profession to offer a wellness certification program for DCs The 40-hour program will enable students to integrate principles of wellness coaching health promotion and disease prevention to their current practices Once the program is completed DCs will become Certified Chiropractic Wellness Specialists ldquoThe program was developed and launched by Dr Evans Cheryl Hawk DC PhD CHES and Mike Perko PhDmdashdoctors who are at the forefront of health promotion illness prevention and wellnessrdquo says Dr Bruns Originally the certification consisted of four different modules and DCs had to travel to select cities to participate in the weekend seminars However ACA quickly realized that it was difficult for DCs to get to these courses and decided to turn the program into an online certification NWI has taken the lead on this conversion

ACA RESOURCES Bookmark wwwacatoday orgpublichealth on your computer for quick and easy access to patient handouts references and research for presentations a calendar of national public health observances and other resources that have all been vetted by the ACA APHAWellness and Health Promotion Committee for use in your office Published in the March 2014 ACA news

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 17)

spring 201419

ASSOCIATES WANTED

Associate Wanted Starting base annual salary range is 50-60K plus additional monthly $500-2K in productivity compensation Benefits include MalpracticeMedical insurance CE Our care model uses the latest in Chiropractic Massage Physical Therapy Acupuncture and Nutritional medicine services South Bend is home to Notre Dame and a short drive to Chicago and Lake Michigan This is a good place to raise a family with good schools and a low cost of living Sendfax a letter of interest and resume to apintodcyahoocom or fax (574) 254-1652 Posted 11514

Chicagoland Associate Doctor Needed Busy office with multiple long term associates Family practice Thirty minutes to downtown Chicago Full timepart time paid vacation $26hour starting pay with periodic raises Proficient in the Thompson leg-check technique We are looking for someone who is ready and willing to blend with a very upbeat fun and positive staff Interested applicants should email their resume to infotrimbolichironet or fax to (219) 836-2344 wwwtrimbolichironet Posted 12914

Opportunity for Doctor to grow own practice with buyout of 40 year family practice in 2-5 years Located in North Central Indiana with easy access to Indianapolis and Chicago Wonderful area to raise a family good schools low crime slower pace of life Contact pdyer4hotmailcom Posted 2614

Associate Needed We are currently searching for an associate doctor to help us at the Osmon Chiropractic Center in Bloomington IN This would be a tremendous opportunity for a new graduate or anyone considering a possible change of location You will be working in a beautiful 2500 square foot state of the art clinic with 1 other doctor and a professional staff of 8 to assist you There will be only a small amount of practice building activities on your part because we will provide you with a practice representative who will do that for you You will enjoy the security of a known income and practice without the stress of practice overhead and staff management All you need to do is learn our system of patient managementmdashthe same system we all use in the office and work together as a team to get and keep our community under chiropractic care It is an exciting place to practice Send resume and cover letter to drosmonhotmailcom and please feel free to visit our website at wwwDrOsmoncom Posted 3314

EQUIPMENT FOR SALE

For SalemdashFutura 3000GT automatic X-ray film processor two 8x10 cassettes two 7x14 cassettes two 14x17 cassettes Xray film cabinet new film xray I D Imprinter amp infra red light for sale $80000 Mikephelps55attnet or call (765) 345-0224 Posted 92413

PRACTICES FOR SALE

Free North Manchester practice Collected gt$300000 in 2012 Drs Kelsey giving practice records and X-ray to DC who buys their building 302 W MainHwy 114 Appraised for $165000 last monthmdashyou can buy it for $145000 Closing office on 103013 so you must act soon for this opportunity (260) 568-4419 or office 260-982-4646 Posted 100213

DCS WANTED

Kauffman Chiropractic PC is looking for a full-time position to be filled October 2013 Successful 25+ years established company with physical therapy massage therapy and rehabilitation Enthusiastic ambitious doctor who is willing to learn is a must Must be proficient in Diversified Thompson and Distraction techniques Nice salary is offered Email resume to chirodancomcastnet Posted 82713

Fantastic opportunity for energetic success-oriented doctor excited to grow with us professionally Comes with ownership possibilities Learn to share chiropractic in your community Train in an established practice run on outstanding systems Great training and support for you with focus on exceptiional patient communication and care including chiropractic rehab and massage Send CV or resume to clarksvillespineandrehabinsightbbcom Contact Joseph Rogers Lousville Kentucky (812) 282-7500 Posted 1714

Career Opportunity ndash URGENT ASSOCIATE WANTED ndash PEORIA IL Work in a state of the art wellness center with upbeat and professional staff ready to support you Utilize chiropractic clinical nutrition and rehabilitation to manage a wide range of conditions Doctor must be bright outgoing enthusiastic and must have excellent clinical skills This is an opportunity you dont want to miss Designed for someone looking for a career not simply another job Extensive training and great income potential Invest in your future Send a resume to lfulleralignlifecom Posted 12414

Part Time DC needed for Gary IN office for DOT Certified Medical Exams and some Chiropractic beginning March 15 2014 NO STRESS NO BILLING No Overhead ndash No Headaches Easy hours (8 am - 5 pm - 2 dayswk) Continue in your own practice and make extra cash in our office or just work part-time for us Will tutor you and pay for your DOT Certification - work 2 daysweek ($25000) Will tutor you and pay for your DOT Certification ($50hr = $25000year for 2 daysweek) Contact Lynn Biese -Carroll DC at lbiesewirrcom or call (262) 515-2168 Posted 2614

Associate Needed ndash Bloomington Indiana Expanding practice in Bloomington Indiana is looking for full-time position to be filled Enthusiastic ambitious doctor is a must Must be proficient in Diversified and Low Force techniques rehab and physical therapy Practice is a very strong stable consistent referral based practice Salary and profit share of clinic are offered We will train and mentor in technique and all areas of patient compliance and success Send resume to Dr Fox 1710 West Third St Bloomington Indiana 47404 or email to jbfprodigynet Posted 21814

vACATION DOCTORS

Mobile Moje Chiropractic Dr Moje is available for vacation relief and office coverage Licensed in IN OH MI WI MN amp PA Specializing in maternity leave injuries and vacations Call or email for CV availability rates references and further information Contact Dr Moje at stephanmojegmailcom or (218) 205-6141 Posted 81613

indiana state ChirOPraCtiC assOCiatiOn Classifieds

Page 4: ISCA Spring Report 2014

spring 20144

thank yOU tO the 2014 dCs Of the day

We thank all the Chiropractors listed below who volunteered to serve as DC of the Day for the 2014 Indiana General Assembly Session Your participation in the ISCArsquos program promotes the benefits of chiropractic to lawmakers and educates them on the cost effectiveness and efficiency of chiropractic treatment THANK YOU FOR REPRESENTING THE ISCA AND MAKING THIS PROGRAM THE SUCCESS THAT IT IS

Dr Clements Dr Doyle Dr S harmon Dr harris Dr hilton Dr hushower Dr kielur Dr Phelps Dr S Roberts Dr Rusk Dr Schulke Dr vuotto Dr Williams and Dr Wolf

Special thanks to DC of the Day Chairwoman Dr Kristen Hartwell for spearheading this effort

thank yOU tO OUr 2014 PaC COntriBUtOrs

Drs Berseth Chalfant Cochran Cripe Daffron Denis Elliott Fulller Furno garl golden hall hartwell hofferth Molin Phelps Rohleder Ruckel Riggle Schaub Spruch Stulc Unterseher and Wolf

as Well as OUr 2014 legislative assessMent COntriBUtOrs

Drs Frishman Garl Hall Hartwell Wolf and Zajac

Your Donations Allow Us to Continue to Have a Strong Voice at the Statehouse on Your Behalf

UPDaTe YoUR conTacT InFoRMaTIon ndash return to IsCA 200 s Meridian suite 410 Indianapolis In 46225 or Fax it to (317) 686-2672 or email infoindianastatechirosorg

Clinic Name Contact Name

Clinic Address

City State Zip

Home Address

City State Zip

e-mail Clinic Phone ( ) Fax ( )

Home Phone ( ) Mobile Phone ( )

the IsCA report will be distributed online for your convenience Please keep the Association office updated on your most current email address as well as practice and home addresses so that we can provide you the most timely and cost effective communications

UPdate yOUr reCOrds

spring 20145

CisCa legislative rePOrt By Dr Anthony Wolf DC FICC Immediate Past President and Chairman Legislative Committee

The 2013 Legislative session began with a review of all bills introduced to the Indiana General Assembly in early January Our lobbyists Pat McGuffey and Jessaca Turner Stulz reviewed nearly 1000 bills to determine if they would have any impact on the chiropractic profession and our ability to practice in Indiana

The Legislative Committee comprised of Dr Anthony Wolf (Chair) Dr Robert Tennant Dr Frank Laux Dr Mike Toney Dr David Davis Dr Mike Phelps Dr Peter Furno Dr Jared Himsel and Dr Justin Gilmore held weekly conference calls on Friday afternoons lasting 1-3 hours to discuss all bills pertinent to the chiropractic profession in Indiana The bills are summarized and e-mailed to the committee members by Pat McGuffey to be reviewed prior to our conference call The bills are discussed in detail with input by all committee members to decide if any action by the ISCA should be taken Pat and Jessaca will follow-up with the committeersquos recommendations and attend all legislative hearings on these bills The following week the ISCA Legislative Committee is updated on any movement of a bill any action needed on any new bills pertinent to our profession This process continues until the end of the legislative session

This year we were able to retain language in the occupational therapistrsquos scope expansion bill that prohibits them from performing spinal manipulation Our lobbying team was also able to coordinate legislators to table a bill to a summer study session that would have reduced the time to collect a bill from a patient in small claims court from 6 years to 2 years The Legislative Committee felt this would impact our ability to collect on delayed accounts such as Personal Injury cases and insurance delays in payment Pat McGuffey will be actively involved in the summer study session regarding this bill

Through the sole efforts of the ISCA lobbying team we were able to revive a bill with language that will allow Doctors of Chiropractic to be included as a provider that can perform school bus driver physicals All eligible providers must be certified The ISCA will be offering certification courses this year to our membership

GOALS FOR 2014-2015The ISCA Legislative Committee will be reviewing our current scope of practice to expand to more of an ldquoopenrdquo scope to allow future graduates the ability to practice to the full extent of their education obtained at a CCE and US Department of Education accredited institution Emphasis will be added that the education must be a part of the core curriculum National Board Tested and must be taught in a majority of chiropractic schools in the United States

Be sure to complete your insurance survey and return to the ISCA within 10 days When preparing your insurance issue be sure to create a ldquosanitizedrdquo paper trail with your correspondence with the insurance company The ISCA Insurance Committee will review the problems and concerns our membership is experiencing The committee will then formulate a list of concerns to present to the Indiana Department of Insurance to attempt to resolve our issues If this proves unsuccessful the ISCA Legislative Committee will determine if legislation will be appropriate and introduce a bill for the 2015 Legislative session

Remember Lawsuits are expensive and usually require an additional assessment to our membership Legislation requires a large BackPAC fund and intense grassroots efforts by our membership The ISCA Insurance and Legislative Committees will always attempt to resolve issues in the most effective and least costly manner for our membership

To protect and move this profession forward to its proper placement in our healthcare system it requires full active participation of our entire membership

Maintain your highest level of Membership in the ISCA

Contribute to BackPAC

Answer to the ldquocallrdquo

ndash Act on Grassroots efforts

ndash Complete Surveys and Requests

Attend ISCA Sponsored CE Seminars

Become ACTIVE on a committee

Encourage a non-member to become an active member

Every insurance check they cash and the very ability to practice Chiropractic in Indiana is a direct result of the ISCArsquos past present and future efforts

Being involved at the state level for more than 20 years and now at the national level as the ACA Delegate for Indiana I have realized without a doubt that the profession would cease to exist without the continued effort of the ISCA and ACA

Thank you for the privilege to serve as your Immediate Past President Legislative Chair and ACA Delegate

As we all look in the mirror we must consider the quote by Russell Wilson (Seattle Seahawks Quarterback)

Why nOt Me

spring 20146

isCa highlights MeMBershiP and lOCal invOlveMent at sPring COnferenCe

Indianapolis ndash The Indiana State Chiropractic Association (ISCA) spoke of the importance of association membership and involvement during the 2014 Spring Conference February 21-23 2014 at the Hilton Indianapolis North

ldquoMembership does the work of the Associationrdquo said Dr Robert Tennant President of ISCA ldquoIt is this work that is vital to the advancement of the chiropractic profession and strengthening our local legislative effortsrdquo

Foot Levelers presenter Dr Kevin Wong discussed the importance of involvement in your State Association to support the profession ldquoWe will not advance without our membersrdquo said Dr Wong ldquoThey are the messengers that keep our mission movingrdquo

Dr Kevin Wong Dr Miles Bodzin and Dr Tim Maggs presented at the conference Dr Wong presented on understanding and treating the feet and extremities to understand why they are vital to whole body health Dr Bodzinrsquos course discussed the methods systems and strategies for freeing yourself from the shackles of insurance dependence Dr Maggsrsquo course described the current medical model care for high school athletes and discussed the need for the biomechanical model

ldquoThis is a time of great opportunity for the chiropractic profession We must work as a team communicate a consistent message to decision makers and engage more of our doctors to improve health and that is what the ISCA works to dordquo said Dr Tennant

ISCA Executive Director Pat McGuffey said the Association organizes two educational conferences each calendar year for Doctors of Chiropractic in Indiana More than 135 Doctors of Chiropractic attended the 2014 ISCA Spring Conference

Mark your calendar for The ISCA Fall Conference October 10-12 2014 at the Indianapolis Marriott East

1 Welcome to the 2014 ISCA Spring Conference

2 President Dr Robert Tennant discusses the importance of involvement with the Association

3 Executive Director Pat McGuffey reviews the work going on during the 2014 Legislative Session

2

1

2

11

3

spring 20147

4 Dr Kevin Wong speaks on Supporting Your Body

5 Dr Toby Harmon Board Member and Conference Committee Chairman energizes the group while describing his committees goals

6 DrPeterFurnocollectsfortheBackPACraffleduringthemembership luncheon

7 ThankstoallwhomadetheBackPACraffleasuccess

8 Dr Miles Bodzin Founder and CEO of Cash Practice Systems addresses the group at the Membership Luncheon and presents during seminar sessions

9 Attendees at the Membership Luncheon

10 Attendees listen to speakers during the Saturday Membership Luncheon

11 Conference attendees enjoyed the sounds of NEXUS during the attendee reception and mixed and mingled with their colleagues

12 Vendors greeted conference attendees through the event

13 Dr Diane Vuotto Board Member and Membership Committee Chairwoman

4

4

45

6

78

8

99

1010

11

12 1212 13

1111 11

spring 20148

ClOsing yOUr PraCtiCe dOnrsquot JUst shUt yOUr dOOrsBy Stephanie T Eckerle Esq Plews Shadley Racher amp Braun

Many chiropractors need to close their practice whether it is due to retirement relocation or a career change In other cases you may not need to close

your practice but you may want to discontinue the chiropractor-patient relationship with a certain patient Regardless of the scenario there are certain regulations that you need to be aware of in order to close your practice or terminate the patient relationship in compliance with all applicable laws

Closing Your Practice you must notify all of your active patients if you plan on retiring discontinuing your practice or moving from the community Generally active patients would be any patients that you have seen in the past two years The notice that you send to the patients should first state the date that your practice will close This date should be at least thirty days after you send the patients the notice Second the notice should provide directions on how the patients can obtain their medical records or transfer those to another chiropractor If you are going to charge patients any fees for copying medical records this should also be included in the notice In addition you may also include a release form for the medical records that is compliant with HIPAA and all applicable state laws which will further protect you when transferring medical records As a chiropractor you have a duty to promptly release a patients records to any other chiropractor or any other health discipline practitioner designated by the patient upon written request of the patient Lastly the letter should encourage your patients to seek the services of another chiropractor If you do refer your clients to a specific chiropractor you cannot receive any compensation for the referral of that patient under Indiana law

Terminating a Patient Relationship as a chiropractor you cannot abandon a patient under indiana law If you desire to terminate the patient relationship you must give due notice to a patient or those responsible for a patientrsquos care when you are withdrawing from a case Generally we recommend that you provide a patient or their caregiver with written notice of the termination at least thirty days in advance In addition you may want to provide the patient with a referral to another chiropractor Lastly you should always ensure that the patient knows how to obtain and transfer their medical records

The Indiana Chiropractic Board does enforce provisions applicable to closing or selling your practice or terminating the patient relationship For example in 2011 the Chiropractic Board brought a complaint against a chiropractor that refused to release a patientrsquos medical records unless that patient signed a general waiver of liability Therefore ensuring compliance with all applicable laws and regulations is critical In addition to regulatory compliance issues there are many other issues that you may want to consider when selling or closing your practice such as transferring your equipment terminating a lease or selling real estate terminating your employees terminating or assigning any contracts with vendors and allocating liability among you and the seller or purchaser as applicable

Stephanie Eckerle is the chair of the health Care and Life Sciences practice group at Plews Shadley Racher amp Braun LLP She represents various types of medical professionals including chiropractors physicians mid-level providers and pharmacists She also represents practice groups pharmacies laboratories and other health care entities If you have any questions about health care matters including how to close or sell your practice please contact Stephanie at (317) 637-0700 or seckerlepsrbcom

spring 20149

sPring Means tiMe fOr isCa MeMBers and nOnMeMBers tO Meet in distriCts By Cathy Orosz Membership Director and ISCA Association Manager

Spring is here and the ISCA is ready to recruit

ldquoThe snow is cleared and we are ready to hit the ground runningrdquo says Dr Diane Vuotto Membership Chairwoman and District 5 Director ldquoISCA District Directors are ready to engage current and potential members in their area and they need your input

Each of the nine District Directors are currently planning special meetings throughout April and May to recruit new members as well as learn from current members on how the ISCA can serve them better

Dr Hilton will be taking to the road in District 6 for one-on-one meetings If you are interested in scheduling a meeting with Dr Hilton please contact him at drhiltonsbcglobalnet

District 9 will be meeting on Tuesday April 29 at 630 pm at Dr Scott Autonrsquos office at 1551 N Main St in Franklin To attend this meeting and learn more about efforts in District 9 please contact Dr Auton at scottautonyahoocom or (317) 346-0799

If you would like to be more involved the ISCA asks that you please consider volunteering your time and talents Please contact Cathy Orosz at (317) 673-4245 (800) 572-8002 or infoindianastatechirosorg to learn how you can become more involved in the Association

WELCOME NEW MEMBERS 2014

Dr Nancy Elwartowski-Cooper Carmel

Dr Kevin Forrest Indianapolis

Dr Anthony Forrest Indianapolis

Dr Julie Carleton Fishers

INDIANA STATECHIROPRACTICASSOCIATIONwwwindianastatechirosorg

spring 201410

Certified Medical Examiner Training WE NEED 20 PAID REGISTRANTS BY APRIL 10 IN ORDER

TO HOST THIS TRAINING Saturday May 3 and Sunday May 4 2014 Indianapolis Location TBD 800 AM to 6 pm Saturday May 3 and 8 AM to noon Sunday May 4 YOU CANNOT DO PHYSICAL EXAMS FOR TRUCK AND BUS DRIVERS ANY LONGER UNLESS YOU OBTAIN THIS CERTIFICATION Interested in becoming a Certified Medical Examiner (CME) and be listed on the National Reg-istry YOU MUST COMPLETE THIS TRAINING AND TESTING on Federal Motor Carrier Safety Ad-ministrationrsquos (FMCSA) physical qualification standards and guidelines If you intend to perform physical examinations and issue medical certificates for commercial motor vehicle (CMV) drivers to meet the requirements of Section 39141 of the Federal Motor Carrier Safety Regulations (FMCSRs) you must be certified and listed on the FMCSArsquos National Registry by May 21 2014 Upon completion of this program you will be eligible to take the Certification Test for $79 at an Indiana testing site The ISCA will provide you with info regarding multiple testing sites Program presented for the ISCA by Michael Megehee DC National Registry Certified Medical Examiner and President TeamCME LLC

Registration Name Clinic Address CityStateZip Phone Email Address Payment Method (Credit Card or Check) Credit Card Type Credit Card Expiration 3 Digit Code Name on Card Signature Questions Contact Cathy Orosz at infoindianastatechirosorg or call 317-673-4245 or toll-free at 800-572-8002 The ISCA needs a minimum of 20 registrants by Friday April 10 for this program to be offered Payment is needed upon regis-tration and no refunds will be granted

Mail Registrations to Indiana State Chiropractic Association 200 S Meridian St Ste 410 Indianapolis IN 46225 Or Fax to 317-686-2672 or email to infoindianastatechirosorg

The Cost of the 12-hour training is $400 for ISCA Members and $450 for Non Members

Because we have to pay for TeamCME in Advance we must have 20 paid registrants by April 10 in order to host this training MAKE YOUR RESERVATIONS TODAY

spring 201411

CONTACT INFORMATION

NAME_____________________________________________________________________

COMPANY __________________________________________________________________

MAILING ADDRESS__________________________________________________________

CITY STATE ZIP_____________________________________________________________

PHONE ________________________________ FAX________________________________

EMAIL_____________________________________________________________________

ADDITIONAL ATTENDEE NAMES________________________________________________

___________________________________________________________________________

PAYMENT OPTIONS

AMEX VISA MASTERCARD CHECK (MAKE PAYABLE TO ISCA BACKPAC)

CARDHOLDER_______________________________________________________________

CARD ____________________________________________________________________

EXP__________________________ 3 DIGIT SECURITY ___________________________

SIGNATURE_________________________________________________________________

MAIL ISCA 200 S Meridian St Suite 410 Indianapolis IN 46225FAX 3176862672 ATTN Cathy Orosz

ISCA REGIONAL VIDEO VIEWINGSNEED CONTINUING EDUCATION HOURS THERErsquoS STILL TIME

Donrsquot miss your opportunity to get your required continuing education credits prior to June 30 2014 Indiana Statute dictates that every Licensed Chiropractor in Indiana gets four hours of risk management each year by attending one of the ISCArsquos Regional Video Viewings

There are a limited number of seats at some locations so pre-registration is necessaryIf you choose to pay at the door Pre-Registration is REQUIRED Non-prior notice of attendance will be subject to the Non-Member rate above Call the ISCA office for availability at your location (317) 673-4245 If you need directions to a location please call the ISCA for host contact information

Proceeds of the viewings are contributed to the ISCA Political Action Committee and are non-business deductible

QUESTIONS Contact Cathy Orosz at 8005728002 3176734245 or email infoindianastatechirosorg Proceeds of the viewings are contributed to the ISCA Political Action Committee and are non-business deductible

Contributions to the ISCA Political Action Committee are non-business deductible

REGIONAL VIDEO RATES

$185 Member In Good Standing $250 Non-Member $165 GoldSilver Member Free Of Charge - Platinum Member

VIEWING DATES amp LOCATIONS

WEDNESDAY MAY 7 830 AM - 1230PM Dr Patrick Case 3027 Mishawa Ave South Bend IN

TUESDAY MAY 8 830 AM - 1230PM Dr Douglas Breger 2652 Charlestown Rd New Albany IN

SATURDAY MAY 10 830 AM - 1230PM Dr John Kostidis Call 2199244456 for location and availability Valparaiso IN

WEDNESDAY MAY 13 7 AM - 11 AM Dr Toby Harmon 2602 Newton St Jasper IN

THURSDAY MAY 15 9 AM - 1PM Dr Michael Hartle 3835 W Jefferson Blvd Fort Wayne IN

spring 201412

MediCaidMediCare UPdateBy Michael Phelps DC Secretary ISCA Board of Directors MedicaidMedicare Advising Committee

2013 saw yet another attempt to take chiropractic care out of Medicaid The ISCA amp its Legislative Committee was successful in stopping this attack on the chiropractic profession Thanks to the hard work of the ISCA Indiana remains one of the limited states where Medicaid covers all chiropractic services under our states scope of practice

January 1 2014 also saw the reinstatement of the 5 reduction in imbursement that we accepted several years ago

The ISCA is able to keep chiropractors in the Medicaid Program as well as other insurance as a paid provider through the hard work and dedication of volunteers If you are able to donate some time there are a number of committees and positions that need to be filled by doctors that want to make a difference If you know of DCs that are not members of the ISCA tell them about the good work we do for the profession and that we need all Doctors of Chiropractic in this state to be members Remember if youre not part of the solution youre part of the problem

As you know with the changes in health care coverage there are changes with respect to Medicare All chiropractors should be reporting PQRS for incentive payment eligibility Those who report satisfactorily for the 2013 amp 2014 program years may avoid the 2015 PQRS payment adjustment Additional information on how to avoid future PQRS payment adjustments can be found through supporting documentation available on the CMS website at httpwwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-InstructionsPQRS Chiropractors are fortunate as they only have to report on three measures

Measure 131 - Pain Assessment and Follow upMeasure 182 - Functional Outcome AssessmentMeasure 317 - Preventive Care and Screening (Screening for High Blood Pressure)

January 1 2014 saw an increase of approximately 9 in the reimbursement for chiropractic adjustments (98940 98941 amp 98942) This increase was due to a reassessment of the RVUs for CMT

The latest CERT report saw a decrease in the percentage of errors for chiropractors Chiropractic physicians need to continue to improve their documentation and coding of services in order to maintain this downward decline of errors

The Wisconsin Physicians Service (WPS) periodically analyzes provider coding patterns to identify deviations within a peer group For the J8 (Indiana and Michigan) Jurisdiction there has been a significantly higher than normal usage of the Code 98942 (CMT of five regions of the spine) There are approximately 35 DCs in the state of Michigan that are on the radar I am happy to report that there are no chiropractors in the state of Indiana under review

All that needs to happen for Chiropractic to fail is for good doctors to do nothing If you know of a chiropractor that is not a member of the ISCA urge them to join

MedicaidMedicare Update (contd on page 13)

spring 201413

MedicaidMedicare Update (contd from page 12)

SGR BILL PASSES HOUSE GOES TO SENATE FOR CONSIDERATIONWe learned that the United States House of Representatives passed House Bill 4302 The bill proposes to extend Medicarersquos Sustainable Growth Rate (SGR) current rate to April 15 2015 and would delay other Medicare deadlines The bill as currently drafted would postpone ICD-10-CM implementation until after October 1 2015 and restrict the Centers for Medicare amp Medicaid Services (CMS) from acting without congressional approval The bill now goes to the US Senate for debate and vote If it passes the Senate it would then be sent to President Obamarsquos desk to be signed or vetoed The ISCA will continue to monitor this situation and recommends preparing for ICD-10 implementation

PLEASE ALSO MARK YOUR CALENDAR WITH THESE DATES Medicare Secondary Payer (MSP) Seminar April 17 2014 from 100 pm to 400 pm Hilton Garden Inn Fort Wayne 8615 US Hwy 24 West Fort Wayne IN Click here to register

There is a Chiropractic Medicare Seminar on April 26 2014 in Mishawaka IN Click here for more information

HELPFUL LINKSNeed help in the transition to ICD-10 Go to the Road to 10 website by clicking here This site is primarily for the MD but has general information that pertains to all health care specialties

Stay up-to-date on changes in Medicare at the WPS Medicare website by clicking here This website is for all providers but sometimes offers information specific to chiropractors

INFORMATION REGARDING THE HOLDING OF APRIL 2014 CLAIMS FOR SERvICES PAID UNDER THE 2014 MEDICARE PHYSICIAN FEE SCHEDULE The 2014 Medicare Physician Fee Schedule (MPFS) final rule stipulated a negative update to the MPFS that was to be effective January 1 2014 That reduction was averted for three months with the passage of the Pathway for SGR Reform Act of 2013 which provided for a 05 percent update for services paid under the MPFS through March 31 2014 CMS is hopeful that there will be congressional action to prevent the negative update from taking effect on April 1 2014 CMS has instructed the Medicare Administrative Contractors to hold claims containing services paid under the MPFS for the first 10 business days of April (ie through April 14 2014) This hold would only affect MPFS claims with dates of service of April 1 2014 and later The hold should have minimal impact on provider cash flow because under current law clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt All claims for services delivered on or before March 31 2014 will be processed and paid under normal procedures regardless of any Congressional actions

spring 201414

insUranCe COMMittee UPdateBy Peter Furno DC ISCA Board of Directors District 4 Director and Insurance Committee Chairman

During 2013 the ISCA Insurance Committee addressed many issues and questions from its members with regard to insurance legalities of advertising and proposed associations with third party vendors offering incentives contrary to our practice statues Doctors with definitively legal questions were referred to their legal counsel for liability reasons Most questions directed to the insurance committee are answered within 24 hours

Because the ISCA continues to receive anecdotal complaints from the field claiming insurer reimbursement discrimination and other transgressions the insurance committee as a part of the ISCArsquos proactive efforts to address this problem has developed a survey to obtain information on various insurance problems or concerns impacting chiropractors in the field The ISCA is aggressively attempting to determine problems that are affecting large numbers of doctors and which may be indicating the development of a trend requiring attention by the ISCA and then the IDOI However although it is the intent to meet with the IDOI once the survey information is correlated so that the contentions of our doctors may be addressed officially without firm evidence of wrong doing by the insurance industry the ISCA cannot go forward Consequently it is imperative that all members who are having trouble submit their complaints to the ISCA together with supportive documentation so that this issue may be addressed

Now that the PPACA is law and will require ldquoevidence-basedrdquo treatment procedures to be utilized before reimbursements are made the intent of the Insurance Committee to make at least one presentation to decision-makers of an employer group regarding the cost-effectiveness and efficacy of chiropractic in the management of work related uncomplicated spine injuries in comparison to traditional medical care Heretofore the majority of employers had no idea of the cost-effectiveness of chiropractic care when compared to traditional medicine and simply allowed their work nurses and medical providers to direct care ndash which the research shows is one of the main reasons costs are so high

The Insurance Committee in an attempt to keep the ISCA membership updated will attempt to address at least two insurance queries weekly and present answers to the membership via the ISCA monthly eNews and Newsletter

Insurance Pearl Medicare and Chiropractic Billing Misconceptions It is worthwhile to address a few of the prevailing misconceptions Here are the nine truisms regarding Medicare and chiropractic

1 There is not a 12-visit limit to Medicare for chiropractic services The limits of care are based on the specific medical necessity of the primary subluxation and its secondary neuromusculoskeletal diagnosis

2 Medicare will pay for both acute and chronic conditions as long as there is documentation or expectation of functional improvement

3 Nonparticipating (nonpar) providers are required to bill for services All covered services under chiropractic (spinal manipulation) must be billed to Medicare

4 Nonpar providers are audited just as par providers are There is no protection from a Medicare audit by being nonpar

5 Nonpar providers must document services in the same manner as any provider of Medicare services Being par or nonpar is irrelevant in reference to documentation of chiropractic services

6 Chiropractors may not opt out of Medicare This is simply not an option for doctors of chiropractic Being nonpar is not opting out but designating oneself as a Medicare provider nonpar In simple terms chiropractors must belong to Medicare to treat Medicare patients

7 Advance Beneficiary Notices (ABNs) should not be used as routine documents for patients to sign on their initial visit However they must be used when there is a genuine belief or reasonable expectation that Medicare will deny or not pay for the service on a specific visit or series of visits In other words a blanket ABN at the beginning of care is not sufficient or compliant

8 Medicare claims are not difficult they are simply different from health insurance claims When not done in Medicares format claims are denied

9 Medicare payment is what it is I will refrain from stating it is good While we all would want higher reimbursements (Who doesnt) the average fees for chiropractic services for manipulation are $30-$36 per visit This is far better reimbursement than under many of the managed care plans chiropractors routinely fight to join Furthermore that dollar amount is for spinal manipulation only other services may be billed to the patient or covered by a secondary insurance plan

spring 201415

trUst BUt verifyBy Dr R A Foxworth FICC MCS-P

I was speaking with a doctor recently who was venting her frustration about not knowing who to believe or trust as an authority when it comes to being in practice today She goes to different seminars because she wants to improve herself personally and professionally She also wants to improve her practice by learning more about her productivity effectiveness documentation compliance and billing She shared that she doesnt simply attend the CEU required hours for her license she puts in seminar hours to improve her practice her clinical skills her compliance and her business insight

Her problem The conflicting information she receives from various experts at each seminar How she asked can they all be right if they all say different things As a result of her experience she wanted to know why a Discount Medical Plan Organization (DMPO) like ChiroHealthUSA was of value in todayrsquos practices Why she asked is this even necessary What are my resources

I passed her third-degree with flying colors by the way

I could appreciate her position because I am a bit of a skeptic myself In fact thats how all this started for me I was a chiropractor in practice just like you trying to maximize my insurance payments so I wasnt leaving money on the table while still working to come up with a way my uninsured patients could afford those fees

Because of my activity within my state (as a governor-appointed health expert as an active participant in my State Chiropractic Association and the state representative for the American Chiropractic Association) I knew there were rules to follow to avoid compliance issues when creating our fee schedule I did my research and initially started a Discount Medical Plan Organization (DMPO) for my state alone I knew this would legally protect my practice and my colleagues and that at the time was my only goal

And as skeptic I wouldnrsquot even take my own word for it when it came to believing that a Discount Medical Plan Organization (DMPO) was the simplest way to keep my fee schedules compliant legal and safe Thatrsquos why I became a Certified Medical Compliance Specialist (MCS-P) so skeptics like me could get a breath and feel at ease As an MCS-P Irsquom quite simply held to a higher standard I have to be able to quote chapter and verse about why any possible fee or activity is or isnrsquot compliant

We know therersquos a plethora of inaccurate information that gets disseminated in our profession Im sad to say that I had to agree with my frustrated colleague when she was venting about all the conflicting advice she was receiving Thatrsquos why ChiroHealthUSA has relationships with many MCS-Ps to help get accurate reliable information out there Many of the brightest minds in our profession agree with and recommend ChiroHealthUSA to their chiropractic colleagues

Looking back when I set up my first DMPO within my state I can see how shortsighted I was I now know that taking ChiroHealthUSA to a national audience to protect all chiropractic practices in the country was the vision I shouldve had at the start Im glad I had an encounter with one of my fellow MCS-Ps who gave me this bigger vision

Learn more about how ChiroHealthUSA can help your practice be more compliant You can attend a free webinar this Tuesday April 1 Register at wwwChiroHealthUSAcom today to find out more

Dr Foxworth is a certified Medical Compliance Specialist and President of ChirohealthUSA A practicing Chiropractor he remains ldquoin the trenchesrdquo facing challenges with billing coding documentation and compliance he has served as president of the Mississippi Chiropractic Association former Staff Chiropractor at

the gv Sonny Montgomery vA Medical Center and is a Fellow of the International College of Chiropractic you can contact Dr Foxworth at 1 (888) 719-9990 infochirohealthusacom or visit the ChirohealthUSA website at wwwchirohealthusacom join us for a free webinar that will give you all the details about how a DMPO can help you practice with more peace of mind go to wwwchirohealthusacom to register today

spring 201416

Were already there ndash ChirOPraCtiC and PUBliC health hand-in-handBy Caitlin Lukacs from the March 2014 issue of ACA news

Public health is a popular buzz phrase in the healthcare arena but what exactly is it and how does chiropractic fit into it ldquoPublic health describes the overall wellbeing of the populacerdquo explains Richard Bruns DC past chairman of the American Chiropractic Associationrsquos (ACA) Wellness and Health Promotion Committee and ACA chairman of the Board of Governors ldquoAll public health issues have future implications for individuals as well as the publicrdquo

Public health encompasses habits and social norms such as smoking alcohol consumption obesity and the use of seatbelts as well as environmental issues such as clean water air quality and how livestock and agricultural practices affect the environment adds Will Evans DC PhD MCHES provost of the University of Western States Public health also includes health education and health promotion

ldquoPublic health and chiropractic go hand-in-handrdquo explains Karen Konarski-Hart DC DABCO FACO vice president of ACArsquos Council of Delegates and chairman of the American Public Health Association (APHA)Wellness and Health Promotion Committee ldquoDCs donrsquot practice in a vacuum they are interested in all aspects of a patientrsquos life that affect his or her health and wellbeing as well as how that person interacts in the healthcare community at largerdquo

Whether they identify it as public health or not all chiropractic physicians address public health issues when dealing with their patients For example when a new patient comes into your office you begin with a detailed history and an initial examination that includes not only taking vital signs but discussing tobacco and alcohol use and other behaviors that affect that patientrsquos health explains Dr Evans ldquoThis allows you to create an individual health-risk assessment based on his or her environment family history lifestyle etc and address public health issues such as tobacco use at the same timerdquo he says

BROACHING THE SUBjECTIt can sometimes be difficult to initiate conversations with patients about issues such as smoking or weight loss ldquoThe best place to address such topics is in your initial report of findings to the patientrdquo suggests Dr Evans ldquoYoursquove examined the patient and determined the cause of the pain or complaint that brought him or her into your office in the first place and now yoursquove got an opportunity to say lsquoI see some lifestyle-related issues that could be contributing to your pain or that could lead to other complaints down the roadrsquordquo

Yoursquore in a position to identify potential problems for your

patients says Dr Konarski-Hart ldquoThey may be setting themselves up for diabetes or cardiovascular disease or maybe they arenrsquot getting enough exercise mdash all of these things should be discussed as part of good primary carerdquo

You never want to force patients to make changes so yoursquoll need to assess their openness to addressing lifestyle changes first Simply ask them if theyrsquod be willing to discuss a healthier weight for example If they are you can let them know that you have multiple resources and partners in place to help them move forward

Dr Evans determines his patientsrsquo willingness to make lifestyle modifications by using the Stages of Change a common model of health behavior change The Stages of Change are

Pre-contemplator stage ndash Patient has no intention of making any changes in the next six months

Contemplator stage ndash Patient is considering a change within the next six months

Preparation stage ndash Patient has decided on a change and is preparing to take some kind of action

Action stage ndash Patient has begun implementing the change

Maintenance stage ndash Patient has made a change and is now working to maintain it

Take the example of an overweight patient Because the average weight of an individual in the United States has increased over the past few years some people who are overweight or borderline overweight donrsquot even realize it says Dr Evans Broach the subject gently and suggest a few small goals such as parking farther away from the office or shopping center or wearing a pedometer and working to increase the number of steps taken in a day You could also teach that patient how to read food labels and discuss healthier meal options Itrsquos about identifying the risk communicating the risk determining where your patient falls in the Stages of Change and then prescribing appropriate modifications explains Dr Evans ldquoAnd donrsquot forget to follow up with that patient at his or her next appointment Itrsquos important that he or she doesnrsquot lose confidence in your recommendations or in you as a healthcare providerrdquo he adds

GET INvOLvEDIn addition to discussions with patients in the treatment

Were Already There ndash Chiropractic and Public health hand-in-hand(contd on page 17)

spring 201417

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 16)

room there are many ways to incorporate public health into your practice One of the easiest ways to get involved is to participate in an observance that already exists such as the APHArsquos Public Health Week held the first week of every April (wwwaphaorgprogramshealthweek) or ACArsquos National Chiropractic Health Month (NCHM) celebrated every October These organizations come up with a new theme each year and gather all of the resources you need to participate ldquoIt takes the thinking and planning aspect off of the individual doctorrdquo says Dr Konarski-Hart ldquoAll you need to do is follow the instructions laid out by the parent organizationrdquo Additionally when you throw your hat into the ring on a larger issue or observance you know that the public health community is focused on that issue at that time so you can reach out to your county or state health department or other local healthcare associations and join in their efforts which will help you to build mutually beneficial long-term relationships says Dr Konarski-Hart ldquoMany state groups are underfunded and understaffed and they welcome participation particularly from physiciansrdquo she notes

DCs can also create their own observances ldquoACA offers webinars teleseminars and patient handouts on a variety of public health issuesmdashperuse the offerings and pick a topic to focus on for a week or a monthrdquo says Dr Konarski-Hart She suggests having your clinic sponsor a wellness competition or challenge You could partner with a local exercise facility or health foods store as well as a school or senior center and make it a community event You could also organize an eat well exercise club in which members meet for a walk or bike ride and then share a healthy breakfast or lunch Your practice could sponsor a poster contest at a local school or community center ldquoHave the kids create posters focused on healthy lifestyle choices and then give out prizes of fun healthy exercise such as a day of horseback riding or ice skatingrdquo Dr Konarski-Hart says Additionally your practice could sponsor a marathon participant or a local amateur sports team to show that you support healthy activities and active lifestyles

Similarly be informed about the public health issues in your community Maybe you live in an area with a high population of smokers or perhaps there have been numerous injuries due to not wearing a seatbelt in recent years Do some background research on these topics and then get involved whether that means simply providing patient handouts in your waiting room giving a community health talk participating in health fairs or working with your local health department (and other relevant organizations) to pass pertinent legislation

Look for organizations in your area that are already offering public health resources or programs and set up

a partnership with them For example for the topic of overweightobesity you could offer your clinic as a weigh-in site for participants in Weight Watchers programs suggests Dr Evans or partner with a local gym to give discounts to chiropractic patients Dr Bruns recommends getting involved with the school lunch program to advocate for healthy options for students For smoking cessation work with the American Lung Association to put on an informational presentation at a local hospital or sponsor a 5k or a stair run to raise awareness (and funds) for lung cancer research For drug addiction set up a referral network with psychologists or addiction centers and either offer acupuncture in your office or refer out to an acupuncturist as it has been shown to help patients through the detox process You can also use your knowledge of nutrition and exercise to facilitate the journey through detox says Dr Bruns

Additionally you should make a point to support these other organizations when they host local events (even if yoursquore not an official partner) or reach out for financial support ldquoI always participate in the American Cancer Societyrsquos golf tournament and I display their materials in my office as wellrdquo says Dr Bruns He also participates in the fundraising efforts of the American Heart Association and the American Lung Association on a regular basis ldquoItrsquos good for your patients and your community to see that you care about and support other healthcare organizationsrdquo he says

Another option for public health involvement is to join the APHArsquos Chiropractic Health Care Section Yoursquoll be informed on public health happenings have access to the latest information and research see what DCs are doing nationally and in other states on particular issues and even have the chance to give input and be involved in decision-making

CONCUSSIONConcussion prevention and treatment is one public health topic that is relevant to every patient population in every region of the United States ldquoWersquore seeing more concussions lately due in part to the number of children participating in contact sports the excessive training involved in these sports and the fact that most people arenrsquot aware of the symptoms and long-term risks of concussionsrdquo says Dr Konarski-Hart Helmets donrsquot actually provide protection against concussions either ldquoThe padding will protect the skull from fracture but because your brain is loose inside your skull it is not protected from impact or traumardquo she explains And with todayrsquos cultural emphasis on pushing through the pain wersquore starting to see more and more professional athletes coming forward with serious emotional psychological and neurological issues that are linked to multiple concussions in their past

spring 201418

As an EMT herself Dr Konarski-Hart attended an EMT convention in the summer of 2013 and heard a presentation from the Childrenrsquos Hospital of Arkansas on injury prevention After speaking with the presenters she discovered that they were having trouble getting buy-in from the allopathic community and she offered her services as a DC Since then Dr Konarski-Hart and the Arkansas Chiropractic Physicians Association (ACPA) have been working with the childrenrsquos hospital on various statewide projects dealing with all aspects of injury prevention One such program focuses on concussions

ldquoThrough this partnership we learned that Arkansas has not finalized its concussion protocols yet and we were able to get someone from our ACPA legislative team involved in that process to ensure chiropracticrsquos inclusion as an involved professionrdquo says Dr Konarski-Hart

Because of DCsrsquo knowledge and training itrsquos important for them to get involved with the concussion issue says Dr Bruns ldquoKnowing what we know about concussions we are doing a tremendous service to athletes and their families by completing pre-participation physicals and screenings and watching for signs and symptoms during participation as wellrdquo he says And itrsquos not just athletes who are suffering from concussions mdash itrsquos children who fall off a bike or a swing set or an older adult who slips on the ice

Itrsquos crucial for DCs to help disseminate information about concussions Whether you see concussion symptoms in a patient in your office or work with local sports teams you have the knowledge to serve as a local expert on the topic DCs can assess injured parties work with school administrators to create concussion protocols and push for legislation on standard concussion treatment says Dr Bruns

Kids parents coaches trainers and doctors all need to be aware of concussions and the potential risks involved with sustaining one or more ldquoItrsquos a matter of understanding the potential risks before making a decision to play in a game or to have a player sit out a game for examplerdquo says Dr Konarski-Hart

WErsquoRE ALREADY THEREAs DCs we focus on the biomechanics structure and function of the human body and we have a unique approach in that we look at the whole person in terms of nutrition flexibility blood flow and muscle and nervous tissue function says Dr Bruns ldquoThe chiropractic profession recognizes the importance of healthful eating nutritional support avoiding the bad habits of smoking and drinking alcohol and has been counseling patients on healthy lifestyles since long before it was fashionablerdquo

According to Dr Konarski-Hart simply choosing to be a doctor of chiropractic means that yoursquore involved in public health on some level because your goal is to make your patient healthier and therefore make your community healthier In other words DCs are already an integral part of public health

With the new health care emphasis on wellness and prevention many healthcare providers legislators insurance companies and government policy developers are focusing on how to offer access to these services especially in medically underserved rural areas or small towns Chiropractic representatives need to be part of those discussions to point out that in many of these communities DCs are already there providing that assessment counseling and care This representation is one of the functions of the ACA and state chiropractic associations and why your membership and involvement with these organizations is so critical says Dr Konarski-Hart

aCa neWs extraCERTIFIED CHIROPRACTIC WELLNESS SPECIALIST PROGRAMIn 2011 ACA began a partnership with the National Wellness Institute (NWI) a well respected organization recognized both inside and outside the chiropractic profession to offer a wellness certification program for DCs The 40-hour program will enable students to integrate principles of wellness coaching health promotion and disease prevention to their current practices Once the program is completed DCs will become Certified Chiropractic Wellness Specialists ldquoThe program was developed and launched by Dr Evans Cheryl Hawk DC PhD CHES and Mike Perko PhDmdashdoctors who are at the forefront of health promotion illness prevention and wellnessrdquo says Dr Bruns Originally the certification consisted of four different modules and DCs had to travel to select cities to participate in the weekend seminars However ACA quickly realized that it was difficult for DCs to get to these courses and decided to turn the program into an online certification NWI has taken the lead on this conversion

ACA RESOURCES Bookmark wwwacatoday orgpublichealth on your computer for quick and easy access to patient handouts references and research for presentations a calendar of national public health observances and other resources that have all been vetted by the ACA APHAWellness and Health Promotion Committee for use in your office Published in the March 2014 ACA news

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 17)

spring 201419

ASSOCIATES WANTED

Associate Wanted Starting base annual salary range is 50-60K plus additional monthly $500-2K in productivity compensation Benefits include MalpracticeMedical insurance CE Our care model uses the latest in Chiropractic Massage Physical Therapy Acupuncture and Nutritional medicine services South Bend is home to Notre Dame and a short drive to Chicago and Lake Michigan This is a good place to raise a family with good schools and a low cost of living Sendfax a letter of interest and resume to apintodcyahoocom or fax (574) 254-1652 Posted 11514

Chicagoland Associate Doctor Needed Busy office with multiple long term associates Family practice Thirty minutes to downtown Chicago Full timepart time paid vacation $26hour starting pay with periodic raises Proficient in the Thompson leg-check technique We are looking for someone who is ready and willing to blend with a very upbeat fun and positive staff Interested applicants should email their resume to infotrimbolichironet or fax to (219) 836-2344 wwwtrimbolichironet Posted 12914

Opportunity for Doctor to grow own practice with buyout of 40 year family practice in 2-5 years Located in North Central Indiana with easy access to Indianapolis and Chicago Wonderful area to raise a family good schools low crime slower pace of life Contact pdyer4hotmailcom Posted 2614

Associate Needed We are currently searching for an associate doctor to help us at the Osmon Chiropractic Center in Bloomington IN This would be a tremendous opportunity for a new graduate or anyone considering a possible change of location You will be working in a beautiful 2500 square foot state of the art clinic with 1 other doctor and a professional staff of 8 to assist you There will be only a small amount of practice building activities on your part because we will provide you with a practice representative who will do that for you You will enjoy the security of a known income and practice without the stress of practice overhead and staff management All you need to do is learn our system of patient managementmdashthe same system we all use in the office and work together as a team to get and keep our community under chiropractic care It is an exciting place to practice Send resume and cover letter to drosmonhotmailcom and please feel free to visit our website at wwwDrOsmoncom Posted 3314

EQUIPMENT FOR SALE

For SalemdashFutura 3000GT automatic X-ray film processor two 8x10 cassettes two 7x14 cassettes two 14x17 cassettes Xray film cabinet new film xray I D Imprinter amp infra red light for sale $80000 Mikephelps55attnet or call (765) 345-0224 Posted 92413

PRACTICES FOR SALE

Free North Manchester practice Collected gt$300000 in 2012 Drs Kelsey giving practice records and X-ray to DC who buys their building 302 W MainHwy 114 Appraised for $165000 last monthmdashyou can buy it for $145000 Closing office on 103013 so you must act soon for this opportunity (260) 568-4419 or office 260-982-4646 Posted 100213

DCS WANTED

Kauffman Chiropractic PC is looking for a full-time position to be filled October 2013 Successful 25+ years established company with physical therapy massage therapy and rehabilitation Enthusiastic ambitious doctor who is willing to learn is a must Must be proficient in Diversified Thompson and Distraction techniques Nice salary is offered Email resume to chirodancomcastnet Posted 82713

Fantastic opportunity for energetic success-oriented doctor excited to grow with us professionally Comes with ownership possibilities Learn to share chiropractic in your community Train in an established practice run on outstanding systems Great training and support for you with focus on exceptiional patient communication and care including chiropractic rehab and massage Send CV or resume to clarksvillespineandrehabinsightbbcom Contact Joseph Rogers Lousville Kentucky (812) 282-7500 Posted 1714

Career Opportunity ndash URGENT ASSOCIATE WANTED ndash PEORIA IL Work in a state of the art wellness center with upbeat and professional staff ready to support you Utilize chiropractic clinical nutrition and rehabilitation to manage a wide range of conditions Doctor must be bright outgoing enthusiastic and must have excellent clinical skills This is an opportunity you dont want to miss Designed for someone looking for a career not simply another job Extensive training and great income potential Invest in your future Send a resume to lfulleralignlifecom Posted 12414

Part Time DC needed for Gary IN office for DOT Certified Medical Exams and some Chiropractic beginning March 15 2014 NO STRESS NO BILLING No Overhead ndash No Headaches Easy hours (8 am - 5 pm - 2 dayswk) Continue in your own practice and make extra cash in our office or just work part-time for us Will tutor you and pay for your DOT Certification - work 2 daysweek ($25000) Will tutor you and pay for your DOT Certification ($50hr = $25000year for 2 daysweek) Contact Lynn Biese -Carroll DC at lbiesewirrcom or call (262) 515-2168 Posted 2614

Associate Needed ndash Bloomington Indiana Expanding practice in Bloomington Indiana is looking for full-time position to be filled Enthusiastic ambitious doctor is a must Must be proficient in Diversified and Low Force techniques rehab and physical therapy Practice is a very strong stable consistent referral based practice Salary and profit share of clinic are offered We will train and mentor in technique and all areas of patient compliance and success Send resume to Dr Fox 1710 West Third St Bloomington Indiana 47404 or email to jbfprodigynet Posted 21814

vACATION DOCTORS

Mobile Moje Chiropractic Dr Moje is available for vacation relief and office coverage Licensed in IN OH MI WI MN amp PA Specializing in maternity leave injuries and vacations Call or email for CV availability rates references and further information Contact Dr Moje at stephanmojegmailcom or (218) 205-6141 Posted 81613

indiana state ChirOPraCtiC assOCiatiOn Classifieds

Page 5: ISCA Spring Report 2014

spring 20145

CisCa legislative rePOrt By Dr Anthony Wolf DC FICC Immediate Past President and Chairman Legislative Committee

The 2013 Legislative session began with a review of all bills introduced to the Indiana General Assembly in early January Our lobbyists Pat McGuffey and Jessaca Turner Stulz reviewed nearly 1000 bills to determine if they would have any impact on the chiropractic profession and our ability to practice in Indiana

The Legislative Committee comprised of Dr Anthony Wolf (Chair) Dr Robert Tennant Dr Frank Laux Dr Mike Toney Dr David Davis Dr Mike Phelps Dr Peter Furno Dr Jared Himsel and Dr Justin Gilmore held weekly conference calls on Friday afternoons lasting 1-3 hours to discuss all bills pertinent to the chiropractic profession in Indiana The bills are summarized and e-mailed to the committee members by Pat McGuffey to be reviewed prior to our conference call The bills are discussed in detail with input by all committee members to decide if any action by the ISCA should be taken Pat and Jessaca will follow-up with the committeersquos recommendations and attend all legislative hearings on these bills The following week the ISCA Legislative Committee is updated on any movement of a bill any action needed on any new bills pertinent to our profession This process continues until the end of the legislative session

This year we were able to retain language in the occupational therapistrsquos scope expansion bill that prohibits them from performing spinal manipulation Our lobbying team was also able to coordinate legislators to table a bill to a summer study session that would have reduced the time to collect a bill from a patient in small claims court from 6 years to 2 years The Legislative Committee felt this would impact our ability to collect on delayed accounts such as Personal Injury cases and insurance delays in payment Pat McGuffey will be actively involved in the summer study session regarding this bill

Through the sole efforts of the ISCA lobbying team we were able to revive a bill with language that will allow Doctors of Chiropractic to be included as a provider that can perform school bus driver physicals All eligible providers must be certified The ISCA will be offering certification courses this year to our membership

GOALS FOR 2014-2015The ISCA Legislative Committee will be reviewing our current scope of practice to expand to more of an ldquoopenrdquo scope to allow future graduates the ability to practice to the full extent of their education obtained at a CCE and US Department of Education accredited institution Emphasis will be added that the education must be a part of the core curriculum National Board Tested and must be taught in a majority of chiropractic schools in the United States

Be sure to complete your insurance survey and return to the ISCA within 10 days When preparing your insurance issue be sure to create a ldquosanitizedrdquo paper trail with your correspondence with the insurance company The ISCA Insurance Committee will review the problems and concerns our membership is experiencing The committee will then formulate a list of concerns to present to the Indiana Department of Insurance to attempt to resolve our issues If this proves unsuccessful the ISCA Legislative Committee will determine if legislation will be appropriate and introduce a bill for the 2015 Legislative session

Remember Lawsuits are expensive and usually require an additional assessment to our membership Legislation requires a large BackPAC fund and intense grassroots efforts by our membership The ISCA Insurance and Legislative Committees will always attempt to resolve issues in the most effective and least costly manner for our membership

To protect and move this profession forward to its proper placement in our healthcare system it requires full active participation of our entire membership

Maintain your highest level of Membership in the ISCA

Contribute to BackPAC

Answer to the ldquocallrdquo

ndash Act on Grassroots efforts

ndash Complete Surveys and Requests

Attend ISCA Sponsored CE Seminars

Become ACTIVE on a committee

Encourage a non-member to become an active member

Every insurance check they cash and the very ability to practice Chiropractic in Indiana is a direct result of the ISCArsquos past present and future efforts

Being involved at the state level for more than 20 years and now at the national level as the ACA Delegate for Indiana I have realized without a doubt that the profession would cease to exist without the continued effort of the ISCA and ACA

Thank you for the privilege to serve as your Immediate Past President Legislative Chair and ACA Delegate

As we all look in the mirror we must consider the quote by Russell Wilson (Seattle Seahawks Quarterback)

Why nOt Me

spring 20146

isCa highlights MeMBershiP and lOCal invOlveMent at sPring COnferenCe

Indianapolis ndash The Indiana State Chiropractic Association (ISCA) spoke of the importance of association membership and involvement during the 2014 Spring Conference February 21-23 2014 at the Hilton Indianapolis North

ldquoMembership does the work of the Associationrdquo said Dr Robert Tennant President of ISCA ldquoIt is this work that is vital to the advancement of the chiropractic profession and strengthening our local legislative effortsrdquo

Foot Levelers presenter Dr Kevin Wong discussed the importance of involvement in your State Association to support the profession ldquoWe will not advance without our membersrdquo said Dr Wong ldquoThey are the messengers that keep our mission movingrdquo

Dr Kevin Wong Dr Miles Bodzin and Dr Tim Maggs presented at the conference Dr Wong presented on understanding and treating the feet and extremities to understand why they are vital to whole body health Dr Bodzinrsquos course discussed the methods systems and strategies for freeing yourself from the shackles of insurance dependence Dr Maggsrsquo course described the current medical model care for high school athletes and discussed the need for the biomechanical model

ldquoThis is a time of great opportunity for the chiropractic profession We must work as a team communicate a consistent message to decision makers and engage more of our doctors to improve health and that is what the ISCA works to dordquo said Dr Tennant

ISCA Executive Director Pat McGuffey said the Association organizes two educational conferences each calendar year for Doctors of Chiropractic in Indiana More than 135 Doctors of Chiropractic attended the 2014 ISCA Spring Conference

Mark your calendar for The ISCA Fall Conference October 10-12 2014 at the Indianapolis Marriott East

1 Welcome to the 2014 ISCA Spring Conference

2 President Dr Robert Tennant discusses the importance of involvement with the Association

3 Executive Director Pat McGuffey reviews the work going on during the 2014 Legislative Session

2

1

2

11

3

spring 20147

4 Dr Kevin Wong speaks on Supporting Your Body

5 Dr Toby Harmon Board Member and Conference Committee Chairman energizes the group while describing his committees goals

6 DrPeterFurnocollectsfortheBackPACraffleduringthemembership luncheon

7 ThankstoallwhomadetheBackPACraffleasuccess

8 Dr Miles Bodzin Founder and CEO of Cash Practice Systems addresses the group at the Membership Luncheon and presents during seminar sessions

9 Attendees at the Membership Luncheon

10 Attendees listen to speakers during the Saturday Membership Luncheon

11 Conference attendees enjoyed the sounds of NEXUS during the attendee reception and mixed and mingled with their colleagues

12 Vendors greeted conference attendees through the event

13 Dr Diane Vuotto Board Member and Membership Committee Chairwoman

4

4

45

6

78

8

99

1010

11

12 1212 13

1111 11

spring 20148

ClOsing yOUr PraCtiCe dOnrsquot JUst shUt yOUr dOOrsBy Stephanie T Eckerle Esq Plews Shadley Racher amp Braun

Many chiropractors need to close their practice whether it is due to retirement relocation or a career change In other cases you may not need to close

your practice but you may want to discontinue the chiropractor-patient relationship with a certain patient Regardless of the scenario there are certain regulations that you need to be aware of in order to close your practice or terminate the patient relationship in compliance with all applicable laws

Closing Your Practice you must notify all of your active patients if you plan on retiring discontinuing your practice or moving from the community Generally active patients would be any patients that you have seen in the past two years The notice that you send to the patients should first state the date that your practice will close This date should be at least thirty days after you send the patients the notice Second the notice should provide directions on how the patients can obtain their medical records or transfer those to another chiropractor If you are going to charge patients any fees for copying medical records this should also be included in the notice In addition you may also include a release form for the medical records that is compliant with HIPAA and all applicable state laws which will further protect you when transferring medical records As a chiropractor you have a duty to promptly release a patients records to any other chiropractor or any other health discipline practitioner designated by the patient upon written request of the patient Lastly the letter should encourage your patients to seek the services of another chiropractor If you do refer your clients to a specific chiropractor you cannot receive any compensation for the referral of that patient under Indiana law

Terminating a Patient Relationship as a chiropractor you cannot abandon a patient under indiana law If you desire to terminate the patient relationship you must give due notice to a patient or those responsible for a patientrsquos care when you are withdrawing from a case Generally we recommend that you provide a patient or their caregiver with written notice of the termination at least thirty days in advance In addition you may want to provide the patient with a referral to another chiropractor Lastly you should always ensure that the patient knows how to obtain and transfer their medical records

The Indiana Chiropractic Board does enforce provisions applicable to closing or selling your practice or terminating the patient relationship For example in 2011 the Chiropractic Board brought a complaint against a chiropractor that refused to release a patientrsquos medical records unless that patient signed a general waiver of liability Therefore ensuring compliance with all applicable laws and regulations is critical In addition to regulatory compliance issues there are many other issues that you may want to consider when selling or closing your practice such as transferring your equipment terminating a lease or selling real estate terminating your employees terminating or assigning any contracts with vendors and allocating liability among you and the seller or purchaser as applicable

Stephanie Eckerle is the chair of the health Care and Life Sciences practice group at Plews Shadley Racher amp Braun LLP She represents various types of medical professionals including chiropractors physicians mid-level providers and pharmacists She also represents practice groups pharmacies laboratories and other health care entities If you have any questions about health care matters including how to close or sell your practice please contact Stephanie at (317) 637-0700 or seckerlepsrbcom

spring 20149

sPring Means tiMe fOr isCa MeMBers and nOnMeMBers tO Meet in distriCts By Cathy Orosz Membership Director and ISCA Association Manager

Spring is here and the ISCA is ready to recruit

ldquoThe snow is cleared and we are ready to hit the ground runningrdquo says Dr Diane Vuotto Membership Chairwoman and District 5 Director ldquoISCA District Directors are ready to engage current and potential members in their area and they need your input

Each of the nine District Directors are currently planning special meetings throughout April and May to recruit new members as well as learn from current members on how the ISCA can serve them better

Dr Hilton will be taking to the road in District 6 for one-on-one meetings If you are interested in scheduling a meeting with Dr Hilton please contact him at drhiltonsbcglobalnet

District 9 will be meeting on Tuesday April 29 at 630 pm at Dr Scott Autonrsquos office at 1551 N Main St in Franklin To attend this meeting and learn more about efforts in District 9 please contact Dr Auton at scottautonyahoocom or (317) 346-0799

If you would like to be more involved the ISCA asks that you please consider volunteering your time and talents Please contact Cathy Orosz at (317) 673-4245 (800) 572-8002 or infoindianastatechirosorg to learn how you can become more involved in the Association

WELCOME NEW MEMBERS 2014

Dr Nancy Elwartowski-Cooper Carmel

Dr Kevin Forrest Indianapolis

Dr Anthony Forrest Indianapolis

Dr Julie Carleton Fishers

INDIANA STATECHIROPRACTICASSOCIATIONwwwindianastatechirosorg

spring 201410

Certified Medical Examiner Training WE NEED 20 PAID REGISTRANTS BY APRIL 10 IN ORDER

TO HOST THIS TRAINING Saturday May 3 and Sunday May 4 2014 Indianapolis Location TBD 800 AM to 6 pm Saturday May 3 and 8 AM to noon Sunday May 4 YOU CANNOT DO PHYSICAL EXAMS FOR TRUCK AND BUS DRIVERS ANY LONGER UNLESS YOU OBTAIN THIS CERTIFICATION Interested in becoming a Certified Medical Examiner (CME) and be listed on the National Reg-istry YOU MUST COMPLETE THIS TRAINING AND TESTING on Federal Motor Carrier Safety Ad-ministrationrsquos (FMCSA) physical qualification standards and guidelines If you intend to perform physical examinations and issue medical certificates for commercial motor vehicle (CMV) drivers to meet the requirements of Section 39141 of the Federal Motor Carrier Safety Regulations (FMCSRs) you must be certified and listed on the FMCSArsquos National Registry by May 21 2014 Upon completion of this program you will be eligible to take the Certification Test for $79 at an Indiana testing site The ISCA will provide you with info regarding multiple testing sites Program presented for the ISCA by Michael Megehee DC National Registry Certified Medical Examiner and President TeamCME LLC

Registration Name Clinic Address CityStateZip Phone Email Address Payment Method (Credit Card or Check) Credit Card Type Credit Card Expiration 3 Digit Code Name on Card Signature Questions Contact Cathy Orosz at infoindianastatechirosorg or call 317-673-4245 or toll-free at 800-572-8002 The ISCA needs a minimum of 20 registrants by Friday April 10 for this program to be offered Payment is needed upon regis-tration and no refunds will be granted

Mail Registrations to Indiana State Chiropractic Association 200 S Meridian St Ste 410 Indianapolis IN 46225 Or Fax to 317-686-2672 or email to infoindianastatechirosorg

The Cost of the 12-hour training is $400 for ISCA Members and $450 for Non Members

Because we have to pay for TeamCME in Advance we must have 20 paid registrants by April 10 in order to host this training MAKE YOUR RESERVATIONS TODAY

spring 201411

CONTACT INFORMATION

NAME_____________________________________________________________________

COMPANY __________________________________________________________________

MAILING ADDRESS__________________________________________________________

CITY STATE ZIP_____________________________________________________________

PHONE ________________________________ FAX________________________________

EMAIL_____________________________________________________________________

ADDITIONAL ATTENDEE NAMES________________________________________________

___________________________________________________________________________

PAYMENT OPTIONS

AMEX VISA MASTERCARD CHECK (MAKE PAYABLE TO ISCA BACKPAC)

CARDHOLDER_______________________________________________________________

CARD ____________________________________________________________________

EXP__________________________ 3 DIGIT SECURITY ___________________________

SIGNATURE_________________________________________________________________

MAIL ISCA 200 S Meridian St Suite 410 Indianapolis IN 46225FAX 3176862672 ATTN Cathy Orosz

ISCA REGIONAL VIDEO VIEWINGSNEED CONTINUING EDUCATION HOURS THERErsquoS STILL TIME

Donrsquot miss your opportunity to get your required continuing education credits prior to June 30 2014 Indiana Statute dictates that every Licensed Chiropractor in Indiana gets four hours of risk management each year by attending one of the ISCArsquos Regional Video Viewings

There are a limited number of seats at some locations so pre-registration is necessaryIf you choose to pay at the door Pre-Registration is REQUIRED Non-prior notice of attendance will be subject to the Non-Member rate above Call the ISCA office for availability at your location (317) 673-4245 If you need directions to a location please call the ISCA for host contact information

Proceeds of the viewings are contributed to the ISCA Political Action Committee and are non-business deductible

QUESTIONS Contact Cathy Orosz at 8005728002 3176734245 or email infoindianastatechirosorg Proceeds of the viewings are contributed to the ISCA Political Action Committee and are non-business deductible

Contributions to the ISCA Political Action Committee are non-business deductible

REGIONAL VIDEO RATES

$185 Member In Good Standing $250 Non-Member $165 GoldSilver Member Free Of Charge - Platinum Member

VIEWING DATES amp LOCATIONS

WEDNESDAY MAY 7 830 AM - 1230PM Dr Patrick Case 3027 Mishawa Ave South Bend IN

TUESDAY MAY 8 830 AM - 1230PM Dr Douglas Breger 2652 Charlestown Rd New Albany IN

SATURDAY MAY 10 830 AM - 1230PM Dr John Kostidis Call 2199244456 for location and availability Valparaiso IN

WEDNESDAY MAY 13 7 AM - 11 AM Dr Toby Harmon 2602 Newton St Jasper IN

THURSDAY MAY 15 9 AM - 1PM Dr Michael Hartle 3835 W Jefferson Blvd Fort Wayne IN

spring 201412

MediCaidMediCare UPdateBy Michael Phelps DC Secretary ISCA Board of Directors MedicaidMedicare Advising Committee

2013 saw yet another attempt to take chiropractic care out of Medicaid The ISCA amp its Legislative Committee was successful in stopping this attack on the chiropractic profession Thanks to the hard work of the ISCA Indiana remains one of the limited states where Medicaid covers all chiropractic services under our states scope of practice

January 1 2014 also saw the reinstatement of the 5 reduction in imbursement that we accepted several years ago

The ISCA is able to keep chiropractors in the Medicaid Program as well as other insurance as a paid provider through the hard work and dedication of volunteers If you are able to donate some time there are a number of committees and positions that need to be filled by doctors that want to make a difference If you know of DCs that are not members of the ISCA tell them about the good work we do for the profession and that we need all Doctors of Chiropractic in this state to be members Remember if youre not part of the solution youre part of the problem

As you know with the changes in health care coverage there are changes with respect to Medicare All chiropractors should be reporting PQRS for incentive payment eligibility Those who report satisfactorily for the 2013 amp 2014 program years may avoid the 2015 PQRS payment adjustment Additional information on how to avoid future PQRS payment adjustments can be found through supporting documentation available on the CMS website at httpwwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-InstructionsPQRS Chiropractors are fortunate as they only have to report on three measures

Measure 131 - Pain Assessment and Follow upMeasure 182 - Functional Outcome AssessmentMeasure 317 - Preventive Care and Screening (Screening for High Blood Pressure)

January 1 2014 saw an increase of approximately 9 in the reimbursement for chiropractic adjustments (98940 98941 amp 98942) This increase was due to a reassessment of the RVUs for CMT

The latest CERT report saw a decrease in the percentage of errors for chiropractors Chiropractic physicians need to continue to improve their documentation and coding of services in order to maintain this downward decline of errors

The Wisconsin Physicians Service (WPS) periodically analyzes provider coding patterns to identify deviations within a peer group For the J8 (Indiana and Michigan) Jurisdiction there has been a significantly higher than normal usage of the Code 98942 (CMT of five regions of the spine) There are approximately 35 DCs in the state of Michigan that are on the radar I am happy to report that there are no chiropractors in the state of Indiana under review

All that needs to happen for Chiropractic to fail is for good doctors to do nothing If you know of a chiropractor that is not a member of the ISCA urge them to join

MedicaidMedicare Update (contd on page 13)

spring 201413

MedicaidMedicare Update (contd from page 12)

SGR BILL PASSES HOUSE GOES TO SENATE FOR CONSIDERATIONWe learned that the United States House of Representatives passed House Bill 4302 The bill proposes to extend Medicarersquos Sustainable Growth Rate (SGR) current rate to April 15 2015 and would delay other Medicare deadlines The bill as currently drafted would postpone ICD-10-CM implementation until after October 1 2015 and restrict the Centers for Medicare amp Medicaid Services (CMS) from acting without congressional approval The bill now goes to the US Senate for debate and vote If it passes the Senate it would then be sent to President Obamarsquos desk to be signed or vetoed The ISCA will continue to monitor this situation and recommends preparing for ICD-10 implementation

PLEASE ALSO MARK YOUR CALENDAR WITH THESE DATES Medicare Secondary Payer (MSP) Seminar April 17 2014 from 100 pm to 400 pm Hilton Garden Inn Fort Wayne 8615 US Hwy 24 West Fort Wayne IN Click here to register

There is a Chiropractic Medicare Seminar on April 26 2014 in Mishawaka IN Click here for more information

HELPFUL LINKSNeed help in the transition to ICD-10 Go to the Road to 10 website by clicking here This site is primarily for the MD but has general information that pertains to all health care specialties

Stay up-to-date on changes in Medicare at the WPS Medicare website by clicking here This website is for all providers but sometimes offers information specific to chiropractors

INFORMATION REGARDING THE HOLDING OF APRIL 2014 CLAIMS FOR SERvICES PAID UNDER THE 2014 MEDICARE PHYSICIAN FEE SCHEDULE The 2014 Medicare Physician Fee Schedule (MPFS) final rule stipulated a negative update to the MPFS that was to be effective January 1 2014 That reduction was averted for three months with the passage of the Pathway for SGR Reform Act of 2013 which provided for a 05 percent update for services paid under the MPFS through March 31 2014 CMS is hopeful that there will be congressional action to prevent the negative update from taking effect on April 1 2014 CMS has instructed the Medicare Administrative Contractors to hold claims containing services paid under the MPFS for the first 10 business days of April (ie through April 14 2014) This hold would only affect MPFS claims with dates of service of April 1 2014 and later The hold should have minimal impact on provider cash flow because under current law clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt All claims for services delivered on or before March 31 2014 will be processed and paid under normal procedures regardless of any Congressional actions

spring 201414

insUranCe COMMittee UPdateBy Peter Furno DC ISCA Board of Directors District 4 Director and Insurance Committee Chairman

During 2013 the ISCA Insurance Committee addressed many issues and questions from its members with regard to insurance legalities of advertising and proposed associations with third party vendors offering incentives contrary to our practice statues Doctors with definitively legal questions were referred to their legal counsel for liability reasons Most questions directed to the insurance committee are answered within 24 hours

Because the ISCA continues to receive anecdotal complaints from the field claiming insurer reimbursement discrimination and other transgressions the insurance committee as a part of the ISCArsquos proactive efforts to address this problem has developed a survey to obtain information on various insurance problems or concerns impacting chiropractors in the field The ISCA is aggressively attempting to determine problems that are affecting large numbers of doctors and which may be indicating the development of a trend requiring attention by the ISCA and then the IDOI However although it is the intent to meet with the IDOI once the survey information is correlated so that the contentions of our doctors may be addressed officially without firm evidence of wrong doing by the insurance industry the ISCA cannot go forward Consequently it is imperative that all members who are having trouble submit their complaints to the ISCA together with supportive documentation so that this issue may be addressed

Now that the PPACA is law and will require ldquoevidence-basedrdquo treatment procedures to be utilized before reimbursements are made the intent of the Insurance Committee to make at least one presentation to decision-makers of an employer group regarding the cost-effectiveness and efficacy of chiropractic in the management of work related uncomplicated spine injuries in comparison to traditional medical care Heretofore the majority of employers had no idea of the cost-effectiveness of chiropractic care when compared to traditional medicine and simply allowed their work nurses and medical providers to direct care ndash which the research shows is one of the main reasons costs are so high

The Insurance Committee in an attempt to keep the ISCA membership updated will attempt to address at least two insurance queries weekly and present answers to the membership via the ISCA monthly eNews and Newsletter

Insurance Pearl Medicare and Chiropractic Billing Misconceptions It is worthwhile to address a few of the prevailing misconceptions Here are the nine truisms regarding Medicare and chiropractic

1 There is not a 12-visit limit to Medicare for chiropractic services The limits of care are based on the specific medical necessity of the primary subluxation and its secondary neuromusculoskeletal diagnosis

2 Medicare will pay for both acute and chronic conditions as long as there is documentation or expectation of functional improvement

3 Nonparticipating (nonpar) providers are required to bill for services All covered services under chiropractic (spinal manipulation) must be billed to Medicare

4 Nonpar providers are audited just as par providers are There is no protection from a Medicare audit by being nonpar

5 Nonpar providers must document services in the same manner as any provider of Medicare services Being par or nonpar is irrelevant in reference to documentation of chiropractic services

6 Chiropractors may not opt out of Medicare This is simply not an option for doctors of chiropractic Being nonpar is not opting out but designating oneself as a Medicare provider nonpar In simple terms chiropractors must belong to Medicare to treat Medicare patients

7 Advance Beneficiary Notices (ABNs) should not be used as routine documents for patients to sign on their initial visit However they must be used when there is a genuine belief or reasonable expectation that Medicare will deny or not pay for the service on a specific visit or series of visits In other words a blanket ABN at the beginning of care is not sufficient or compliant

8 Medicare claims are not difficult they are simply different from health insurance claims When not done in Medicares format claims are denied

9 Medicare payment is what it is I will refrain from stating it is good While we all would want higher reimbursements (Who doesnt) the average fees for chiropractic services for manipulation are $30-$36 per visit This is far better reimbursement than under many of the managed care plans chiropractors routinely fight to join Furthermore that dollar amount is for spinal manipulation only other services may be billed to the patient or covered by a secondary insurance plan

spring 201415

trUst BUt verifyBy Dr R A Foxworth FICC MCS-P

I was speaking with a doctor recently who was venting her frustration about not knowing who to believe or trust as an authority when it comes to being in practice today She goes to different seminars because she wants to improve herself personally and professionally She also wants to improve her practice by learning more about her productivity effectiveness documentation compliance and billing She shared that she doesnt simply attend the CEU required hours for her license she puts in seminar hours to improve her practice her clinical skills her compliance and her business insight

Her problem The conflicting information she receives from various experts at each seminar How she asked can they all be right if they all say different things As a result of her experience she wanted to know why a Discount Medical Plan Organization (DMPO) like ChiroHealthUSA was of value in todayrsquos practices Why she asked is this even necessary What are my resources

I passed her third-degree with flying colors by the way

I could appreciate her position because I am a bit of a skeptic myself In fact thats how all this started for me I was a chiropractor in practice just like you trying to maximize my insurance payments so I wasnt leaving money on the table while still working to come up with a way my uninsured patients could afford those fees

Because of my activity within my state (as a governor-appointed health expert as an active participant in my State Chiropractic Association and the state representative for the American Chiropractic Association) I knew there were rules to follow to avoid compliance issues when creating our fee schedule I did my research and initially started a Discount Medical Plan Organization (DMPO) for my state alone I knew this would legally protect my practice and my colleagues and that at the time was my only goal

And as skeptic I wouldnrsquot even take my own word for it when it came to believing that a Discount Medical Plan Organization (DMPO) was the simplest way to keep my fee schedules compliant legal and safe Thatrsquos why I became a Certified Medical Compliance Specialist (MCS-P) so skeptics like me could get a breath and feel at ease As an MCS-P Irsquom quite simply held to a higher standard I have to be able to quote chapter and verse about why any possible fee or activity is or isnrsquot compliant

We know therersquos a plethora of inaccurate information that gets disseminated in our profession Im sad to say that I had to agree with my frustrated colleague when she was venting about all the conflicting advice she was receiving Thatrsquos why ChiroHealthUSA has relationships with many MCS-Ps to help get accurate reliable information out there Many of the brightest minds in our profession agree with and recommend ChiroHealthUSA to their chiropractic colleagues

Looking back when I set up my first DMPO within my state I can see how shortsighted I was I now know that taking ChiroHealthUSA to a national audience to protect all chiropractic practices in the country was the vision I shouldve had at the start Im glad I had an encounter with one of my fellow MCS-Ps who gave me this bigger vision

Learn more about how ChiroHealthUSA can help your practice be more compliant You can attend a free webinar this Tuesday April 1 Register at wwwChiroHealthUSAcom today to find out more

Dr Foxworth is a certified Medical Compliance Specialist and President of ChirohealthUSA A practicing Chiropractor he remains ldquoin the trenchesrdquo facing challenges with billing coding documentation and compliance he has served as president of the Mississippi Chiropractic Association former Staff Chiropractor at

the gv Sonny Montgomery vA Medical Center and is a Fellow of the International College of Chiropractic you can contact Dr Foxworth at 1 (888) 719-9990 infochirohealthusacom or visit the ChirohealthUSA website at wwwchirohealthusacom join us for a free webinar that will give you all the details about how a DMPO can help you practice with more peace of mind go to wwwchirohealthusacom to register today

spring 201416

Were already there ndash ChirOPraCtiC and PUBliC health hand-in-handBy Caitlin Lukacs from the March 2014 issue of ACA news

Public health is a popular buzz phrase in the healthcare arena but what exactly is it and how does chiropractic fit into it ldquoPublic health describes the overall wellbeing of the populacerdquo explains Richard Bruns DC past chairman of the American Chiropractic Associationrsquos (ACA) Wellness and Health Promotion Committee and ACA chairman of the Board of Governors ldquoAll public health issues have future implications for individuals as well as the publicrdquo

Public health encompasses habits and social norms such as smoking alcohol consumption obesity and the use of seatbelts as well as environmental issues such as clean water air quality and how livestock and agricultural practices affect the environment adds Will Evans DC PhD MCHES provost of the University of Western States Public health also includes health education and health promotion

ldquoPublic health and chiropractic go hand-in-handrdquo explains Karen Konarski-Hart DC DABCO FACO vice president of ACArsquos Council of Delegates and chairman of the American Public Health Association (APHA)Wellness and Health Promotion Committee ldquoDCs donrsquot practice in a vacuum they are interested in all aspects of a patientrsquos life that affect his or her health and wellbeing as well as how that person interacts in the healthcare community at largerdquo

Whether they identify it as public health or not all chiropractic physicians address public health issues when dealing with their patients For example when a new patient comes into your office you begin with a detailed history and an initial examination that includes not only taking vital signs but discussing tobacco and alcohol use and other behaviors that affect that patientrsquos health explains Dr Evans ldquoThis allows you to create an individual health-risk assessment based on his or her environment family history lifestyle etc and address public health issues such as tobacco use at the same timerdquo he says

BROACHING THE SUBjECTIt can sometimes be difficult to initiate conversations with patients about issues such as smoking or weight loss ldquoThe best place to address such topics is in your initial report of findings to the patientrdquo suggests Dr Evans ldquoYoursquove examined the patient and determined the cause of the pain or complaint that brought him or her into your office in the first place and now yoursquove got an opportunity to say lsquoI see some lifestyle-related issues that could be contributing to your pain or that could lead to other complaints down the roadrsquordquo

Yoursquore in a position to identify potential problems for your

patients says Dr Konarski-Hart ldquoThey may be setting themselves up for diabetes or cardiovascular disease or maybe they arenrsquot getting enough exercise mdash all of these things should be discussed as part of good primary carerdquo

You never want to force patients to make changes so yoursquoll need to assess their openness to addressing lifestyle changes first Simply ask them if theyrsquod be willing to discuss a healthier weight for example If they are you can let them know that you have multiple resources and partners in place to help them move forward

Dr Evans determines his patientsrsquo willingness to make lifestyle modifications by using the Stages of Change a common model of health behavior change The Stages of Change are

Pre-contemplator stage ndash Patient has no intention of making any changes in the next six months

Contemplator stage ndash Patient is considering a change within the next six months

Preparation stage ndash Patient has decided on a change and is preparing to take some kind of action

Action stage ndash Patient has begun implementing the change

Maintenance stage ndash Patient has made a change and is now working to maintain it

Take the example of an overweight patient Because the average weight of an individual in the United States has increased over the past few years some people who are overweight or borderline overweight donrsquot even realize it says Dr Evans Broach the subject gently and suggest a few small goals such as parking farther away from the office or shopping center or wearing a pedometer and working to increase the number of steps taken in a day You could also teach that patient how to read food labels and discuss healthier meal options Itrsquos about identifying the risk communicating the risk determining where your patient falls in the Stages of Change and then prescribing appropriate modifications explains Dr Evans ldquoAnd donrsquot forget to follow up with that patient at his or her next appointment Itrsquos important that he or she doesnrsquot lose confidence in your recommendations or in you as a healthcare providerrdquo he adds

GET INvOLvEDIn addition to discussions with patients in the treatment

Were Already There ndash Chiropractic and Public health hand-in-hand(contd on page 17)

spring 201417

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 16)

room there are many ways to incorporate public health into your practice One of the easiest ways to get involved is to participate in an observance that already exists such as the APHArsquos Public Health Week held the first week of every April (wwwaphaorgprogramshealthweek) or ACArsquos National Chiropractic Health Month (NCHM) celebrated every October These organizations come up with a new theme each year and gather all of the resources you need to participate ldquoIt takes the thinking and planning aspect off of the individual doctorrdquo says Dr Konarski-Hart ldquoAll you need to do is follow the instructions laid out by the parent organizationrdquo Additionally when you throw your hat into the ring on a larger issue or observance you know that the public health community is focused on that issue at that time so you can reach out to your county or state health department or other local healthcare associations and join in their efforts which will help you to build mutually beneficial long-term relationships says Dr Konarski-Hart ldquoMany state groups are underfunded and understaffed and they welcome participation particularly from physiciansrdquo she notes

DCs can also create their own observances ldquoACA offers webinars teleseminars and patient handouts on a variety of public health issuesmdashperuse the offerings and pick a topic to focus on for a week or a monthrdquo says Dr Konarski-Hart She suggests having your clinic sponsor a wellness competition or challenge You could partner with a local exercise facility or health foods store as well as a school or senior center and make it a community event You could also organize an eat well exercise club in which members meet for a walk or bike ride and then share a healthy breakfast or lunch Your practice could sponsor a poster contest at a local school or community center ldquoHave the kids create posters focused on healthy lifestyle choices and then give out prizes of fun healthy exercise such as a day of horseback riding or ice skatingrdquo Dr Konarski-Hart says Additionally your practice could sponsor a marathon participant or a local amateur sports team to show that you support healthy activities and active lifestyles

Similarly be informed about the public health issues in your community Maybe you live in an area with a high population of smokers or perhaps there have been numerous injuries due to not wearing a seatbelt in recent years Do some background research on these topics and then get involved whether that means simply providing patient handouts in your waiting room giving a community health talk participating in health fairs or working with your local health department (and other relevant organizations) to pass pertinent legislation

Look for organizations in your area that are already offering public health resources or programs and set up

a partnership with them For example for the topic of overweightobesity you could offer your clinic as a weigh-in site for participants in Weight Watchers programs suggests Dr Evans or partner with a local gym to give discounts to chiropractic patients Dr Bruns recommends getting involved with the school lunch program to advocate for healthy options for students For smoking cessation work with the American Lung Association to put on an informational presentation at a local hospital or sponsor a 5k or a stair run to raise awareness (and funds) for lung cancer research For drug addiction set up a referral network with psychologists or addiction centers and either offer acupuncture in your office or refer out to an acupuncturist as it has been shown to help patients through the detox process You can also use your knowledge of nutrition and exercise to facilitate the journey through detox says Dr Bruns

Additionally you should make a point to support these other organizations when they host local events (even if yoursquore not an official partner) or reach out for financial support ldquoI always participate in the American Cancer Societyrsquos golf tournament and I display their materials in my office as wellrdquo says Dr Bruns He also participates in the fundraising efforts of the American Heart Association and the American Lung Association on a regular basis ldquoItrsquos good for your patients and your community to see that you care about and support other healthcare organizationsrdquo he says

Another option for public health involvement is to join the APHArsquos Chiropractic Health Care Section Yoursquoll be informed on public health happenings have access to the latest information and research see what DCs are doing nationally and in other states on particular issues and even have the chance to give input and be involved in decision-making

CONCUSSIONConcussion prevention and treatment is one public health topic that is relevant to every patient population in every region of the United States ldquoWersquore seeing more concussions lately due in part to the number of children participating in contact sports the excessive training involved in these sports and the fact that most people arenrsquot aware of the symptoms and long-term risks of concussionsrdquo says Dr Konarski-Hart Helmets donrsquot actually provide protection against concussions either ldquoThe padding will protect the skull from fracture but because your brain is loose inside your skull it is not protected from impact or traumardquo she explains And with todayrsquos cultural emphasis on pushing through the pain wersquore starting to see more and more professional athletes coming forward with serious emotional psychological and neurological issues that are linked to multiple concussions in their past

spring 201418

As an EMT herself Dr Konarski-Hart attended an EMT convention in the summer of 2013 and heard a presentation from the Childrenrsquos Hospital of Arkansas on injury prevention After speaking with the presenters she discovered that they were having trouble getting buy-in from the allopathic community and she offered her services as a DC Since then Dr Konarski-Hart and the Arkansas Chiropractic Physicians Association (ACPA) have been working with the childrenrsquos hospital on various statewide projects dealing with all aspects of injury prevention One such program focuses on concussions

ldquoThrough this partnership we learned that Arkansas has not finalized its concussion protocols yet and we were able to get someone from our ACPA legislative team involved in that process to ensure chiropracticrsquos inclusion as an involved professionrdquo says Dr Konarski-Hart

Because of DCsrsquo knowledge and training itrsquos important for them to get involved with the concussion issue says Dr Bruns ldquoKnowing what we know about concussions we are doing a tremendous service to athletes and their families by completing pre-participation physicals and screenings and watching for signs and symptoms during participation as wellrdquo he says And itrsquos not just athletes who are suffering from concussions mdash itrsquos children who fall off a bike or a swing set or an older adult who slips on the ice

Itrsquos crucial for DCs to help disseminate information about concussions Whether you see concussion symptoms in a patient in your office or work with local sports teams you have the knowledge to serve as a local expert on the topic DCs can assess injured parties work with school administrators to create concussion protocols and push for legislation on standard concussion treatment says Dr Bruns

Kids parents coaches trainers and doctors all need to be aware of concussions and the potential risks involved with sustaining one or more ldquoItrsquos a matter of understanding the potential risks before making a decision to play in a game or to have a player sit out a game for examplerdquo says Dr Konarski-Hart

WErsquoRE ALREADY THEREAs DCs we focus on the biomechanics structure and function of the human body and we have a unique approach in that we look at the whole person in terms of nutrition flexibility blood flow and muscle and nervous tissue function says Dr Bruns ldquoThe chiropractic profession recognizes the importance of healthful eating nutritional support avoiding the bad habits of smoking and drinking alcohol and has been counseling patients on healthy lifestyles since long before it was fashionablerdquo

According to Dr Konarski-Hart simply choosing to be a doctor of chiropractic means that yoursquore involved in public health on some level because your goal is to make your patient healthier and therefore make your community healthier In other words DCs are already an integral part of public health

With the new health care emphasis on wellness and prevention many healthcare providers legislators insurance companies and government policy developers are focusing on how to offer access to these services especially in medically underserved rural areas or small towns Chiropractic representatives need to be part of those discussions to point out that in many of these communities DCs are already there providing that assessment counseling and care This representation is one of the functions of the ACA and state chiropractic associations and why your membership and involvement with these organizations is so critical says Dr Konarski-Hart

aCa neWs extraCERTIFIED CHIROPRACTIC WELLNESS SPECIALIST PROGRAMIn 2011 ACA began a partnership with the National Wellness Institute (NWI) a well respected organization recognized both inside and outside the chiropractic profession to offer a wellness certification program for DCs The 40-hour program will enable students to integrate principles of wellness coaching health promotion and disease prevention to their current practices Once the program is completed DCs will become Certified Chiropractic Wellness Specialists ldquoThe program was developed and launched by Dr Evans Cheryl Hawk DC PhD CHES and Mike Perko PhDmdashdoctors who are at the forefront of health promotion illness prevention and wellnessrdquo says Dr Bruns Originally the certification consisted of four different modules and DCs had to travel to select cities to participate in the weekend seminars However ACA quickly realized that it was difficult for DCs to get to these courses and decided to turn the program into an online certification NWI has taken the lead on this conversion

ACA RESOURCES Bookmark wwwacatoday orgpublichealth on your computer for quick and easy access to patient handouts references and research for presentations a calendar of national public health observances and other resources that have all been vetted by the ACA APHAWellness and Health Promotion Committee for use in your office Published in the March 2014 ACA news

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 17)

spring 201419

ASSOCIATES WANTED

Associate Wanted Starting base annual salary range is 50-60K plus additional monthly $500-2K in productivity compensation Benefits include MalpracticeMedical insurance CE Our care model uses the latest in Chiropractic Massage Physical Therapy Acupuncture and Nutritional medicine services South Bend is home to Notre Dame and a short drive to Chicago and Lake Michigan This is a good place to raise a family with good schools and a low cost of living Sendfax a letter of interest and resume to apintodcyahoocom or fax (574) 254-1652 Posted 11514

Chicagoland Associate Doctor Needed Busy office with multiple long term associates Family practice Thirty minutes to downtown Chicago Full timepart time paid vacation $26hour starting pay with periodic raises Proficient in the Thompson leg-check technique We are looking for someone who is ready and willing to blend with a very upbeat fun and positive staff Interested applicants should email their resume to infotrimbolichironet or fax to (219) 836-2344 wwwtrimbolichironet Posted 12914

Opportunity for Doctor to grow own practice with buyout of 40 year family practice in 2-5 years Located in North Central Indiana with easy access to Indianapolis and Chicago Wonderful area to raise a family good schools low crime slower pace of life Contact pdyer4hotmailcom Posted 2614

Associate Needed We are currently searching for an associate doctor to help us at the Osmon Chiropractic Center in Bloomington IN This would be a tremendous opportunity for a new graduate or anyone considering a possible change of location You will be working in a beautiful 2500 square foot state of the art clinic with 1 other doctor and a professional staff of 8 to assist you There will be only a small amount of practice building activities on your part because we will provide you with a practice representative who will do that for you You will enjoy the security of a known income and practice without the stress of practice overhead and staff management All you need to do is learn our system of patient managementmdashthe same system we all use in the office and work together as a team to get and keep our community under chiropractic care It is an exciting place to practice Send resume and cover letter to drosmonhotmailcom and please feel free to visit our website at wwwDrOsmoncom Posted 3314

EQUIPMENT FOR SALE

For SalemdashFutura 3000GT automatic X-ray film processor two 8x10 cassettes two 7x14 cassettes two 14x17 cassettes Xray film cabinet new film xray I D Imprinter amp infra red light for sale $80000 Mikephelps55attnet or call (765) 345-0224 Posted 92413

PRACTICES FOR SALE

Free North Manchester practice Collected gt$300000 in 2012 Drs Kelsey giving practice records and X-ray to DC who buys their building 302 W MainHwy 114 Appraised for $165000 last monthmdashyou can buy it for $145000 Closing office on 103013 so you must act soon for this opportunity (260) 568-4419 or office 260-982-4646 Posted 100213

DCS WANTED

Kauffman Chiropractic PC is looking for a full-time position to be filled October 2013 Successful 25+ years established company with physical therapy massage therapy and rehabilitation Enthusiastic ambitious doctor who is willing to learn is a must Must be proficient in Diversified Thompson and Distraction techniques Nice salary is offered Email resume to chirodancomcastnet Posted 82713

Fantastic opportunity for energetic success-oriented doctor excited to grow with us professionally Comes with ownership possibilities Learn to share chiropractic in your community Train in an established practice run on outstanding systems Great training and support for you with focus on exceptiional patient communication and care including chiropractic rehab and massage Send CV or resume to clarksvillespineandrehabinsightbbcom Contact Joseph Rogers Lousville Kentucky (812) 282-7500 Posted 1714

Career Opportunity ndash URGENT ASSOCIATE WANTED ndash PEORIA IL Work in a state of the art wellness center with upbeat and professional staff ready to support you Utilize chiropractic clinical nutrition and rehabilitation to manage a wide range of conditions Doctor must be bright outgoing enthusiastic and must have excellent clinical skills This is an opportunity you dont want to miss Designed for someone looking for a career not simply another job Extensive training and great income potential Invest in your future Send a resume to lfulleralignlifecom Posted 12414

Part Time DC needed for Gary IN office for DOT Certified Medical Exams and some Chiropractic beginning March 15 2014 NO STRESS NO BILLING No Overhead ndash No Headaches Easy hours (8 am - 5 pm - 2 dayswk) Continue in your own practice and make extra cash in our office or just work part-time for us Will tutor you and pay for your DOT Certification - work 2 daysweek ($25000) Will tutor you and pay for your DOT Certification ($50hr = $25000year for 2 daysweek) Contact Lynn Biese -Carroll DC at lbiesewirrcom or call (262) 515-2168 Posted 2614

Associate Needed ndash Bloomington Indiana Expanding practice in Bloomington Indiana is looking for full-time position to be filled Enthusiastic ambitious doctor is a must Must be proficient in Diversified and Low Force techniques rehab and physical therapy Practice is a very strong stable consistent referral based practice Salary and profit share of clinic are offered We will train and mentor in technique and all areas of patient compliance and success Send resume to Dr Fox 1710 West Third St Bloomington Indiana 47404 or email to jbfprodigynet Posted 21814

vACATION DOCTORS

Mobile Moje Chiropractic Dr Moje is available for vacation relief and office coverage Licensed in IN OH MI WI MN amp PA Specializing in maternity leave injuries and vacations Call or email for CV availability rates references and further information Contact Dr Moje at stephanmojegmailcom or (218) 205-6141 Posted 81613

indiana state ChirOPraCtiC assOCiatiOn Classifieds

Page 6: ISCA Spring Report 2014

spring 20146

isCa highlights MeMBershiP and lOCal invOlveMent at sPring COnferenCe

Indianapolis ndash The Indiana State Chiropractic Association (ISCA) spoke of the importance of association membership and involvement during the 2014 Spring Conference February 21-23 2014 at the Hilton Indianapolis North

ldquoMembership does the work of the Associationrdquo said Dr Robert Tennant President of ISCA ldquoIt is this work that is vital to the advancement of the chiropractic profession and strengthening our local legislative effortsrdquo

Foot Levelers presenter Dr Kevin Wong discussed the importance of involvement in your State Association to support the profession ldquoWe will not advance without our membersrdquo said Dr Wong ldquoThey are the messengers that keep our mission movingrdquo

Dr Kevin Wong Dr Miles Bodzin and Dr Tim Maggs presented at the conference Dr Wong presented on understanding and treating the feet and extremities to understand why they are vital to whole body health Dr Bodzinrsquos course discussed the methods systems and strategies for freeing yourself from the shackles of insurance dependence Dr Maggsrsquo course described the current medical model care for high school athletes and discussed the need for the biomechanical model

ldquoThis is a time of great opportunity for the chiropractic profession We must work as a team communicate a consistent message to decision makers and engage more of our doctors to improve health and that is what the ISCA works to dordquo said Dr Tennant

ISCA Executive Director Pat McGuffey said the Association organizes two educational conferences each calendar year for Doctors of Chiropractic in Indiana More than 135 Doctors of Chiropractic attended the 2014 ISCA Spring Conference

Mark your calendar for The ISCA Fall Conference October 10-12 2014 at the Indianapolis Marriott East

1 Welcome to the 2014 ISCA Spring Conference

2 President Dr Robert Tennant discusses the importance of involvement with the Association

3 Executive Director Pat McGuffey reviews the work going on during the 2014 Legislative Session

2

1

2

11

3

spring 20147

4 Dr Kevin Wong speaks on Supporting Your Body

5 Dr Toby Harmon Board Member and Conference Committee Chairman energizes the group while describing his committees goals

6 DrPeterFurnocollectsfortheBackPACraffleduringthemembership luncheon

7 ThankstoallwhomadetheBackPACraffleasuccess

8 Dr Miles Bodzin Founder and CEO of Cash Practice Systems addresses the group at the Membership Luncheon and presents during seminar sessions

9 Attendees at the Membership Luncheon

10 Attendees listen to speakers during the Saturday Membership Luncheon

11 Conference attendees enjoyed the sounds of NEXUS during the attendee reception and mixed and mingled with their colleagues

12 Vendors greeted conference attendees through the event

13 Dr Diane Vuotto Board Member and Membership Committee Chairwoman

4

4

45

6

78

8

99

1010

11

12 1212 13

1111 11

spring 20148

ClOsing yOUr PraCtiCe dOnrsquot JUst shUt yOUr dOOrsBy Stephanie T Eckerle Esq Plews Shadley Racher amp Braun

Many chiropractors need to close their practice whether it is due to retirement relocation or a career change In other cases you may not need to close

your practice but you may want to discontinue the chiropractor-patient relationship with a certain patient Regardless of the scenario there are certain regulations that you need to be aware of in order to close your practice or terminate the patient relationship in compliance with all applicable laws

Closing Your Practice you must notify all of your active patients if you plan on retiring discontinuing your practice or moving from the community Generally active patients would be any patients that you have seen in the past two years The notice that you send to the patients should first state the date that your practice will close This date should be at least thirty days after you send the patients the notice Second the notice should provide directions on how the patients can obtain their medical records or transfer those to another chiropractor If you are going to charge patients any fees for copying medical records this should also be included in the notice In addition you may also include a release form for the medical records that is compliant with HIPAA and all applicable state laws which will further protect you when transferring medical records As a chiropractor you have a duty to promptly release a patients records to any other chiropractor or any other health discipline practitioner designated by the patient upon written request of the patient Lastly the letter should encourage your patients to seek the services of another chiropractor If you do refer your clients to a specific chiropractor you cannot receive any compensation for the referral of that patient under Indiana law

Terminating a Patient Relationship as a chiropractor you cannot abandon a patient under indiana law If you desire to terminate the patient relationship you must give due notice to a patient or those responsible for a patientrsquos care when you are withdrawing from a case Generally we recommend that you provide a patient or their caregiver with written notice of the termination at least thirty days in advance In addition you may want to provide the patient with a referral to another chiropractor Lastly you should always ensure that the patient knows how to obtain and transfer their medical records

The Indiana Chiropractic Board does enforce provisions applicable to closing or selling your practice or terminating the patient relationship For example in 2011 the Chiropractic Board brought a complaint against a chiropractor that refused to release a patientrsquos medical records unless that patient signed a general waiver of liability Therefore ensuring compliance with all applicable laws and regulations is critical In addition to regulatory compliance issues there are many other issues that you may want to consider when selling or closing your practice such as transferring your equipment terminating a lease or selling real estate terminating your employees terminating or assigning any contracts with vendors and allocating liability among you and the seller or purchaser as applicable

Stephanie Eckerle is the chair of the health Care and Life Sciences practice group at Plews Shadley Racher amp Braun LLP She represents various types of medical professionals including chiropractors physicians mid-level providers and pharmacists She also represents practice groups pharmacies laboratories and other health care entities If you have any questions about health care matters including how to close or sell your practice please contact Stephanie at (317) 637-0700 or seckerlepsrbcom

spring 20149

sPring Means tiMe fOr isCa MeMBers and nOnMeMBers tO Meet in distriCts By Cathy Orosz Membership Director and ISCA Association Manager

Spring is here and the ISCA is ready to recruit

ldquoThe snow is cleared and we are ready to hit the ground runningrdquo says Dr Diane Vuotto Membership Chairwoman and District 5 Director ldquoISCA District Directors are ready to engage current and potential members in their area and they need your input

Each of the nine District Directors are currently planning special meetings throughout April and May to recruit new members as well as learn from current members on how the ISCA can serve them better

Dr Hilton will be taking to the road in District 6 for one-on-one meetings If you are interested in scheduling a meeting with Dr Hilton please contact him at drhiltonsbcglobalnet

District 9 will be meeting on Tuesday April 29 at 630 pm at Dr Scott Autonrsquos office at 1551 N Main St in Franklin To attend this meeting and learn more about efforts in District 9 please contact Dr Auton at scottautonyahoocom or (317) 346-0799

If you would like to be more involved the ISCA asks that you please consider volunteering your time and talents Please contact Cathy Orosz at (317) 673-4245 (800) 572-8002 or infoindianastatechirosorg to learn how you can become more involved in the Association

WELCOME NEW MEMBERS 2014

Dr Nancy Elwartowski-Cooper Carmel

Dr Kevin Forrest Indianapolis

Dr Anthony Forrest Indianapolis

Dr Julie Carleton Fishers

INDIANA STATECHIROPRACTICASSOCIATIONwwwindianastatechirosorg

spring 201410

Certified Medical Examiner Training WE NEED 20 PAID REGISTRANTS BY APRIL 10 IN ORDER

TO HOST THIS TRAINING Saturday May 3 and Sunday May 4 2014 Indianapolis Location TBD 800 AM to 6 pm Saturday May 3 and 8 AM to noon Sunday May 4 YOU CANNOT DO PHYSICAL EXAMS FOR TRUCK AND BUS DRIVERS ANY LONGER UNLESS YOU OBTAIN THIS CERTIFICATION Interested in becoming a Certified Medical Examiner (CME) and be listed on the National Reg-istry YOU MUST COMPLETE THIS TRAINING AND TESTING on Federal Motor Carrier Safety Ad-ministrationrsquos (FMCSA) physical qualification standards and guidelines If you intend to perform physical examinations and issue medical certificates for commercial motor vehicle (CMV) drivers to meet the requirements of Section 39141 of the Federal Motor Carrier Safety Regulations (FMCSRs) you must be certified and listed on the FMCSArsquos National Registry by May 21 2014 Upon completion of this program you will be eligible to take the Certification Test for $79 at an Indiana testing site The ISCA will provide you with info regarding multiple testing sites Program presented for the ISCA by Michael Megehee DC National Registry Certified Medical Examiner and President TeamCME LLC

Registration Name Clinic Address CityStateZip Phone Email Address Payment Method (Credit Card or Check) Credit Card Type Credit Card Expiration 3 Digit Code Name on Card Signature Questions Contact Cathy Orosz at infoindianastatechirosorg or call 317-673-4245 or toll-free at 800-572-8002 The ISCA needs a minimum of 20 registrants by Friday April 10 for this program to be offered Payment is needed upon regis-tration and no refunds will be granted

Mail Registrations to Indiana State Chiropractic Association 200 S Meridian St Ste 410 Indianapolis IN 46225 Or Fax to 317-686-2672 or email to infoindianastatechirosorg

The Cost of the 12-hour training is $400 for ISCA Members and $450 for Non Members

Because we have to pay for TeamCME in Advance we must have 20 paid registrants by April 10 in order to host this training MAKE YOUR RESERVATIONS TODAY

spring 201411

CONTACT INFORMATION

NAME_____________________________________________________________________

COMPANY __________________________________________________________________

MAILING ADDRESS__________________________________________________________

CITY STATE ZIP_____________________________________________________________

PHONE ________________________________ FAX________________________________

EMAIL_____________________________________________________________________

ADDITIONAL ATTENDEE NAMES________________________________________________

___________________________________________________________________________

PAYMENT OPTIONS

AMEX VISA MASTERCARD CHECK (MAKE PAYABLE TO ISCA BACKPAC)

CARDHOLDER_______________________________________________________________

CARD ____________________________________________________________________

EXP__________________________ 3 DIGIT SECURITY ___________________________

SIGNATURE_________________________________________________________________

MAIL ISCA 200 S Meridian St Suite 410 Indianapolis IN 46225FAX 3176862672 ATTN Cathy Orosz

ISCA REGIONAL VIDEO VIEWINGSNEED CONTINUING EDUCATION HOURS THERErsquoS STILL TIME

Donrsquot miss your opportunity to get your required continuing education credits prior to June 30 2014 Indiana Statute dictates that every Licensed Chiropractor in Indiana gets four hours of risk management each year by attending one of the ISCArsquos Regional Video Viewings

There are a limited number of seats at some locations so pre-registration is necessaryIf you choose to pay at the door Pre-Registration is REQUIRED Non-prior notice of attendance will be subject to the Non-Member rate above Call the ISCA office for availability at your location (317) 673-4245 If you need directions to a location please call the ISCA for host contact information

Proceeds of the viewings are contributed to the ISCA Political Action Committee and are non-business deductible

QUESTIONS Contact Cathy Orosz at 8005728002 3176734245 or email infoindianastatechirosorg Proceeds of the viewings are contributed to the ISCA Political Action Committee and are non-business deductible

Contributions to the ISCA Political Action Committee are non-business deductible

REGIONAL VIDEO RATES

$185 Member In Good Standing $250 Non-Member $165 GoldSilver Member Free Of Charge - Platinum Member

VIEWING DATES amp LOCATIONS

WEDNESDAY MAY 7 830 AM - 1230PM Dr Patrick Case 3027 Mishawa Ave South Bend IN

TUESDAY MAY 8 830 AM - 1230PM Dr Douglas Breger 2652 Charlestown Rd New Albany IN

SATURDAY MAY 10 830 AM - 1230PM Dr John Kostidis Call 2199244456 for location and availability Valparaiso IN

WEDNESDAY MAY 13 7 AM - 11 AM Dr Toby Harmon 2602 Newton St Jasper IN

THURSDAY MAY 15 9 AM - 1PM Dr Michael Hartle 3835 W Jefferson Blvd Fort Wayne IN

spring 201412

MediCaidMediCare UPdateBy Michael Phelps DC Secretary ISCA Board of Directors MedicaidMedicare Advising Committee

2013 saw yet another attempt to take chiropractic care out of Medicaid The ISCA amp its Legislative Committee was successful in stopping this attack on the chiropractic profession Thanks to the hard work of the ISCA Indiana remains one of the limited states where Medicaid covers all chiropractic services under our states scope of practice

January 1 2014 also saw the reinstatement of the 5 reduction in imbursement that we accepted several years ago

The ISCA is able to keep chiropractors in the Medicaid Program as well as other insurance as a paid provider through the hard work and dedication of volunteers If you are able to donate some time there are a number of committees and positions that need to be filled by doctors that want to make a difference If you know of DCs that are not members of the ISCA tell them about the good work we do for the profession and that we need all Doctors of Chiropractic in this state to be members Remember if youre not part of the solution youre part of the problem

As you know with the changes in health care coverage there are changes with respect to Medicare All chiropractors should be reporting PQRS for incentive payment eligibility Those who report satisfactorily for the 2013 amp 2014 program years may avoid the 2015 PQRS payment adjustment Additional information on how to avoid future PQRS payment adjustments can be found through supporting documentation available on the CMS website at httpwwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-InstructionsPQRS Chiropractors are fortunate as they only have to report on three measures

Measure 131 - Pain Assessment and Follow upMeasure 182 - Functional Outcome AssessmentMeasure 317 - Preventive Care and Screening (Screening for High Blood Pressure)

January 1 2014 saw an increase of approximately 9 in the reimbursement for chiropractic adjustments (98940 98941 amp 98942) This increase was due to a reassessment of the RVUs for CMT

The latest CERT report saw a decrease in the percentage of errors for chiropractors Chiropractic physicians need to continue to improve their documentation and coding of services in order to maintain this downward decline of errors

The Wisconsin Physicians Service (WPS) periodically analyzes provider coding patterns to identify deviations within a peer group For the J8 (Indiana and Michigan) Jurisdiction there has been a significantly higher than normal usage of the Code 98942 (CMT of five regions of the spine) There are approximately 35 DCs in the state of Michigan that are on the radar I am happy to report that there are no chiropractors in the state of Indiana under review

All that needs to happen for Chiropractic to fail is for good doctors to do nothing If you know of a chiropractor that is not a member of the ISCA urge them to join

MedicaidMedicare Update (contd on page 13)

spring 201413

MedicaidMedicare Update (contd from page 12)

SGR BILL PASSES HOUSE GOES TO SENATE FOR CONSIDERATIONWe learned that the United States House of Representatives passed House Bill 4302 The bill proposes to extend Medicarersquos Sustainable Growth Rate (SGR) current rate to April 15 2015 and would delay other Medicare deadlines The bill as currently drafted would postpone ICD-10-CM implementation until after October 1 2015 and restrict the Centers for Medicare amp Medicaid Services (CMS) from acting without congressional approval The bill now goes to the US Senate for debate and vote If it passes the Senate it would then be sent to President Obamarsquos desk to be signed or vetoed The ISCA will continue to monitor this situation and recommends preparing for ICD-10 implementation

PLEASE ALSO MARK YOUR CALENDAR WITH THESE DATES Medicare Secondary Payer (MSP) Seminar April 17 2014 from 100 pm to 400 pm Hilton Garden Inn Fort Wayne 8615 US Hwy 24 West Fort Wayne IN Click here to register

There is a Chiropractic Medicare Seminar on April 26 2014 in Mishawaka IN Click here for more information

HELPFUL LINKSNeed help in the transition to ICD-10 Go to the Road to 10 website by clicking here This site is primarily for the MD but has general information that pertains to all health care specialties

Stay up-to-date on changes in Medicare at the WPS Medicare website by clicking here This website is for all providers but sometimes offers information specific to chiropractors

INFORMATION REGARDING THE HOLDING OF APRIL 2014 CLAIMS FOR SERvICES PAID UNDER THE 2014 MEDICARE PHYSICIAN FEE SCHEDULE The 2014 Medicare Physician Fee Schedule (MPFS) final rule stipulated a negative update to the MPFS that was to be effective January 1 2014 That reduction was averted for three months with the passage of the Pathway for SGR Reform Act of 2013 which provided for a 05 percent update for services paid under the MPFS through March 31 2014 CMS is hopeful that there will be congressional action to prevent the negative update from taking effect on April 1 2014 CMS has instructed the Medicare Administrative Contractors to hold claims containing services paid under the MPFS for the first 10 business days of April (ie through April 14 2014) This hold would only affect MPFS claims with dates of service of April 1 2014 and later The hold should have minimal impact on provider cash flow because under current law clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt All claims for services delivered on or before March 31 2014 will be processed and paid under normal procedures regardless of any Congressional actions

spring 201414

insUranCe COMMittee UPdateBy Peter Furno DC ISCA Board of Directors District 4 Director and Insurance Committee Chairman

During 2013 the ISCA Insurance Committee addressed many issues and questions from its members with regard to insurance legalities of advertising and proposed associations with third party vendors offering incentives contrary to our practice statues Doctors with definitively legal questions were referred to their legal counsel for liability reasons Most questions directed to the insurance committee are answered within 24 hours

Because the ISCA continues to receive anecdotal complaints from the field claiming insurer reimbursement discrimination and other transgressions the insurance committee as a part of the ISCArsquos proactive efforts to address this problem has developed a survey to obtain information on various insurance problems or concerns impacting chiropractors in the field The ISCA is aggressively attempting to determine problems that are affecting large numbers of doctors and which may be indicating the development of a trend requiring attention by the ISCA and then the IDOI However although it is the intent to meet with the IDOI once the survey information is correlated so that the contentions of our doctors may be addressed officially without firm evidence of wrong doing by the insurance industry the ISCA cannot go forward Consequently it is imperative that all members who are having trouble submit their complaints to the ISCA together with supportive documentation so that this issue may be addressed

Now that the PPACA is law and will require ldquoevidence-basedrdquo treatment procedures to be utilized before reimbursements are made the intent of the Insurance Committee to make at least one presentation to decision-makers of an employer group regarding the cost-effectiveness and efficacy of chiropractic in the management of work related uncomplicated spine injuries in comparison to traditional medical care Heretofore the majority of employers had no idea of the cost-effectiveness of chiropractic care when compared to traditional medicine and simply allowed their work nurses and medical providers to direct care ndash which the research shows is one of the main reasons costs are so high

The Insurance Committee in an attempt to keep the ISCA membership updated will attempt to address at least two insurance queries weekly and present answers to the membership via the ISCA monthly eNews and Newsletter

Insurance Pearl Medicare and Chiropractic Billing Misconceptions It is worthwhile to address a few of the prevailing misconceptions Here are the nine truisms regarding Medicare and chiropractic

1 There is not a 12-visit limit to Medicare for chiropractic services The limits of care are based on the specific medical necessity of the primary subluxation and its secondary neuromusculoskeletal diagnosis

2 Medicare will pay for both acute and chronic conditions as long as there is documentation or expectation of functional improvement

3 Nonparticipating (nonpar) providers are required to bill for services All covered services under chiropractic (spinal manipulation) must be billed to Medicare

4 Nonpar providers are audited just as par providers are There is no protection from a Medicare audit by being nonpar

5 Nonpar providers must document services in the same manner as any provider of Medicare services Being par or nonpar is irrelevant in reference to documentation of chiropractic services

6 Chiropractors may not opt out of Medicare This is simply not an option for doctors of chiropractic Being nonpar is not opting out but designating oneself as a Medicare provider nonpar In simple terms chiropractors must belong to Medicare to treat Medicare patients

7 Advance Beneficiary Notices (ABNs) should not be used as routine documents for patients to sign on their initial visit However they must be used when there is a genuine belief or reasonable expectation that Medicare will deny or not pay for the service on a specific visit or series of visits In other words a blanket ABN at the beginning of care is not sufficient or compliant

8 Medicare claims are not difficult they are simply different from health insurance claims When not done in Medicares format claims are denied

9 Medicare payment is what it is I will refrain from stating it is good While we all would want higher reimbursements (Who doesnt) the average fees for chiropractic services for manipulation are $30-$36 per visit This is far better reimbursement than under many of the managed care plans chiropractors routinely fight to join Furthermore that dollar amount is for spinal manipulation only other services may be billed to the patient or covered by a secondary insurance plan

spring 201415

trUst BUt verifyBy Dr R A Foxworth FICC MCS-P

I was speaking with a doctor recently who was venting her frustration about not knowing who to believe or trust as an authority when it comes to being in practice today She goes to different seminars because she wants to improve herself personally and professionally She also wants to improve her practice by learning more about her productivity effectiveness documentation compliance and billing She shared that she doesnt simply attend the CEU required hours for her license she puts in seminar hours to improve her practice her clinical skills her compliance and her business insight

Her problem The conflicting information she receives from various experts at each seminar How she asked can they all be right if they all say different things As a result of her experience she wanted to know why a Discount Medical Plan Organization (DMPO) like ChiroHealthUSA was of value in todayrsquos practices Why she asked is this even necessary What are my resources

I passed her third-degree with flying colors by the way

I could appreciate her position because I am a bit of a skeptic myself In fact thats how all this started for me I was a chiropractor in practice just like you trying to maximize my insurance payments so I wasnt leaving money on the table while still working to come up with a way my uninsured patients could afford those fees

Because of my activity within my state (as a governor-appointed health expert as an active participant in my State Chiropractic Association and the state representative for the American Chiropractic Association) I knew there were rules to follow to avoid compliance issues when creating our fee schedule I did my research and initially started a Discount Medical Plan Organization (DMPO) for my state alone I knew this would legally protect my practice and my colleagues and that at the time was my only goal

And as skeptic I wouldnrsquot even take my own word for it when it came to believing that a Discount Medical Plan Organization (DMPO) was the simplest way to keep my fee schedules compliant legal and safe Thatrsquos why I became a Certified Medical Compliance Specialist (MCS-P) so skeptics like me could get a breath and feel at ease As an MCS-P Irsquom quite simply held to a higher standard I have to be able to quote chapter and verse about why any possible fee or activity is or isnrsquot compliant

We know therersquos a plethora of inaccurate information that gets disseminated in our profession Im sad to say that I had to agree with my frustrated colleague when she was venting about all the conflicting advice she was receiving Thatrsquos why ChiroHealthUSA has relationships with many MCS-Ps to help get accurate reliable information out there Many of the brightest minds in our profession agree with and recommend ChiroHealthUSA to their chiropractic colleagues

Looking back when I set up my first DMPO within my state I can see how shortsighted I was I now know that taking ChiroHealthUSA to a national audience to protect all chiropractic practices in the country was the vision I shouldve had at the start Im glad I had an encounter with one of my fellow MCS-Ps who gave me this bigger vision

Learn more about how ChiroHealthUSA can help your practice be more compliant You can attend a free webinar this Tuesday April 1 Register at wwwChiroHealthUSAcom today to find out more

Dr Foxworth is a certified Medical Compliance Specialist and President of ChirohealthUSA A practicing Chiropractor he remains ldquoin the trenchesrdquo facing challenges with billing coding documentation and compliance he has served as president of the Mississippi Chiropractic Association former Staff Chiropractor at

the gv Sonny Montgomery vA Medical Center and is a Fellow of the International College of Chiropractic you can contact Dr Foxworth at 1 (888) 719-9990 infochirohealthusacom or visit the ChirohealthUSA website at wwwchirohealthusacom join us for a free webinar that will give you all the details about how a DMPO can help you practice with more peace of mind go to wwwchirohealthusacom to register today

spring 201416

Were already there ndash ChirOPraCtiC and PUBliC health hand-in-handBy Caitlin Lukacs from the March 2014 issue of ACA news

Public health is a popular buzz phrase in the healthcare arena but what exactly is it and how does chiropractic fit into it ldquoPublic health describes the overall wellbeing of the populacerdquo explains Richard Bruns DC past chairman of the American Chiropractic Associationrsquos (ACA) Wellness and Health Promotion Committee and ACA chairman of the Board of Governors ldquoAll public health issues have future implications for individuals as well as the publicrdquo

Public health encompasses habits and social norms such as smoking alcohol consumption obesity and the use of seatbelts as well as environmental issues such as clean water air quality and how livestock and agricultural practices affect the environment adds Will Evans DC PhD MCHES provost of the University of Western States Public health also includes health education and health promotion

ldquoPublic health and chiropractic go hand-in-handrdquo explains Karen Konarski-Hart DC DABCO FACO vice president of ACArsquos Council of Delegates and chairman of the American Public Health Association (APHA)Wellness and Health Promotion Committee ldquoDCs donrsquot practice in a vacuum they are interested in all aspects of a patientrsquos life that affect his or her health and wellbeing as well as how that person interacts in the healthcare community at largerdquo

Whether they identify it as public health or not all chiropractic physicians address public health issues when dealing with their patients For example when a new patient comes into your office you begin with a detailed history and an initial examination that includes not only taking vital signs but discussing tobacco and alcohol use and other behaviors that affect that patientrsquos health explains Dr Evans ldquoThis allows you to create an individual health-risk assessment based on his or her environment family history lifestyle etc and address public health issues such as tobacco use at the same timerdquo he says

BROACHING THE SUBjECTIt can sometimes be difficult to initiate conversations with patients about issues such as smoking or weight loss ldquoThe best place to address such topics is in your initial report of findings to the patientrdquo suggests Dr Evans ldquoYoursquove examined the patient and determined the cause of the pain or complaint that brought him or her into your office in the first place and now yoursquove got an opportunity to say lsquoI see some lifestyle-related issues that could be contributing to your pain or that could lead to other complaints down the roadrsquordquo

Yoursquore in a position to identify potential problems for your

patients says Dr Konarski-Hart ldquoThey may be setting themselves up for diabetes or cardiovascular disease or maybe they arenrsquot getting enough exercise mdash all of these things should be discussed as part of good primary carerdquo

You never want to force patients to make changes so yoursquoll need to assess their openness to addressing lifestyle changes first Simply ask them if theyrsquod be willing to discuss a healthier weight for example If they are you can let them know that you have multiple resources and partners in place to help them move forward

Dr Evans determines his patientsrsquo willingness to make lifestyle modifications by using the Stages of Change a common model of health behavior change The Stages of Change are

Pre-contemplator stage ndash Patient has no intention of making any changes in the next six months

Contemplator stage ndash Patient is considering a change within the next six months

Preparation stage ndash Patient has decided on a change and is preparing to take some kind of action

Action stage ndash Patient has begun implementing the change

Maintenance stage ndash Patient has made a change and is now working to maintain it

Take the example of an overweight patient Because the average weight of an individual in the United States has increased over the past few years some people who are overweight or borderline overweight donrsquot even realize it says Dr Evans Broach the subject gently and suggest a few small goals such as parking farther away from the office or shopping center or wearing a pedometer and working to increase the number of steps taken in a day You could also teach that patient how to read food labels and discuss healthier meal options Itrsquos about identifying the risk communicating the risk determining where your patient falls in the Stages of Change and then prescribing appropriate modifications explains Dr Evans ldquoAnd donrsquot forget to follow up with that patient at his or her next appointment Itrsquos important that he or she doesnrsquot lose confidence in your recommendations or in you as a healthcare providerrdquo he adds

GET INvOLvEDIn addition to discussions with patients in the treatment

Were Already There ndash Chiropractic and Public health hand-in-hand(contd on page 17)

spring 201417

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 16)

room there are many ways to incorporate public health into your practice One of the easiest ways to get involved is to participate in an observance that already exists such as the APHArsquos Public Health Week held the first week of every April (wwwaphaorgprogramshealthweek) or ACArsquos National Chiropractic Health Month (NCHM) celebrated every October These organizations come up with a new theme each year and gather all of the resources you need to participate ldquoIt takes the thinking and planning aspect off of the individual doctorrdquo says Dr Konarski-Hart ldquoAll you need to do is follow the instructions laid out by the parent organizationrdquo Additionally when you throw your hat into the ring on a larger issue or observance you know that the public health community is focused on that issue at that time so you can reach out to your county or state health department or other local healthcare associations and join in their efforts which will help you to build mutually beneficial long-term relationships says Dr Konarski-Hart ldquoMany state groups are underfunded and understaffed and they welcome participation particularly from physiciansrdquo she notes

DCs can also create their own observances ldquoACA offers webinars teleseminars and patient handouts on a variety of public health issuesmdashperuse the offerings and pick a topic to focus on for a week or a monthrdquo says Dr Konarski-Hart She suggests having your clinic sponsor a wellness competition or challenge You could partner with a local exercise facility or health foods store as well as a school or senior center and make it a community event You could also organize an eat well exercise club in which members meet for a walk or bike ride and then share a healthy breakfast or lunch Your practice could sponsor a poster contest at a local school or community center ldquoHave the kids create posters focused on healthy lifestyle choices and then give out prizes of fun healthy exercise such as a day of horseback riding or ice skatingrdquo Dr Konarski-Hart says Additionally your practice could sponsor a marathon participant or a local amateur sports team to show that you support healthy activities and active lifestyles

Similarly be informed about the public health issues in your community Maybe you live in an area with a high population of smokers or perhaps there have been numerous injuries due to not wearing a seatbelt in recent years Do some background research on these topics and then get involved whether that means simply providing patient handouts in your waiting room giving a community health talk participating in health fairs or working with your local health department (and other relevant organizations) to pass pertinent legislation

Look for organizations in your area that are already offering public health resources or programs and set up

a partnership with them For example for the topic of overweightobesity you could offer your clinic as a weigh-in site for participants in Weight Watchers programs suggests Dr Evans or partner with a local gym to give discounts to chiropractic patients Dr Bruns recommends getting involved with the school lunch program to advocate for healthy options for students For smoking cessation work with the American Lung Association to put on an informational presentation at a local hospital or sponsor a 5k or a stair run to raise awareness (and funds) for lung cancer research For drug addiction set up a referral network with psychologists or addiction centers and either offer acupuncture in your office or refer out to an acupuncturist as it has been shown to help patients through the detox process You can also use your knowledge of nutrition and exercise to facilitate the journey through detox says Dr Bruns

Additionally you should make a point to support these other organizations when they host local events (even if yoursquore not an official partner) or reach out for financial support ldquoI always participate in the American Cancer Societyrsquos golf tournament and I display their materials in my office as wellrdquo says Dr Bruns He also participates in the fundraising efforts of the American Heart Association and the American Lung Association on a regular basis ldquoItrsquos good for your patients and your community to see that you care about and support other healthcare organizationsrdquo he says

Another option for public health involvement is to join the APHArsquos Chiropractic Health Care Section Yoursquoll be informed on public health happenings have access to the latest information and research see what DCs are doing nationally and in other states on particular issues and even have the chance to give input and be involved in decision-making

CONCUSSIONConcussion prevention and treatment is one public health topic that is relevant to every patient population in every region of the United States ldquoWersquore seeing more concussions lately due in part to the number of children participating in contact sports the excessive training involved in these sports and the fact that most people arenrsquot aware of the symptoms and long-term risks of concussionsrdquo says Dr Konarski-Hart Helmets donrsquot actually provide protection against concussions either ldquoThe padding will protect the skull from fracture but because your brain is loose inside your skull it is not protected from impact or traumardquo she explains And with todayrsquos cultural emphasis on pushing through the pain wersquore starting to see more and more professional athletes coming forward with serious emotional psychological and neurological issues that are linked to multiple concussions in their past

spring 201418

As an EMT herself Dr Konarski-Hart attended an EMT convention in the summer of 2013 and heard a presentation from the Childrenrsquos Hospital of Arkansas on injury prevention After speaking with the presenters she discovered that they were having trouble getting buy-in from the allopathic community and she offered her services as a DC Since then Dr Konarski-Hart and the Arkansas Chiropractic Physicians Association (ACPA) have been working with the childrenrsquos hospital on various statewide projects dealing with all aspects of injury prevention One such program focuses on concussions

ldquoThrough this partnership we learned that Arkansas has not finalized its concussion protocols yet and we were able to get someone from our ACPA legislative team involved in that process to ensure chiropracticrsquos inclusion as an involved professionrdquo says Dr Konarski-Hart

Because of DCsrsquo knowledge and training itrsquos important for them to get involved with the concussion issue says Dr Bruns ldquoKnowing what we know about concussions we are doing a tremendous service to athletes and their families by completing pre-participation physicals and screenings and watching for signs and symptoms during participation as wellrdquo he says And itrsquos not just athletes who are suffering from concussions mdash itrsquos children who fall off a bike or a swing set or an older adult who slips on the ice

Itrsquos crucial for DCs to help disseminate information about concussions Whether you see concussion symptoms in a patient in your office or work with local sports teams you have the knowledge to serve as a local expert on the topic DCs can assess injured parties work with school administrators to create concussion protocols and push for legislation on standard concussion treatment says Dr Bruns

Kids parents coaches trainers and doctors all need to be aware of concussions and the potential risks involved with sustaining one or more ldquoItrsquos a matter of understanding the potential risks before making a decision to play in a game or to have a player sit out a game for examplerdquo says Dr Konarski-Hart

WErsquoRE ALREADY THEREAs DCs we focus on the biomechanics structure and function of the human body and we have a unique approach in that we look at the whole person in terms of nutrition flexibility blood flow and muscle and nervous tissue function says Dr Bruns ldquoThe chiropractic profession recognizes the importance of healthful eating nutritional support avoiding the bad habits of smoking and drinking alcohol and has been counseling patients on healthy lifestyles since long before it was fashionablerdquo

According to Dr Konarski-Hart simply choosing to be a doctor of chiropractic means that yoursquore involved in public health on some level because your goal is to make your patient healthier and therefore make your community healthier In other words DCs are already an integral part of public health

With the new health care emphasis on wellness and prevention many healthcare providers legislators insurance companies and government policy developers are focusing on how to offer access to these services especially in medically underserved rural areas or small towns Chiropractic representatives need to be part of those discussions to point out that in many of these communities DCs are already there providing that assessment counseling and care This representation is one of the functions of the ACA and state chiropractic associations and why your membership and involvement with these organizations is so critical says Dr Konarski-Hart

aCa neWs extraCERTIFIED CHIROPRACTIC WELLNESS SPECIALIST PROGRAMIn 2011 ACA began a partnership with the National Wellness Institute (NWI) a well respected organization recognized both inside and outside the chiropractic profession to offer a wellness certification program for DCs The 40-hour program will enable students to integrate principles of wellness coaching health promotion and disease prevention to their current practices Once the program is completed DCs will become Certified Chiropractic Wellness Specialists ldquoThe program was developed and launched by Dr Evans Cheryl Hawk DC PhD CHES and Mike Perko PhDmdashdoctors who are at the forefront of health promotion illness prevention and wellnessrdquo says Dr Bruns Originally the certification consisted of four different modules and DCs had to travel to select cities to participate in the weekend seminars However ACA quickly realized that it was difficult for DCs to get to these courses and decided to turn the program into an online certification NWI has taken the lead on this conversion

ACA RESOURCES Bookmark wwwacatoday orgpublichealth on your computer for quick and easy access to patient handouts references and research for presentations a calendar of national public health observances and other resources that have all been vetted by the ACA APHAWellness and Health Promotion Committee for use in your office Published in the March 2014 ACA news

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 17)

spring 201419

ASSOCIATES WANTED

Associate Wanted Starting base annual salary range is 50-60K plus additional monthly $500-2K in productivity compensation Benefits include MalpracticeMedical insurance CE Our care model uses the latest in Chiropractic Massage Physical Therapy Acupuncture and Nutritional medicine services South Bend is home to Notre Dame and a short drive to Chicago and Lake Michigan This is a good place to raise a family with good schools and a low cost of living Sendfax a letter of interest and resume to apintodcyahoocom or fax (574) 254-1652 Posted 11514

Chicagoland Associate Doctor Needed Busy office with multiple long term associates Family practice Thirty minutes to downtown Chicago Full timepart time paid vacation $26hour starting pay with periodic raises Proficient in the Thompson leg-check technique We are looking for someone who is ready and willing to blend with a very upbeat fun and positive staff Interested applicants should email their resume to infotrimbolichironet or fax to (219) 836-2344 wwwtrimbolichironet Posted 12914

Opportunity for Doctor to grow own practice with buyout of 40 year family practice in 2-5 years Located in North Central Indiana with easy access to Indianapolis and Chicago Wonderful area to raise a family good schools low crime slower pace of life Contact pdyer4hotmailcom Posted 2614

Associate Needed We are currently searching for an associate doctor to help us at the Osmon Chiropractic Center in Bloomington IN This would be a tremendous opportunity for a new graduate or anyone considering a possible change of location You will be working in a beautiful 2500 square foot state of the art clinic with 1 other doctor and a professional staff of 8 to assist you There will be only a small amount of practice building activities on your part because we will provide you with a practice representative who will do that for you You will enjoy the security of a known income and practice without the stress of practice overhead and staff management All you need to do is learn our system of patient managementmdashthe same system we all use in the office and work together as a team to get and keep our community under chiropractic care It is an exciting place to practice Send resume and cover letter to drosmonhotmailcom and please feel free to visit our website at wwwDrOsmoncom Posted 3314

EQUIPMENT FOR SALE

For SalemdashFutura 3000GT automatic X-ray film processor two 8x10 cassettes two 7x14 cassettes two 14x17 cassettes Xray film cabinet new film xray I D Imprinter amp infra red light for sale $80000 Mikephelps55attnet or call (765) 345-0224 Posted 92413

PRACTICES FOR SALE

Free North Manchester practice Collected gt$300000 in 2012 Drs Kelsey giving practice records and X-ray to DC who buys their building 302 W MainHwy 114 Appraised for $165000 last monthmdashyou can buy it for $145000 Closing office on 103013 so you must act soon for this opportunity (260) 568-4419 or office 260-982-4646 Posted 100213

DCS WANTED

Kauffman Chiropractic PC is looking for a full-time position to be filled October 2013 Successful 25+ years established company with physical therapy massage therapy and rehabilitation Enthusiastic ambitious doctor who is willing to learn is a must Must be proficient in Diversified Thompson and Distraction techniques Nice salary is offered Email resume to chirodancomcastnet Posted 82713

Fantastic opportunity for energetic success-oriented doctor excited to grow with us professionally Comes with ownership possibilities Learn to share chiropractic in your community Train in an established practice run on outstanding systems Great training and support for you with focus on exceptiional patient communication and care including chiropractic rehab and massage Send CV or resume to clarksvillespineandrehabinsightbbcom Contact Joseph Rogers Lousville Kentucky (812) 282-7500 Posted 1714

Career Opportunity ndash URGENT ASSOCIATE WANTED ndash PEORIA IL Work in a state of the art wellness center with upbeat and professional staff ready to support you Utilize chiropractic clinical nutrition and rehabilitation to manage a wide range of conditions Doctor must be bright outgoing enthusiastic and must have excellent clinical skills This is an opportunity you dont want to miss Designed for someone looking for a career not simply another job Extensive training and great income potential Invest in your future Send a resume to lfulleralignlifecom Posted 12414

Part Time DC needed for Gary IN office for DOT Certified Medical Exams and some Chiropractic beginning March 15 2014 NO STRESS NO BILLING No Overhead ndash No Headaches Easy hours (8 am - 5 pm - 2 dayswk) Continue in your own practice and make extra cash in our office or just work part-time for us Will tutor you and pay for your DOT Certification - work 2 daysweek ($25000) Will tutor you and pay for your DOT Certification ($50hr = $25000year for 2 daysweek) Contact Lynn Biese -Carroll DC at lbiesewirrcom or call (262) 515-2168 Posted 2614

Associate Needed ndash Bloomington Indiana Expanding practice in Bloomington Indiana is looking for full-time position to be filled Enthusiastic ambitious doctor is a must Must be proficient in Diversified and Low Force techniques rehab and physical therapy Practice is a very strong stable consistent referral based practice Salary and profit share of clinic are offered We will train and mentor in technique and all areas of patient compliance and success Send resume to Dr Fox 1710 West Third St Bloomington Indiana 47404 or email to jbfprodigynet Posted 21814

vACATION DOCTORS

Mobile Moje Chiropractic Dr Moje is available for vacation relief and office coverage Licensed in IN OH MI WI MN amp PA Specializing in maternity leave injuries and vacations Call or email for CV availability rates references and further information Contact Dr Moje at stephanmojegmailcom or (218) 205-6141 Posted 81613

indiana state ChirOPraCtiC assOCiatiOn Classifieds

Page 7: ISCA Spring Report 2014

spring 20147

4 Dr Kevin Wong speaks on Supporting Your Body

5 Dr Toby Harmon Board Member and Conference Committee Chairman energizes the group while describing his committees goals

6 DrPeterFurnocollectsfortheBackPACraffleduringthemembership luncheon

7 ThankstoallwhomadetheBackPACraffleasuccess

8 Dr Miles Bodzin Founder and CEO of Cash Practice Systems addresses the group at the Membership Luncheon and presents during seminar sessions

9 Attendees at the Membership Luncheon

10 Attendees listen to speakers during the Saturday Membership Luncheon

11 Conference attendees enjoyed the sounds of NEXUS during the attendee reception and mixed and mingled with their colleagues

12 Vendors greeted conference attendees through the event

13 Dr Diane Vuotto Board Member and Membership Committee Chairwoman

4

4

45

6

78

8

99

1010

11

12 1212 13

1111 11

spring 20148

ClOsing yOUr PraCtiCe dOnrsquot JUst shUt yOUr dOOrsBy Stephanie T Eckerle Esq Plews Shadley Racher amp Braun

Many chiropractors need to close their practice whether it is due to retirement relocation or a career change In other cases you may not need to close

your practice but you may want to discontinue the chiropractor-patient relationship with a certain patient Regardless of the scenario there are certain regulations that you need to be aware of in order to close your practice or terminate the patient relationship in compliance with all applicable laws

Closing Your Practice you must notify all of your active patients if you plan on retiring discontinuing your practice or moving from the community Generally active patients would be any patients that you have seen in the past two years The notice that you send to the patients should first state the date that your practice will close This date should be at least thirty days after you send the patients the notice Second the notice should provide directions on how the patients can obtain their medical records or transfer those to another chiropractor If you are going to charge patients any fees for copying medical records this should also be included in the notice In addition you may also include a release form for the medical records that is compliant with HIPAA and all applicable state laws which will further protect you when transferring medical records As a chiropractor you have a duty to promptly release a patients records to any other chiropractor or any other health discipline practitioner designated by the patient upon written request of the patient Lastly the letter should encourage your patients to seek the services of another chiropractor If you do refer your clients to a specific chiropractor you cannot receive any compensation for the referral of that patient under Indiana law

Terminating a Patient Relationship as a chiropractor you cannot abandon a patient under indiana law If you desire to terminate the patient relationship you must give due notice to a patient or those responsible for a patientrsquos care when you are withdrawing from a case Generally we recommend that you provide a patient or their caregiver with written notice of the termination at least thirty days in advance In addition you may want to provide the patient with a referral to another chiropractor Lastly you should always ensure that the patient knows how to obtain and transfer their medical records

The Indiana Chiropractic Board does enforce provisions applicable to closing or selling your practice or terminating the patient relationship For example in 2011 the Chiropractic Board brought a complaint against a chiropractor that refused to release a patientrsquos medical records unless that patient signed a general waiver of liability Therefore ensuring compliance with all applicable laws and regulations is critical In addition to regulatory compliance issues there are many other issues that you may want to consider when selling or closing your practice such as transferring your equipment terminating a lease or selling real estate terminating your employees terminating or assigning any contracts with vendors and allocating liability among you and the seller or purchaser as applicable

Stephanie Eckerle is the chair of the health Care and Life Sciences practice group at Plews Shadley Racher amp Braun LLP She represents various types of medical professionals including chiropractors physicians mid-level providers and pharmacists She also represents practice groups pharmacies laboratories and other health care entities If you have any questions about health care matters including how to close or sell your practice please contact Stephanie at (317) 637-0700 or seckerlepsrbcom

spring 20149

sPring Means tiMe fOr isCa MeMBers and nOnMeMBers tO Meet in distriCts By Cathy Orosz Membership Director and ISCA Association Manager

Spring is here and the ISCA is ready to recruit

ldquoThe snow is cleared and we are ready to hit the ground runningrdquo says Dr Diane Vuotto Membership Chairwoman and District 5 Director ldquoISCA District Directors are ready to engage current and potential members in their area and they need your input

Each of the nine District Directors are currently planning special meetings throughout April and May to recruit new members as well as learn from current members on how the ISCA can serve them better

Dr Hilton will be taking to the road in District 6 for one-on-one meetings If you are interested in scheduling a meeting with Dr Hilton please contact him at drhiltonsbcglobalnet

District 9 will be meeting on Tuesday April 29 at 630 pm at Dr Scott Autonrsquos office at 1551 N Main St in Franklin To attend this meeting and learn more about efforts in District 9 please contact Dr Auton at scottautonyahoocom or (317) 346-0799

If you would like to be more involved the ISCA asks that you please consider volunteering your time and talents Please contact Cathy Orosz at (317) 673-4245 (800) 572-8002 or infoindianastatechirosorg to learn how you can become more involved in the Association

WELCOME NEW MEMBERS 2014

Dr Nancy Elwartowski-Cooper Carmel

Dr Kevin Forrest Indianapolis

Dr Anthony Forrest Indianapolis

Dr Julie Carleton Fishers

INDIANA STATECHIROPRACTICASSOCIATIONwwwindianastatechirosorg

spring 201410

Certified Medical Examiner Training WE NEED 20 PAID REGISTRANTS BY APRIL 10 IN ORDER

TO HOST THIS TRAINING Saturday May 3 and Sunday May 4 2014 Indianapolis Location TBD 800 AM to 6 pm Saturday May 3 and 8 AM to noon Sunday May 4 YOU CANNOT DO PHYSICAL EXAMS FOR TRUCK AND BUS DRIVERS ANY LONGER UNLESS YOU OBTAIN THIS CERTIFICATION Interested in becoming a Certified Medical Examiner (CME) and be listed on the National Reg-istry YOU MUST COMPLETE THIS TRAINING AND TESTING on Federal Motor Carrier Safety Ad-ministrationrsquos (FMCSA) physical qualification standards and guidelines If you intend to perform physical examinations and issue medical certificates for commercial motor vehicle (CMV) drivers to meet the requirements of Section 39141 of the Federal Motor Carrier Safety Regulations (FMCSRs) you must be certified and listed on the FMCSArsquos National Registry by May 21 2014 Upon completion of this program you will be eligible to take the Certification Test for $79 at an Indiana testing site The ISCA will provide you with info regarding multiple testing sites Program presented for the ISCA by Michael Megehee DC National Registry Certified Medical Examiner and President TeamCME LLC

Registration Name Clinic Address CityStateZip Phone Email Address Payment Method (Credit Card or Check) Credit Card Type Credit Card Expiration 3 Digit Code Name on Card Signature Questions Contact Cathy Orosz at infoindianastatechirosorg or call 317-673-4245 or toll-free at 800-572-8002 The ISCA needs a minimum of 20 registrants by Friday April 10 for this program to be offered Payment is needed upon regis-tration and no refunds will be granted

Mail Registrations to Indiana State Chiropractic Association 200 S Meridian St Ste 410 Indianapolis IN 46225 Or Fax to 317-686-2672 or email to infoindianastatechirosorg

The Cost of the 12-hour training is $400 for ISCA Members and $450 for Non Members

Because we have to pay for TeamCME in Advance we must have 20 paid registrants by April 10 in order to host this training MAKE YOUR RESERVATIONS TODAY

spring 201411

CONTACT INFORMATION

NAME_____________________________________________________________________

COMPANY __________________________________________________________________

MAILING ADDRESS__________________________________________________________

CITY STATE ZIP_____________________________________________________________

PHONE ________________________________ FAX________________________________

EMAIL_____________________________________________________________________

ADDITIONAL ATTENDEE NAMES________________________________________________

___________________________________________________________________________

PAYMENT OPTIONS

AMEX VISA MASTERCARD CHECK (MAKE PAYABLE TO ISCA BACKPAC)

CARDHOLDER_______________________________________________________________

CARD ____________________________________________________________________

EXP__________________________ 3 DIGIT SECURITY ___________________________

SIGNATURE_________________________________________________________________

MAIL ISCA 200 S Meridian St Suite 410 Indianapolis IN 46225FAX 3176862672 ATTN Cathy Orosz

ISCA REGIONAL VIDEO VIEWINGSNEED CONTINUING EDUCATION HOURS THERErsquoS STILL TIME

Donrsquot miss your opportunity to get your required continuing education credits prior to June 30 2014 Indiana Statute dictates that every Licensed Chiropractor in Indiana gets four hours of risk management each year by attending one of the ISCArsquos Regional Video Viewings

There are a limited number of seats at some locations so pre-registration is necessaryIf you choose to pay at the door Pre-Registration is REQUIRED Non-prior notice of attendance will be subject to the Non-Member rate above Call the ISCA office for availability at your location (317) 673-4245 If you need directions to a location please call the ISCA for host contact information

Proceeds of the viewings are contributed to the ISCA Political Action Committee and are non-business deductible

QUESTIONS Contact Cathy Orosz at 8005728002 3176734245 or email infoindianastatechirosorg Proceeds of the viewings are contributed to the ISCA Political Action Committee and are non-business deductible

Contributions to the ISCA Political Action Committee are non-business deductible

REGIONAL VIDEO RATES

$185 Member In Good Standing $250 Non-Member $165 GoldSilver Member Free Of Charge - Platinum Member

VIEWING DATES amp LOCATIONS

WEDNESDAY MAY 7 830 AM - 1230PM Dr Patrick Case 3027 Mishawa Ave South Bend IN

TUESDAY MAY 8 830 AM - 1230PM Dr Douglas Breger 2652 Charlestown Rd New Albany IN

SATURDAY MAY 10 830 AM - 1230PM Dr John Kostidis Call 2199244456 for location and availability Valparaiso IN

WEDNESDAY MAY 13 7 AM - 11 AM Dr Toby Harmon 2602 Newton St Jasper IN

THURSDAY MAY 15 9 AM - 1PM Dr Michael Hartle 3835 W Jefferson Blvd Fort Wayne IN

spring 201412

MediCaidMediCare UPdateBy Michael Phelps DC Secretary ISCA Board of Directors MedicaidMedicare Advising Committee

2013 saw yet another attempt to take chiropractic care out of Medicaid The ISCA amp its Legislative Committee was successful in stopping this attack on the chiropractic profession Thanks to the hard work of the ISCA Indiana remains one of the limited states where Medicaid covers all chiropractic services under our states scope of practice

January 1 2014 also saw the reinstatement of the 5 reduction in imbursement that we accepted several years ago

The ISCA is able to keep chiropractors in the Medicaid Program as well as other insurance as a paid provider through the hard work and dedication of volunteers If you are able to donate some time there are a number of committees and positions that need to be filled by doctors that want to make a difference If you know of DCs that are not members of the ISCA tell them about the good work we do for the profession and that we need all Doctors of Chiropractic in this state to be members Remember if youre not part of the solution youre part of the problem

As you know with the changes in health care coverage there are changes with respect to Medicare All chiropractors should be reporting PQRS for incentive payment eligibility Those who report satisfactorily for the 2013 amp 2014 program years may avoid the 2015 PQRS payment adjustment Additional information on how to avoid future PQRS payment adjustments can be found through supporting documentation available on the CMS website at httpwwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-InstructionsPQRS Chiropractors are fortunate as they only have to report on three measures

Measure 131 - Pain Assessment and Follow upMeasure 182 - Functional Outcome AssessmentMeasure 317 - Preventive Care and Screening (Screening for High Blood Pressure)

January 1 2014 saw an increase of approximately 9 in the reimbursement for chiropractic adjustments (98940 98941 amp 98942) This increase was due to a reassessment of the RVUs for CMT

The latest CERT report saw a decrease in the percentage of errors for chiropractors Chiropractic physicians need to continue to improve their documentation and coding of services in order to maintain this downward decline of errors

The Wisconsin Physicians Service (WPS) periodically analyzes provider coding patterns to identify deviations within a peer group For the J8 (Indiana and Michigan) Jurisdiction there has been a significantly higher than normal usage of the Code 98942 (CMT of five regions of the spine) There are approximately 35 DCs in the state of Michigan that are on the radar I am happy to report that there are no chiropractors in the state of Indiana under review

All that needs to happen for Chiropractic to fail is for good doctors to do nothing If you know of a chiropractor that is not a member of the ISCA urge them to join

MedicaidMedicare Update (contd on page 13)

spring 201413

MedicaidMedicare Update (contd from page 12)

SGR BILL PASSES HOUSE GOES TO SENATE FOR CONSIDERATIONWe learned that the United States House of Representatives passed House Bill 4302 The bill proposes to extend Medicarersquos Sustainable Growth Rate (SGR) current rate to April 15 2015 and would delay other Medicare deadlines The bill as currently drafted would postpone ICD-10-CM implementation until after October 1 2015 and restrict the Centers for Medicare amp Medicaid Services (CMS) from acting without congressional approval The bill now goes to the US Senate for debate and vote If it passes the Senate it would then be sent to President Obamarsquos desk to be signed or vetoed The ISCA will continue to monitor this situation and recommends preparing for ICD-10 implementation

PLEASE ALSO MARK YOUR CALENDAR WITH THESE DATES Medicare Secondary Payer (MSP) Seminar April 17 2014 from 100 pm to 400 pm Hilton Garden Inn Fort Wayne 8615 US Hwy 24 West Fort Wayne IN Click here to register

There is a Chiropractic Medicare Seminar on April 26 2014 in Mishawaka IN Click here for more information

HELPFUL LINKSNeed help in the transition to ICD-10 Go to the Road to 10 website by clicking here This site is primarily for the MD but has general information that pertains to all health care specialties

Stay up-to-date on changes in Medicare at the WPS Medicare website by clicking here This website is for all providers but sometimes offers information specific to chiropractors

INFORMATION REGARDING THE HOLDING OF APRIL 2014 CLAIMS FOR SERvICES PAID UNDER THE 2014 MEDICARE PHYSICIAN FEE SCHEDULE The 2014 Medicare Physician Fee Schedule (MPFS) final rule stipulated a negative update to the MPFS that was to be effective January 1 2014 That reduction was averted for three months with the passage of the Pathway for SGR Reform Act of 2013 which provided for a 05 percent update for services paid under the MPFS through March 31 2014 CMS is hopeful that there will be congressional action to prevent the negative update from taking effect on April 1 2014 CMS has instructed the Medicare Administrative Contractors to hold claims containing services paid under the MPFS for the first 10 business days of April (ie through April 14 2014) This hold would only affect MPFS claims with dates of service of April 1 2014 and later The hold should have minimal impact on provider cash flow because under current law clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt All claims for services delivered on or before March 31 2014 will be processed and paid under normal procedures regardless of any Congressional actions

spring 201414

insUranCe COMMittee UPdateBy Peter Furno DC ISCA Board of Directors District 4 Director and Insurance Committee Chairman

During 2013 the ISCA Insurance Committee addressed many issues and questions from its members with regard to insurance legalities of advertising and proposed associations with third party vendors offering incentives contrary to our practice statues Doctors with definitively legal questions were referred to their legal counsel for liability reasons Most questions directed to the insurance committee are answered within 24 hours

Because the ISCA continues to receive anecdotal complaints from the field claiming insurer reimbursement discrimination and other transgressions the insurance committee as a part of the ISCArsquos proactive efforts to address this problem has developed a survey to obtain information on various insurance problems or concerns impacting chiropractors in the field The ISCA is aggressively attempting to determine problems that are affecting large numbers of doctors and which may be indicating the development of a trend requiring attention by the ISCA and then the IDOI However although it is the intent to meet with the IDOI once the survey information is correlated so that the contentions of our doctors may be addressed officially without firm evidence of wrong doing by the insurance industry the ISCA cannot go forward Consequently it is imperative that all members who are having trouble submit their complaints to the ISCA together with supportive documentation so that this issue may be addressed

Now that the PPACA is law and will require ldquoevidence-basedrdquo treatment procedures to be utilized before reimbursements are made the intent of the Insurance Committee to make at least one presentation to decision-makers of an employer group regarding the cost-effectiveness and efficacy of chiropractic in the management of work related uncomplicated spine injuries in comparison to traditional medical care Heretofore the majority of employers had no idea of the cost-effectiveness of chiropractic care when compared to traditional medicine and simply allowed their work nurses and medical providers to direct care ndash which the research shows is one of the main reasons costs are so high

The Insurance Committee in an attempt to keep the ISCA membership updated will attempt to address at least two insurance queries weekly and present answers to the membership via the ISCA monthly eNews and Newsletter

Insurance Pearl Medicare and Chiropractic Billing Misconceptions It is worthwhile to address a few of the prevailing misconceptions Here are the nine truisms regarding Medicare and chiropractic

1 There is not a 12-visit limit to Medicare for chiropractic services The limits of care are based on the specific medical necessity of the primary subluxation and its secondary neuromusculoskeletal diagnosis

2 Medicare will pay for both acute and chronic conditions as long as there is documentation or expectation of functional improvement

3 Nonparticipating (nonpar) providers are required to bill for services All covered services under chiropractic (spinal manipulation) must be billed to Medicare

4 Nonpar providers are audited just as par providers are There is no protection from a Medicare audit by being nonpar

5 Nonpar providers must document services in the same manner as any provider of Medicare services Being par or nonpar is irrelevant in reference to documentation of chiropractic services

6 Chiropractors may not opt out of Medicare This is simply not an option for doctors of chiropractic Being nonpar is not opting out but designating oneself as a Medicare provider nonpar In simple terms chiropractors must belong to Medicare to treat Medicare patients

7 Advance Beneficiary Notices (ABNs) should not be used as routine documents for patients to sign on their initial visit However they must be used when there is a genuine belief or reasonable expectation that Medicare will deny or not pay for the service on a specific visit or series of visits In other words a blanket ABN at the beginning of care is not sufficient or compliant

8 Medicare claims are not difficult they are simply different from health insurance claims When not done in Medicares format claims are denied

9 Medicare payment is what it is I will refrain from stating it is good While we all would want higher reimbursements (Who doesnt) the average fees for chiropractic services for manipulation are $30-$36 per visit This is far better reimbursement than under many of the managed care plans chiropractors routinely fight to join Furthermore that dollar amount is for spinal manipulation only other services may be billed to the patient or covered by a secondary insurance plan

spring 201415

trUst BUt verifyBy Dr R A Foxworth FICC MCS-P

I was speaking with a doctor recently who was venting her frustration about not knowing who to believe or trust as an authority when it comes to being in practice today She goes to different seminars because she wants to improve herself personally and professionally She also wants to improve her practice by learning more about her productivity effectiveness documentation compliance and billing She shared that she doesnt simply attend the CEU required hours for her license she puts in seminar hours to improve her practice her clinical skills her compliance and her business insight

Her problem The conflicting information she receives from various experts at each seminar How she asked can they all be right if they all say different things As a result of her experience she wanted to know why a Discount Medical Plan Organization (DMPO) like ChiroHealthUSA was of value in todayrsquos practices Why she asked is this even necessary What are my resources

I passed her third-degree with flying colors by the way

I could appreciate her position because I am a bit of a skeptic myself In fact thats how all this started for me I was a chiropractor in practice just like you trying to maximize my insurance payments so I wasnt leaving money on the table while still working to come up with a way my uninsured patients could afford those fees

Because of my activity within my state (as a governor-appointed health expert as an active participant in my State Chiropractic Association and the state representative for the American Chiropractic Association) I knew there were rules to follow to avoid compliance issues when creating our fee schedule I did my research and initially started a Discount Medical Plan Organization (DMPO) for my state alone I knew this would legally protect my practice and my colleagues and that at the time was my only goal

And as skeptic I wouldnrsquot even take my own word for it when it came to believing that a Discount Medical Plan Organization (DMPO) was the simplest way to keep my fee schedules compliant legal and safe Thatrsquos why I became a Certified Medical Compliance Specialist (MCS-P) so skeptics like me could get a breath and feel at ease As an MCS-P Irsquom quite simply held to a higher standard I have to be able to quote chapter and verse about why any possible fee or activity is or isnrsquot compliant

We know therersquos a plethora of inaccurate information that gets disseminated in our profession Im sad to say that I had to agree with my frustrated colleague when she was venting about all the conflicting advice she was receiving Thatrsquos why ChiroHealthUSA has relationships with many MCS-Ps to help get accurate reliable information out there Many of the brightest minds in our profession agree with and recommend ChiroHealthUSA to their chiropractic colleagues

Looking back when I set up my first DMPO within my state I can see how shortsighted I was I now know that taking ChiroHealthUSA to a national audience to protect all chiropractic practices in the country was the vision I shouldve had at the start Im glad I had an encounter with one of my fellow MCS-Ps who gave me this bigger vision

Learn more about how ChiroHealthUSA can help your practice be more compliant You can attend a free webinar this Tuesday April 1 Register at wwwChiroHealthUSAcom today to find out more

Dr Foxworth is a certified Medical Compliance Specialist and President of ChirohealthUSA A practicing Chiropractor he remains ldquoin the trenchesrdquo facing challenges with billing coding documentation and compliance he has served as president of the Mississippi Chiropractic Association former Staff Chiropractor at

the gv Sonny Montgomery vA Medical Center and is a Fellow of the International College of Chiropractic you can contact Dr Foxworth at 1 (888) 719-9990 infochirohealthusacom or visit the ChirohealthUSA website at wwwchirohealthusacom join us for a free webinar that will give you all the details about how a DMPO can help you practice with more peace of mind go to wwwchirohealthusacom to register today

spring 201416

Were already there ndash ChirOPraCtiC and PUBliC health hand-in-handBy Caitlin Lukacs from the March 2014 issue of ACA news

Public health is a popular buzz phrase in the healthcare arena but what exactly is it and how does chiropractic fit into it ldquoPublic health describes the overall wellbeing of the populacerdquo explains Richard Bruns DC past chairman of the American Chiropractic Associationrsquos (ACA) Wellness and Health Promotion Committee and ACA chairman of the Board of Governors ldquoAll public health issues have future implications for individuals as well as the publicrdquo

Public health encompasses habits and social norms such as smoking alcohol consumption obesity and the use of seatbelts as well as environmental issues such as clean water air quality and how livestock and agricultural practices affect the environment adds Will Evans DC PhD MCHES provost of the University of Western States Public health also includes health education and health promotion

ldquoPublic health and chiropractic go hand-in-handrdquo explains Karen Konarski-Hart DC DABCO FACO vice president of ACArsquos Council of Delegates and chairman of the American Public Health Association (APHA)Wellness and Health Promotion Committee ldquoDCs donrsquot practice in a vacuum they are interested in all aspects of a patientrsquos life that affect his or her health and wellbeing as well as how that person interacts in the healthcare community at largerdquo

Whether they identify it as public health or not all chiropractic physicians address public health issues when dealing with their patients For example when a new patient comes into your office you begin with a detailed history and an initial examination that includes not only taking vital signs but discussing tobacco and alcohol use and other behaviors that affect that patientrsquos health explains Dr Evans ldquoThis allows you to create an individual health-risk assessment based on his or her environment family history lifestyle etc and address public health issues such as tobacco use at the same timerdquo he says

BROACHING THE SUBjECTIt can sometimes be difficult to initiate conversations with patients about issues such as smoking or weight loss ldquoThe best place to address such topics is in your initial report of findings to the patientrdquo suggests Dr Evans ldquoYoursquove examined the patient and determined the cause of the pain or complaint that brought him or her into your office in the first place and now yoursquove got an opportunity to say lsquoI see some lifestyle-related issues that could be contributing to your pain or that could lead to other complaints down the roadrsquordquo

Yoursquore in a position to identify potential problems for your

patients says Dr Konarski-Hart ldquoThey may be setting themselves up for diabetes or cardiovascular disease or maybe they arenrsquot getting enough exercise mdash all of these things should be discussed as part of good primary carerdquo

You never want to force patients to make changes so yoursquoll need to assess their openness to addressing lifestyle changes first Simply ask them if theyrsquod be willing to discuss a healthier weight for example If they are you can let them know that you have multiple resources and partners in place to help them move forward

Dr Evans determines his patientsrsquo willingness to make lifestyle modifications by using the Stages of Change a common model of health behavior change The Stages of Change are

Pre-contemplator stage ndash Patient has no intention of making any changes in the next six months

Contemplator stage ndash Patient is considering a change within the next six months

Preparation stage ndash Patient has decided on a change and is preparing to take some kind of action

Action stage ndash Patient has begun implementing the change

Maintenance stage ndash Patient has made a change and is now working to maintain it

Take the example of an overweight patient Because the average weight of an individual in the United States has increased over the past few years some people who are overweight or borderline overweight donrsquot even realize it says Dr Evans Broach the subject gently and suggest a few small goals such as parking farther away from the office or shopping center or wearing a pedometer and working to increase the number of steps taken in a day You could also teach that patient how to read food labels and discuss healthier meal options Itrsquos about identifying the risk communicating the risk determining where your patient falls in the Stages of Change and then prescribing appropriate modifications explains Dr Evans ldquoAnd donrsquot forget to follow up with that patient at his or her next appointment Itrsquos important that he or she doesnrsquot lose confidence in your recommendations or in you as a healthcare providerrdquo he adds

GET INvOLvEDIn addition to discussions with patients in the treatment

Were Already There ndash Chiropractic and Public health hand-in-hand(contd on page 17)

spring 201417

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 16)

room there are many ways to incorporate public health into your practice One of the easiest ways to get involved is to participate in an observance that already exists such as the APHArsquos Public Health Week held the first week of every April (wwwaphaorgprogramshealthweek) or ACArsquos National Chiropractic Health Month (NCHM) celebrated every October These organizations come up with a new theme each year and gather all of the resources you need to participate ldquoIt takes the thinking and planning aspect off of the individual doctorrdquo says Dr Konarski-Hart ldquoAll you need to do is follow the instructions laid out by the parent organizationrdquo Additionally when you throw your hat into the ring on a larger issue or observance you know that the public health community is focused on that issue at that time so you can reach out to your county or state health department or other local healthcare associations and join in their efforts which will help you to build mutually beneficial long-term relationships says Dr Konarski-Hart ldquoMany state groups are underfunded and understaffed and they welcome participation particularly from physiciansrdquo she notes

DCs can also create their own observances ldquoACA offers webinars teleseminars and patient handouts on a variety of public health issuesmdashperuse the offerings and pick a topic to focus on for a week or a monthrdquo says Dr Konarski-Hart She suggests having your clinic sponsor a wellness competition or challenge You could partner with a local exercise facility or health foods store as well as a school or senior center and make it a community event You could also organize an eat well exercise club in which members meet for a walk or bike ride and then share a healthy breakfast or lunch Your practice could sponsor a poster contest at a local school or community center ldquoHave the kids create posters focused on healthy lifestyle choices and then give out prizes of fun healthy exercise such as a day of horseback riding or ice skatingrdquo Dr Konarski-Hart says Additionally your practice could sponsor a marathon participant or a local amateur sports team to show that you support healthy activities and active lifestyles

Similarly be informed about the public health issues in your community Maybe you live in an area with a high population of smokers or perhaps there have been numerous injuries due to not wearing a seatbelt in recent years Do some background research on these topics and then get involved whether that means simply providing patient handouts in your waiting room giving a community health talk participating in health fairs or working with your local health department (and other relevant organizations) to pass pertinent legislation

Look for organizations in your area that are already offering public health resources or programs and set up

a partnership with them For example for the topic of overweightobesity you could offer your clinic as a weigh-in site for participants in Weight Watchers programs suggests Dr Evans or partner with a local gym to give discounts to chiropractic patients Dr Bruns recommends getting involved with the school lunch program to advocate for healthy options for students For smoking cessation work with the American Lung Association to put on an informational presentation at a local hospital or sponsor a 5k or a stair run to raise awareness (and funds) for lung cancer research For drug addiction set up a referral network with psychologists or addiction centers and either offer acupuncture in your office or refer out to an acupuncturist as it has been shown to help patients through the detox process You can also use your knowledge of nutrition and exercise to facilitate the journey through detox says Dr Bruns

Additionally you should make a point to support these other organizations when they host local events (even if yoursquore not an official partner) or reach out for financial support ldquoI always participate in the American Cancer Societyrsquos golf tournament and I display their materials in my office as wellrdquo says Dr Bruns He also participates in the fundraising efforts of the American Heart Association and the American Lung Association on a regular basis ldquoItrsquos good for your patients and your community to see that you care about and support other healthcare organizationsrdquo he says

Another option for public health involvement is to join the APHArsquos Chiropractic Health Care Section Yoursquoll be informed on public health happenings have access to the latest information and research see what DCs are doing nationally and in other states on particular issues and even have the chance to give input and be involved in decision-making

CONCUSSIONConcussion prevention and treatment is one public health topic that is relevant to every patient population in every region of the United States ldquoWersquore seeing more concussions lately due in part to the number of children participating in contact sports the excessive training involved in these sports and the fact that most people arenrsquot aware of the symptoms and long-term risks of concussionsrdquo says Dr Konarski-Hart Helmets donrsquot actually provide protection against concussions either ldquoThe padding will protect the skull from fracture but because your brain is loose inside your skull it is not protected from impact or traumardquo she explains And with todayrsquos cultural emphasis on pushing through the pain wersquore starting to see more and more professional athletes coming forward with serious emotional psychological and neurological issues that are linked to multiple concussions in their past

spring 201418

As an EMT herself Dr Konarski-Hart attended an EMT convention in the summer of 2013 and heard a presentation from the Childrenrsquos Hospital of Arkansas on injury prevention After speaking with the presenters she discovered that they were having trouble getting buy-in from the allopathic community and she offered her services as a DC Since then Dr Konarski-Hart and the Arkansas Chiropractic Physicians Association (ACPA) have been working with the childrenrsquos hospital on various statewide projects dealing with all aspects of injury prevention One such program focuses on concussions

ldquoThrough this partnership we learned that Arkansas has not finalized its concussion protocols yet and we were able to get someone from our ACPA legislative team involved in that process to ensure chiropracticrsquos inclusion as an involved professionrdquo says Dr Konarski-Hart

Because of DCsrsquo knowledge and training itrsquos important for them to get involved with the concussion issue says Dr Bruns ldquoKnowing what we know about concussions we are doing a tremendous service to athletes and their families by completing pre-participation physicals and screenings and watching for signs and symptoms during participation as wellrdquo he says And itrsquos not just athletes who are suffering from concussions mdash itrsquos children who fall off a bike or a swing set or an older adult who slips on the ice

Itrsquos crucial for DCs to help disseminate information about concussions Whether you see concussion symptoms in a patient in your office or work with local sports teams you have the knowledge to serve as a local expert on the topic DCs can assess injured parties work with school administrators to create concussion protocols and push for legislation on standard concussion treatment says Dr Bruns

Kids parents coaches trainers and doctors all need to be aware of concussions and the potential risks involved with sustaining one or more ldquoItrsquos a matter of understanding the potential risks before making a decision to play in a game or to have a player sit out a game for examplerdquo says Dr Konarski-Hart

WErsquoRE ALREADY THEREAs DCs we focus on the biomechanics structure and function of the human body and we have a unique approach in that we look at the whole person in terms of nutrition flexibility blood flow and muscle and nervous tissue function says Dr Bruns ldquoThe chiropractic profession recognizes the importance of healthful eating nutritional support avoiding the bad habits of smoking and drinking alcohol and has been counseling patients on healthy lifestyles since long before it was fashionablerdquo

According to Dr Konarski-Hart simply choosing to be a doctor of chiropractic means that yoursquore involved in public health on some level because your goal is to make your patient healthier and therefore make your community healthier In other words DCs are already an integral part of public health

With the new health care emphasis on wellness and prevention many healthcare providers legislators insurance companies and government policy developers are focusing on how to offer access to these services especially in medically underserved rural areas or small towns Chiropractic representatives need to be part of those discussions to point out that in many of these communities DCs are already there providing that assessment counseling and care This representation is one of the functions of the ACA and state chiropractic associations and why your membership and involvement with these organizations is so critical says Dr Konarski-Hart

aCa neWs extraCERTIFIED CHIROPRACTIC WELLNESS SPECIALIST PROGRAMIn 2011 ACA began a partnership with the National Wellness Institute (NWI) a well respected organization recognized both inside and outside the chiropractic profession to offer a wellness certification program for DCs The 40-hour program will enable students to integrate principles of wellness coaching health promotion and disease prevention to their current practices Once the program is completed DCs will become Certified Chiropractic Wellness Specialists ldquoThe program was developed and launched by Dr Evans Cheryl Hawk DC PhD CHES and Mike Perko PhDmdashdoctors who are at the forefront of health promotion illness prevention and wellnessrdquo says Dr Bruns Originally the certification consisted of four different modules and DCs had to travel to select cities to participate in the weekend seminars However ACA quickly realized that it was difficult for DCs to get to these courses and decided to turn the program into an online certification NWI has taken the lead on this conversion

ACA RESOURCES Bookmark wwwacatoday orgpublichealth on your computer for quick and easy access to patient handouts references and research for presentations a calendar of national public health observances and other resources that have all been vetted by the ACA APHAWellness and Health Promotion Committee for use in your office Published in the March 2014 ACA news

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 17)

spring 201419

ASSOCIATES WANTED

Associate Wanted Starting base annual salary range is 50-60K plus additional monthly $500-2K in productivity compensation Benefits include MalpracticeMedical insurance CE Our care model uses the latest in Chiropractic Massage Physical Therapy Acupuncture and Nutritional medicine services South Bend is home to Notre Dame and a short drive to Chicago and Lake Michigan This is a good place to raise a family with good schools and a low cost of living Sendfax a letter of interest and resume to apintodcyahoocom or fax (574) 254-1652 Posted 11514

Chicagoland Associate Doctor Needed Busy office with multiple long term associates Family practice Thirty minutes to downtown Chicago Full timepart time paid vacation $26hour starting pay with periodic raises Proficient in the Thompson leg-check technique We are looking for someone who is ready and willing to blend with a very upbeat fun and positive staff Interested applicants should email their resume to infotrimbolichironet or fax to (219) 836-2344 wwwtrimbolichironet Posted 12914

Opportunity for Doctor to grow own practice with buyout of 40 year family practice in 2-5 years Located in North Central Indiana with easy access to Indianapolis and Chicago Wonderful area to raise a family good schools low crime slower pace of life Contact pdyer4hotmailcom Posted 2614

Associate Needed We are currently searching for an associate doctor to help us at the Osmon Chiropractic Center in Bloomington IN This would be a tremendous opportunity for a new graduate or anyone considering a possible change of location You will be working in a beautiful 2500 square foot state of the art clinic with 1 other doctor and a professional staff of 8 to assist you There will be only a small amount of practice building activities on your part because we will provide you with a practice representative who will do that for you You will enjoy the security of a known income and practice without the stress of practice overhead and staff management All you need to do is learn our system of patient managementmdashthe same system we all use in the office and work together as a team to get and keep our community under chiropractic care It is an exciting place to practice Send resume and cover letter to drosmonhotmailcom and please feel free to visit our website at wwwDrOsmoncom Posted 3314

EQUIPMENT FOR SALE

For SalemdashFutura 3000GT automatic X-ray film processor two 8x10 cassettes two 7x14 cassettes two 14x17 cassettes Xray film cabinet new film xray I D Imprinter amp infra red light for sale $80000 Mikephelps55attnet or call (765) 345-0224 Posted 92413

PRACTICES FOR SALE

Free North Manchester practice Collected gt$300000 in 2012 Drs Kelsey giving practice records and X-ray to DC who buys their building 302 W MainHwy 114 Appraised for $165000 last monthmdashyou can buy it for $145000 Closing office on 103013 so you must act soon for this opportunity (260) 568-4419 or office 260-982-4646 Posted 100213

DCS WANTED

Kauffman Chiropractic PC is looking for a full-time position to be filled October 2013 Successful 25+ years established company with physical therapy massage therapy and rehabilitation Enthusiastic ambitious doctor who is willing to learn is a must Must be proficient in Diversified Thompson and Distraction techniques Nice salary is offered Email resume to chirodancomcastnet Posted 82713

Fantastic opportunity for energetic success-oriented doctor excited to grow with us professionally Comes with ownership possibilities Learn to share chiropractic in your community Train in an established practice run on outstanding systems Great training and support for you with focus on exceptiional patient communication and care including chiropractic rehab and massage Send CV or resume to clarksvillespineandrehabinsightbbcom Contact Joseph Rogers Lousville Kentucky (812) 282-7500 Posted 1714

Career Opportunity ndash URGENT ASSOCIATE WANTED ndash PEORIA IL Work in a state of the art wellness center with upbeat and professional staff ready to support you Utilize chiropractic clinical nutrition and rehabilitation to manage a wide range of conditions Doctor must be bright outgoing enthusiastic and must have excellent clinical skills This is an opportunity you dont want to miss Designed for someone looking for a career not simply another job Extensive training and great income potential Invest in your future Send a resume to lfulleralignlifecom Posted 12414

Part Time DC needed for Gary IN office for DOT Certified Medical Exams and some Chiropractic beginning March 15 2014 NO STRESS NO BILLING No Overhead ndash No Headaches Easy hours (8 am - 5 pm - 2 dayswk) Continue in your own practice and make extra cash in our office or just work part-time for us Will tutor you and pay for your DOT Certification - work 2 daysweek ($25000) Will tutor you and pay for your DOT Certification ($50hr = $25000year for 2 daysweek) Contact Lynn Biese -Carroll DC at lbiesewirrcom or call (262) 515-2168 Posted 2614

Associate Needed ndash Bloomington Indiana Expanding practice in Bloomington Indiana is looking for full-time position to be filled Enthusiastic ambitious doctor is a must Must be proficient in Diversified and Low Force techniques rehab and physical therapy Practice is a very strong stable consistent referral based practice Salary and profit share of clinic are offered We will train and mentor in technique and all areas of patient compliance and success Send resume to Dr Fox 1710 West Third St Bloomington Indiana 47404 or email to jbfprodigynet Posted 21814

vACATION DOCTORS

Mobile Moje Chiropractic Dr Moje is available for vacation relief and office coverage Licensed in IN OH MI WI MN amp PA Specializing in maternity leave injuries and vacations Call or email for CV availability rates references and further information Contact Dr Moje at stephanmojegmailcom or (218) 205-6141 Posted 81613

indiana state ChirOPraCtiC assOCiatiOn Classifieds

Page 8: ISCA Spring Report 2014

spring 20148

ClOsing yOUr PraCtiCe dOnrsquot JUst shUt yOUr dOOrsBy Stephanie T Eckerle Esq Plews Shadley Racher amp Braun

Many chiropractors need to close their practice whether it is due to retirement relocation or a career change In other cases you may not need to close

your practice but you may want to discontinue the chiropractor-patient relationship with a certain patient Regardless of the scenario there are certain regulations that you need to be aware of in order to close your practice or terminate the patient relationship in compliance with all applicable laws

Closing Your Practice you must notify all of your active patients if you plan on retiring discontinuing your practice or moving from the community Generally active patients would be any patients that you have seen in the past two years The notice that you send to the patients should first state the date that your practice will close This date should be at least thirty days after you send the patients the notice Second the notice should provide directions on how the patients can obtain their medical records or transfer those to another chiropractor If you are going to charge patients any fees for copying medical records this should also be included in the notice In addition you may also include a release form for the medical records that is compliant with HIPAA and all applicable state laws which will further protect you when transferring medical records As a chiropractor you have a duty to promptly release a patients records to any other chiropractor or any other health discipline practitioner designated by the patient upon written request of the patient Lastly the letter should encourage your patients to seek the services of another chiropractor If you do refer your clients to a specific chiropractor you cannot receive any compensation for the referral of that patient under Indiana law

Terminating a Patient Relationship as a chiropractor you cannot abandon a patient under indiana law If you desire to terminate the patient relationship you must give due notice to a patient or those responsible for a patientrsquos care when you are withdrawing from a case Generally we recommend that you provide a patient or their caregiver with written notice of the termination at least thirty days in advance In addition you may want to provide the patient with a referral to another chiropractor Lastly you should always ensure that the patient knows how to obtain and transfer their medical records

The Indiana Chiropractic Board does enforce provisions applicable to closing or selling your practice or terminating the patient relationship For example in 2011 the Chiropractic Board brought a complaint against a chiropractor that refused to release a patientrsquos medical records unless that patient signed a general waiver of liability Therefore ensuring compliance with all applicable laws and regulations is critical In addition to regulatory compliance issues there are many other issues that you may want to consider when selling or closing your practice such as transferring your equipment terminating a lease or selling real estate terminating your employees terminating or assigning any contracts with vendors and allocating liability among you and the seller or purchaser as applicable

Stephanie Eckerle is the chair of the health Care and Life Sciences practice group at Plews Shadley Racher amp Braun LLP She represents various types of medical professionals including chiropractors physicians mid-level providers and pharmacists She also represents practice groups pharmacies laboratories and other health care entities If you have any questions about health care matters including how to close or sell your practice please contact Stephanie at (317) 637-0700 or seckerlepsrbcom

spring 20149

sPring Means tiMe fOr isCa MeMBers and nOnMeMBers tO Meet in distriCts By Cathy Orosz Membership Director and ISCA Association Manager

Spring is here and the ISCA is ready to recruit

ldquoThe snow is cleared and we are ready to hit the ground runningrdquo says Dr Diane Vuotto Membership Chairwoman and District 5 Director ldquoISCA District Directors are ready to engage current and potential members in their area and they need your input

Each of the nine District Directors are currently planning special meetings throughout April and May to recruit new members as well as learn from current members on how the ISCA can serve them better

Dr Hilton will be taking to the road in District 6 for one-on-one meetings If you are interested in scheduling a meeting with Dr Hilton please contact him at drhiltonsbcglobalnet

District 9 will be meeting on Tuesday April 29 at 630 pm at Dr Scott Autonrsquos office at 1551 N Main St in Franklin To attend this meeting and learn more about efforts in District 9 please contact Dr Auton at scottautonyahoocom or (317) 346-0799

If you would like to be more involved the ISCA asks that you please consider volunteering your time and talents Please contact Cathy Orosz at (317) 673-4245 (800) 572-8002 or infoindianastatechirosorg to learn how you can become more involved in the Association

WELCOME NEW MEMBERS 2014

Dr Nancy Elwartowski-Cooper Carmel

Dr Kevin Forrest Indianapolis

Dr Anthony Forrest Indianapolis

Dr Julie Carleton Fishers

INDIANA STATECHIROPRACTICASSOCIATIONwwwindianastatechirosorg

spring 201410

Certified Medical Examiner Training WE NEED 20 PAID REGISTRANTS BY APRIL 10 IN ORDER

TO HOST THIS TRAINING Saturday May 3 and Sunday May 4 2014 Indianapolis Location TBD 800 AM to 6 pm Saturday May 3 and 8 AM to noon Sunday May 4 YOU CANNOT DO PHYSICAL EXAMS FOR TRUCK AND BUS DRIVERS ANY LONGER UNLESS YOU OBTAIN THIS CERTIFICATION Interested in becoming a Certified Medical Examiner (CME) and be listed on the National Reg-istry YOU MUST COMPLETE THIS TRAINING AND TESTING on Federal Motor Carrier Safety Ad-ministrationrsquos (FMCSA) physical qualification standards and guidelines If you intend to perform physical examinations and issue medical certificates for commercial motor vehicle (CMV) drivers to meet the requirements of Section 39141 of the Federal Motor Carrier Safety Regulations (FMCSRs) you must be certified and listed on the FMCSArsquos National Registry by May 21 2014 Upon completion of this program you will be eligible to take the Certification Test for $79 at an Indiana testing site The ISCA will provide you with info regarding multiple testing sites Program presented for the ISCA by Michael Megehee DC National Registry Certified Medical Examiner and President TeamCME LLC

Registration Name Clinic Address CityStateZip Phone Email Address Payment Method (Credit Card or Check) Credit Card Type Credit Card Expiration 3 Digit Code Name on Card Signature Questions Contact Cathy Orosz at infoindianastatechirosorg or call 317-673-4245 or toll-free at 800-572-8002 The ISCA needs a minimum of 20 registrants by Friday April 10 for this program to be offered Payment is needed upon regis-tration and no refunds will be granted

Mail Registrations to Indiana State Chiropractic Association 200 S Meridian St Ste 410 Indianapolis IN 46225 Or Fax to 317-686-2672 or email to infoindianastatechirosorg

The Cost of the 12-hour training is $400 for ISCA Members and $450 for Non Members

Because we have to pay for TeamCME in Advance we must have 20 paid registrants by April 10 in order to host this training MAKE YOUR RESERVATIONS TODAY

spring 201411

CONTACT INFORMATION

NAME_____________________________________________________________________

COMPANY __________________________________________________________________

MAILING ADDRESS__________________________________________________________

CITY STATE ZIP_____________________________________________________________

PHONE ________________________________ FAX________________________________

EMAIL_____________________________________________________________________

ADDITIONAL ATTENDEE NAMES________________________________________________

___________________________________________________________________________

PAYMENT OPTIONS

AMEX VISA MASTERCARD CHECK (MAKE PAYABLE TO ISCA BACKPAC)

CARDHOLDER_______________________________________________________________

CARD ____________________________________________________________________

EXP__________________________ 3 DIGIT SECURITY ___________________________

SIGNATURE_________________________________________________________________

MAIL ISCA 200 S Meridian St Suite 410 Indianapolis IN 46225FAX 3176862672 ATTN Cathy Orosz

ISCA REGIONAL VIDEO VIEWINGSNEED CONTINUING EDUCATION HOURS THERErsquoS STILL TIME

Donrsquot miss your opportunity to get your required continuing education credits prior to June 30 2014 Indiana Statute dictates that every Licensed Chiropractor in Indiana gets four hours of risk management each year by attending one of the ISCArsquos Regional Video Viewings

There are a limited number of seats at some locations so pre-registration is necessaryIf you choose to pay at the door Pre-Registration is REQUIRED Non-prior notice of attendance will be subject to the Non-Member rate above Call the ISCA office for availability at your location (317) 673-4245 If you need directions to a location please call the ISCA for host contact information

Proceeds of the viewings are contributed to the ISCA Political Action Committee and are non-business deductible

QUESTIONS Contact Cathy Orosz at 8005728002 3176734245 or email infoindianastatechirosorg Proceeds of the viewings are contributed to the ISCA Political Action Committee and are non-business deductible

Contributions to the ISCA Political Action Committee are non-business deductible

REGIONAL VIDEO RATES

$185 Member In Good Standing $250 Non-Member $165 GoldSilver Member Free Of Charge - Platinum Member

VIEWING DATES amp LOCATIONS

WEDNESDAY MAY 7 830 AM - 1230PM Dr Patrick Case 3027 Mishawa Ave South Bend IN

TUESDAY MAY 8 830 AM - 1230PM Dr Douglas Breger 2652 Charlestown Rd New Albany IN

SATURDAY MAY 10 830 AM - 1230PM Dr John Kostidis Call 2199244456 for location and availability Valparaiso IN

WEDNESDAY MAY 13 7 AM - 11 AM Dr Toby Harmon 2602 Newton St Jasper IN

THURSDAY MAY 15 9 AM - 1PM Dr Michael Hartle 3835 W Jefferson Blvd Fort Wayne IN

spring 201412

MediCaidMediCare UPdateBy Michael Phelps DC Secretary ISCA Board of Directors MedicaidMedicare Advising Committee

2013 saw yet another attempt to take chiropractic care out of Medicaid The ISCA amp its Legislative Committee was successful in stopping this attack on the chiropractic profession Thanks to the hard work of the ISCA Indiana remains one of the limited states where Medicaid covers all chiropractic services under our states scope of practice

January 1 2014 also saw the reinstatement of the 5 reduction in imbursement that we accepted several years ago

The ISCA is able to keep chiropractors in the Medicaid Program as well as other insurance as a paid provider through the hard work and dedication of volunteers If you are able to donate some time there are a number of committees and positions that need to be filled by doctors that want to make a difference If you know of DCs that are not members of the ISCA tell them about the good work we do for the profession and that we need all Doctors of Chiropractic in this state to be members Remember if youre not part of the solution youre part of the problem

As you know with the changes in health care coverage there are changes with respect to Medicare All chiropractors should be reporting PQRS for incentive payment eligibility Those who report satisfactorily for the 2013 amp 2014 program years may avoid the 2015 PQRS payment adjustment Additional information on how to avoid future PQRS payment adjustments can be found through supporting documentation available on the CMS website at httpwwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-InstructionsPQRS Chiropractors are fortunate as they only have to report on three measures

Measure 131 - Pain Assessment and Follow upMeasure 182 - Functional Outcome AssessmentMeasure 317 - Preventive Care and Screening (Screening for High Blood Pressure)

January 1 2014 saw an increase of approximately 9 in the reimbursement for chiropractic adjustments (98940 98941 amp 98942) This increase was due to a reassessment of the RVUs for CMT

The latest CERT report saw a decrease in the percentage of errors for chiropractors Chiropractic physicians need to continue to improve their documentation and coding of services in order to maintain this downward decline of errors

The Wisconsin Physicians Service (WPS) periodically analyzes provider coding patterns to identify deviations within a peer group For the J8 (Indiana and Michigan) Jurisdiction there has been a significantly higher than normal usage of the Code 98942 (CMT of five regions of the spine) There are approximately 35 DCs in the state of Michigan that are on the radar I am happy to report that there are no chiropractors in the state of Indiana under review

All that needs to happen for Chiropractic to fail is for good doctors to do nothing If you know of a chiropractor that is not a member of the ISCA urge them to join

MedicaidMedicare Update (contd on page 13)

spring 201413

MedicaidMedicare Update (contd from page 12)

SGR BILL PASSES HOUSE GOES TO SENATE FOR CONSIDERATIONWe learned that the United States House of Representatives passed House Bill 4302 The bill proposes to extend Medicarersquos Sustainable Growth Rate (SGR) current rate to April 15 2015 and would delay other Medicare deadlines The bill as currently drafted would postpone ICD-10-CM implementation until after October 1 2015 and restrict the Centers for Medicare amp Medicaid Services (CMS) from acting without congressional approval The bill now goes to the US Senate for debate and vote If it passes the Senate it would then be sent to President Obamarsquos desk to be signed or vetoed The ISCA will continue to monitor this situation and recommends preparing for ICD-10 implementation

PLEASE ALSO MARK YOUR CALENDAR WITH THESE DATES Medicare Secondary Payer (MSP) Seminar April 17 2014 from 100 pm to 400 pm Hilton Garden Inn Fort Wayne 8615 US Hwy 24 West Fort Wayne IN Click here to register

There is a Chiropractic Medicare Seminar on April 26 2014 in Mishawaka IN Click here for more information

HELPFUL LINKSNeed help in the transition to ICD-10 Go to the Road to 10 website by clicking here This site is primarily for the MD but has general information that pertains to all health care specialties

Stay up-to-date on changes in Medicare at the WPS Medicare website by clicking here This website is for all providers but sometimes offers information specific to chiropractors

INFORMATION REGARDING THE HOLDING OF APRIL 2014 CLAIMS FOR SERvICES PAID UNDER THE 2014 MEDICARE PHYSICIAN FEE SCHEDULE The 2014 Medicare Physician Fee Schedule (MPFS) final rule stipulated a negative update to the MPFS that was to be effective January 1 2014 That reduction was averted for three months with the passage of the Pathway for SGR Reform Act of 2013 which provided for a 05 percent update for services paid under the MPFS through March 31 2014 CMS is hopeful that there will be congressional action to prevent the negative update from taking effect on April 1 2014 CMS has instructed the Medicare Administrative Contractors to hold claims containing services paid under the MPFS for the first 10 business days of April (ie through April 14 2014) This hold would only affect MPFS claims with dates of service of April 1 2014 and later The hold should have minimal impact on provider cash flow because under current law clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt All claims for services delivered on or before March 31 2014 will be processed and paid under normal procedures regardless of any Congressional actions

spring 201414

insUranCe COMMittee UPdateBy Peter Furno DC ISCA Board of Directors District 4 Director and Insurance Committee Chairman

During 2013 the ISCA Insurance Committee addressed many issues and questions from its members with regard to insurance legalities of advertising and proposed associations with third party vendors offering incentives contrary to our practice statues Doctors with definitively legal questions were referred to their legal counsel for liability reasons Most questions directed to the insurance committee are answered within 24 hours

Because the ISCA continues to receive anecdotal complaints from the field claiming insurer reimbursement discrimination and other transgressions the insurance committee as a part of the ISCArsquos proactive efforts to address this problem has developed a survey to obtain information on various insurance problems or concerns impacting chiropractors in the field The ISCA is aggressively attempting to determine problems that are affecting large numbers of doctors and which may be indicating the development of a trend requiring attention by the ISCA and then the IDOI However although it is the intent to meet with the IDOI once the survey information is correlated so that the contentions of our doctors may be addressed officially without firm evidence of wrong doing by the insurance industry the ISCA cannot go forward Consequently it is imperative that all members who are having trouble submit their complaints to the ISCA together with supportive documentation so that this issue may be addressed

Now that the PPACA is law and will require ldquoevidence-basedrdquo treatment procedures to be utilized before reimbursements are made the intent of the Insurance Committee to make at least one presentation to decision-makers of an employer group regarding the cost-effectiveness and efficacy of chiropractic in the management of work related uncomplicated spine injuries in comparison to traditional medical care Heretofore the majority of employers had no idea of the cost-effectiveness of chiropractic care when compared to traditional medicine and simply allowed their work nurses and medical providers to direct care ndash which the research shows is one of the main reasons costs are so high

The Insurance Committee in an attempt to keep the ISCA membership updated will attempt to address at least two insurance queries weekly and present answers to the membership via the ISCA monthly eNews and Newsletter

Insurance Pearl Medicare and Chiropractic Billing Misconceptions It is worthwhile to address a few of the prevailing misconceptions Here are the nine truisms regarding Medicare and chiropractic

1 There is not a 12-visit limit to Medicare for chiropractic services The limits of care are based on the specific medical necessity of the primary subluxation and its secondary neuromusculoskeletal diagnosis

2 Medicare will pay for both acute and chronic conditions as long as there is documentation or expectation of functional improvement

3 Nonparticipating (nonpar) providers are required to bill for services All covered services under chiropractic (spinal manipulation) must be billed to Medicare

4 Nonpar providers are audited just as par providers are There is no protection from a Medicare audit by being nonpar

5 Nonpar providers must document services in the same manner as any provider of Medicare services Being par or nonpar is irrelevant in reference to documentation of chiropractic services

6 Chiropractors may not opt out of Medicare This is simply not an option for doctors of chiropractic Being nonpar is not opting out but designating oneself as a Medicare provider nonpar In simple terms chiropractors must belong to Medicare to treat Medicare patients

7 Advance Beneficiary Notices (ABNs) should not be used as routine documents for patients to sign on their initial visit However they must be used when there is a genuine belief or reasonable expectation that Medicare will deny or not pay for the service on a specific visit or series of visits In other words a blanket ABN at the beginning of care is not sufficient or compliant

8 Medicare claims are not difficult they are simply different from health insurance claims When not done in Medicares format claims are denied

9 Medicare payment is what it is I will refrain from stating it is good While we all would want higher reimbursements (Who doesnt) the average fees for chiropractic services for manipulation are $30-$36 per visit This is far better reimbursement than under many of the managed care plans chiropractors routinely fight to join Furthermore that dollar amount is for spinal manipulation only other services may be billed to the patient or covered by a secondary insurance plan

spring 201415

trUst BUt verifyBy Dr R A Foxworth FICC MCS-P

I was speaking with a doctor recently who was venting her frustration about not knowing who to believe or trust as an authority when it comes to being in practice today She goes to different seminars because she wants to improve herself personally and professionally She also wants to improve her practice by learning more about her productivity effectiveness documentation compliance and billing She shared that she doesnt simply attend the CEU required hours for her license she puts in seminar hours to improve her practice her clinical skills her compliance and her business insight

Her problem The conflicting information she receives from various experts at each seminar How she asked can they all be right if they all say different things As a result of her experience she wanted to know why a Discount Medical Plan Organization (DMPO) like ChiroHealthUSA was of value in todayrsquos practices Why she asked is this even necessary What are my resources

I passed her third-degree with flying colors by the way

I could appreciate her position because I am a bit of a skeptic myself In fact thats how all this started for me I was a chiropractor in practice just like you trying to maximize my insurance payments so I wasnt leaving money on the table while still working to come up with a way my uninsured patients could afford those fees

Because of my activity within my state (as a governor-appointed health expert as an active participant in my State Chiropractic Association and the state representative for the American Chiropractic Association) I knew there were rules to follow to avoid compliance issues when creating our fee schedule I did my research and initially started a Discount Medical Plan Organization (DMPO) for my state alone I knew this would legally protect my practice and my colleagues and that at the time was my only goal

And as skeptic I wouldnrsquot even take my own word for it when it came to believing that a Discount Medical Plan Organization (DMPO) was the simplest way to keep my fee schedules compliant legal and safe Thatrsquos why I became a Certified Medical Compliance Specialist (MCS-P) so skeptics like me could get a breath and feel at ease As an MCS-P Irsquom quite simply held to a higher standard I have to be able to quote chapter and verse about why any possible fee or activity is or isnrsquot compliant

We know therersquos a plethora of inaccurate information that gets disseminated in our profession Im sad to say that I had to agree with my frustrated colleague when she was venting about all the conflicting advice she was receiving Thatrsquos why ChiroHealthUSA has relationships with many MCS-Ps to help get accurate reliable information out there Many of the brightest minds in our profession agree with and recommend ChiroHealthUSA to their chiropractic colleagues

Looking back when I set up my first DMPO within my state I can see how shortsighted I was I now know that taking ChiroHealthUSA to a national audience to protect all chiropractic practices in the country was the vision I shouldve had at the start Im glad I had an encounter with one of my fellow MCS-Ps who gave me this bigger vision

Learn more about how ChiroHealthUSA can help your practice be more compliant You can attend a free webinar this Tuesday April 1 Register at wwwChiroHealthUSAcom today to find out more

Dr Foxworth is a certified Medical Compliance Specialist and President of ChirohealthUSA A practicing Chiropractor he remains ldquoin the trenchesrdquo facing challenges with billing coding documentation and compliance he has served as president of the Mississippi Chiropractic Association former Staff Chiropractor at

the gv Sonny Montgomery vA Medical Center and is a Fellow of the International College of Chiropractic you can contact Dr Foxworth at 1 (888) 719-9990 infochirohealthusacom or visit the ChirohealthUSA website at wwwchirohealthusacom join us for a free webinar that will give you all the details about how a DMPO can help you practice with more peace of mind go to wwwchirohealthusacom to register today

spring 201416

Were already there ndash ChirOPraCtiC and PUBliC health hand-in-handBy Caitlin Lukacs from the March 2014 issue of ACA news

Public health is a popular buzz phrase in the healthcare arena but what exactly is it and how does chiropractic fit into it ldquoPublic health describes the overall wellbeing of the populacerdquo explains Richard Bruns DC past chairman of the American Chiropractic Associationrsquos (ACA) Wellness and Health Promotion Committee and ACA chairman of the Board of Governors ldquoAll public health issues have future implications for individuals as well as the publicrdquo

Public health encompasses habits and social norms such as smoking alcohol consumption obesity and the use of seatbelts as well as environmental issues such as clean water air quality and how livestock and agricultural practices affect the environment adds Will Evans DC PhD MCHES provost of the University of Western States Public health also includes health education and health promotion

ldquoPublic health and chiropractic go hand-in-handrdquo explains Karen Konarski-Hart DC DABCO FACO vice president of ACArsquos Council of Delegates and chairman of the American Public Health Association (APHA)Wellness and Health Promotion Committee ldquoDCs donrsquot practice in a vacuum they are interested in all aspects of a patientrsquos life that affect his or her health and wellbeing as well as how that person interacts in the healthcare community at largerdquo

Whether they identify it as public health or not all chiropractic physicians address public health issues when dealing with their patients For example when a new patient comes into your office you begin with a detailed history and an initial examination that includes not only taking vital signs but discussing tobacco and alcohol use and other behaviors that affect that patientrsquos health explains Dr Evans ldquoThis allows you to create an individual health-risk assessment based on his or her environment family history lifestyle etc and address public health issues such as tobacco use at the same timerdquo he says

BROACHING THE SUBjECTIt can sometimes be difficult to initiate conversations with patients about issues such as smoking or weight loss ldquoThe best place to address such topics is in your initial report of findings to the patientrdquo suggests Dr Evans ldquoYoursquove examined the patient and determined the cause of the pain or complaint that brought him or her into your office in the first place and now yoursquove got an opportunity to say lsquoI see some lifestyle-related issues that could be contributing to your pain or that could lead to other complaints down the roadrsquordquo

Yoursquore in a position to identify potential problems for your

patients says Dr Konarski-Hart ldquoThey may be setting themselves up for diabetes or cardiovascular disease or maybe they arenrsquot getting enough exercise mdash all of these things should be discussed as part of good primary carerdquo

You never want to force patients to make changes so yoursquoll need to assess their openness to addressing lifestyle changes first Simply ask them if theyrsquod be willing to discuss a healthier weight for example If they are you can let them know that you have multiple resources and partners in place to help them move forward

Dr Evans determines his patientsrsquo willingness to make lifestyle modifications by using the Stages of Change a common model of health behavior change The Stages of Change are

Pre-contemplator stage ndash Patient has no intention of making any changes in the next six months

Contemplator stage ndash Patient is considering a change within the next six months

Preparation stage ndash Patient has decided on a change and is preparing to take some kind of action

Action stage ndash Patient has begun implementing the change

Maintenance stage ndash Patient has made a change and is now working to maintain it

Take the example of an overweight patient Because the average weight of an individual in the United States has increased over the past few years some people who are overweight or borderline overweight donrsquot even realize it says Dr Evans Broach the subject gently and suggest a few small goals such as parking farther away from the office or shopping center or wearing a pedometer and working to increase the number of steps taken in a day You could also teach that patient how to read food labels and discuss healthier meal options Itrsquos about identifying the risk communicating the risk determining where your patient falls in the Stages of Change and then prescribing appropriate modifications explains Dr Evans ldquoAnd donrsquot forget to follow up with that patient at his or her next appointment Itrsquos important that he or she doesnrsquot lose confidence in your recommendations or in you as a healthcare providerrdquo he adds

GET INvOLvEDIn addition to discussions with patients in the treatment

Were Already There ndash Chiropractic and Public health hand-in-hand(contd on page 17)

spring 201417

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 16)

room there are many ways to incorporate public health into your practice One of the easiest ways to get involved is to participate in an observance that already exists such as the APHArsquos Public Health Week held the first week of every April (wwwaphaorgprogramshealthweek) or ACArsquos National Chiropractic Health Month (NCHM) celebrated every October These organizations come up with a new theme each year and gather all of the resources you need to participate ldquoIt takes the thinking and planning aspect off of the individual doctorrdquo says Dr Konarski-Hart ldquoAll you need to do is follow the instructions laid out by the parent organizationrdquo Additionally when you throw your hat into the ring on a larger issue or observance you know that the public health community is focused on that issue at that time so you can reach out to your county or state health department or other local healthcare associations and join in their efforts which will help you to build mutually beneficial long-term relationships says Dr Konarski-Hart ldquoMany state groups are underfunded and understaffed and they welcome participation particularly from physiciansrdquo she notes

DCs can also create their own observances ldquoACA offers webinars teleseminars and patient handouts on a variety of public health issuesmdashperuse the offerings and pick a topic to focus on for a week or a monthrdquo says Dr Konarski-Hart She suggests having your clinic sponsor a wellness competition or challenge You could partner with a local exercise facility or health foods store as well as a school or senior center and make it a community event You could also organize an eat well exercise club in which members meet for a walk or bike ride and then share a healthy breakfast or lunch Your practice could sponsor a poster contest at a local school or community center ldquoHave the kids create posters focused on healthy lifestyle choices and then give out prizes of fun healthy exercise such as a day of horseback riding or ice skatingrdquo Dr Konarski-Hart says Additionally your practice could sponsor a marathon participant or a local amateur sports team to show that you support healthy activities and active lifestyles

Similarly be informed about the public health issues in your community Maybe you live in an area with a high population of smokers or perhaps there have been numerous injuries due to not wearing a seatbelt in recent years Do some background research on these topics and then get involved whether that means simply providing patient handouts in your waiting room giving a community health talk participating in health fairs or working with your local health department (and other relevant organizations) to pass pertinent legislation

Look for organizations in your area that are already offering public health resources or programs and set up

a partnership with them For example for the topic of overweightobesity you could offer your clinic as a weigh-in site for participants in Weight Watchers programs suggests Dr Evans or partner with a local gym to give discounts to chiropractic patients Dr Bruns recommends getting involved with the school lunch program to advocate for healthy options for students For smoking cessation work with the American Lung Association to put on an informational presentation at a local hospital or sponsor a 5k or a stair run to raise awareness (and funds) for lung cancer research For drug addiction set up a referral network with psychologists or addiction centers and either offer acupuncture in your office or refer out to an acupuncturist as it has been shown to help patients through the detox process You can also use your knowledge of nutrition and exercise to facilitate the journey through detox says Dr Bruns

Additionally you should make a point to support these other organizations when they host local events (even if yoursquore not an official partner) or reach out for financial support ldquoI always participate in the American Cancer Societyrsquos golf tournament and I display their materials in my office as wellrdquo says Dr Bruns He also participates in the fundraising efforts of the American Heart Association and the American Lung Association on a regular basis ldquoItrsquos good for your patients and your community to see that you care about and support other healthcare organizationsrdquo he says

Another option for public health involvement is to join the APHArsquos Chiropractic Health Care Section Yoursquoll be informed on public health happenings have access to the latest information and research see what DCs are doing nationally and in other states on particular issues and even have the chance to give input and be involved in decision-making

CONCUSSIONConcussion prevention and treatment is one public health topic that is relevant to every patient population in every region of the United States ldquoWersquore seeing more concussions lately due in part to the number of children participating in contact sports the excessive training involved in these sports and the fact that most people arenrsquot aware of the symptoms and long-term risks of concussionsrdquo says Dr Konarski-Hart Helmets donrsquot actually provide protection against concussions either ldquoThe padding will protect the skull from fracture but because your brain is loose inside your skull it is not protected from impact or traumardquo she explains And with todayrsquos cultural emphasis on pushing through the pain wersquore starting to see more and more professional athletes coming forward with serious emotional psychological and neurological issues that are linked to multiple concussions in their past

spring 201418

As an EMT herself Dr Konarski-Hart attended an EMT convention in the summer of 2013 and heard a presentation from the Childrenrsquos Hospital of Arkansas on injury prevention After speaking with the presenters she discovered that they were having trouble getting buy-in from the allopathic community and she offered her services as a DC Since then Dr Konarski-Hart and the Arkansas Chiropractic Physicians Association (ACPA) have been working with the childrenrsquos hospital on various statewide projects dealing with all aspects of injury prevention One such program focuses on concussions

ldquoThrough this partnership we learned that Arkansas has not finalized its concussion protocols yet and we were able to get someone from our ACPA legislative team involved in that process to ensure chiropracticrsquos inclusion as an involved professionrdquo says Dr Konarski-Hart

Because of DCsrsquo knowledge and training itrsquos important for them to get involved with the concussion issue says Dr Bruns ldquoKnowing what we know about concussions we are doing a tremendous service to athletes and their families by completing pre-participation physicals and screenings and watching for signs and symptoms during participation as wellrdquo he says And itrsquos not just athletes who are suffering from concussions mdash itrsquos children who fall off a bike or a swing set or an older adult who slips on the ice

Itrsquos crucial for DCs to help disseminate information about concussions Whether you see concussion symptoms in a patient in your office or work with local sports teams you have the knowledge to serve as a local expert on the topic DCs can assess injured parties work with school administrators to create concussion protocols and push for legislation on standard concussion treatment says Dr Bruns

Kids parents coaches trainers and doctors all need to be aware of concussions and the potential risks involved with sustaining one or more ldquoItrsquos a matter of understanding the potential risks before making a decision to play in a game or to have a player sit out a game for examplerdquo says Dr Konarski-Hart

WErsquoRE ALREADY THEREAs DCs we focus on the biomechanics structure and function of the human body and we have a unique approach in that we look at the whole person in terms of nutrition flexibility blood flow and muscle and nervous tissue function says Dr Bruns ldquoThe chiropractic profession recognizes the importance of healthful eating nutritional support avoiding the bad habits of smoking and drinking alcohol and has been counseling patients on healthy lifestyles since long before it was fashionablerdquo

According to Dr Konarski-Hart simply choosing to be a doctor of chiropractic means that yoursquore involved in public health on some level because your goal is to make your patient healthier and therefore make your community healthier In other words DCs are already an integral part of public health

With the new health care emphasis on wellness and prevention many healthcare providers legislators insurance companies and government policy developers are focusing on how to offer access to these services especially in medically underserved rural areas or small towns Chiropractic representatives need to be part of those discussions to point out that in many of these communities DCs are already there providing that assessment counseling and care This representation is one of the functions of the ACA and state chiropractic associations and why your membership and involvement with these organizations is so critical says Dr Konarski-Hart

aCa neWs extraCERTIFIED CHIROPRACTIC WELLNESS SPECIALIST PROGRAMIn 2011 ACA began a partnership with the National Wellness Institute (NWI) a well respected organization recognized both inside and outside the chiropractic profession to offer a wellness certification program for DCs The 40-hour program will enable students to integrate principles of wellness coaching health promotion and disease prevention to their current practices Once the program is completed DCs will become Certified Chiropractic Wellness Specialists ldquoThe program was developed and launched by Dr Evans Cheryl Hawk DC PhD CHES and Mike Perko PhDmdashdoctors who are at the forefront of health promotion illness prevention and wellnessrdquo says Dr Bruns Originally the certification consisted of four different modules and DCs had to travel to select cities to participate in the weekend seminars However ACA quickly realized that it was difficult for DCs to get to these courses and decided to turn the program into an online certification NWI has taken the lead on this conversion

ACA RESOURCES Bookmark wwwacatoday orgpublichealth on your computer for quick and easy access to patient handouts references and research for presentations a calendar of national public health observances and other resources that have all been vetted by the ACA APHAWellness and Health Promotion Committee for use in your office Published in the March 2014 ACA news

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 17)

spring 201419

ASSOCIATES WANTED

Associate Wanted Starting base annual salary range is 50-60K plus additional monthly $500-2K in productivity compensation Benefits include MalpracticeMedical insurance CE Our care model uses the latest in Chiropractic Massage Physical Therapy Acupuncture and Nutritional medicine services South Bend is home to Notre Dame and a short drive to Chicago and Lake Michigan This is a good place to raise a family with good schools and a low cost of living Sendfax a letter of interest and resume to apintodcyahoocom or fax (574) 254-1652 Posted 11514

Chicagoland Associate Doctor Needed Busy office with multiple long term associates Family practice Thirty minutes to downtown Chicago Full timepart time paid vacation $26hour starting pay with periodic raises Proficient in the Thompson leg-check technique We are looking for someone who is ready and willing to blend with a very upbeat fun and positive staff Interested applicants should email their resume to infotrimbolichironet or fax to (219) 836-2344 wwwtrimbolichironet Posted 12914

Opportunity for Doctor to grow own practice with buyout of 40 year family practice in 2-5 years Located in North Central Indiana with easy access to Indianapolis and Chicago Wonderful area to raise a family good schools low crime slower pace of life Contact pdyer4hotmailcom Posted 2614

Associate Needed We are currently searching for an associate doctor to help us at the Osmon Chiropractic Center in Bloomington IN This would be a tremendous opportunity for a new graduate or anyone considering a possible change of location You will be working in a beautiful 2500 square foot state of the art clinic with 1 other doctor and a professional staff of 8 to assist you There will be only a small amount of practice building activities on your part because we will provide you with a practice representative who will do that for you You will enjoy the security of a known income and practice without the stress of practice overhead and staff management All you need to do is learn our system of patient managementmdashthe same system we all use in the office and work together as a team to get and keep our community under chiropractic care It is an exciting place to practice Send resume and cover letter to drosmonhotmailcom and please feel free to visit our website at wwwDrOsmoncom Posted 3314

EQUIPMENT FOR SALE

For SalemdashFutura 3000GT automatic X-ray film processor two 8x10 cassettes two 7x14 cassettes two 14x17 cassettes Xray film cabinet new film xray I D Imprinter amp infra red light for sale $80000 Mikephelps55attnet or call (765) 345-0224 Posted 92413

PRACTICES FOR SALE

Free North Manchester practice Collected gt$300000 in 2012 Drs Kelsey giving practice records and X-ray to DC who buys their building 302 W MainHwy 114 Appraised for $165000 last monthmdashyou can buy it for $145000 Closing office on 103013 so you must act soon for this opportunity (260) 568-4419 or office 260-982-4646 Posted 100213

DCS WANTED

Kauffman Chiropractic PC is looking for a full-time position to be filled October 2013 Successful 25+ years established company with physical therapy massage therapy and rehabilitation Enthusiastic ambitious doctor who is willing to learn is a must Must be proficient in Diversified Thompson and Distraction techniques Nice salary is offered Email resume to chirodancomcastnet Posted 82713

Fantastic opportunity for energetic success-oriented doctor excited to grow with us professionally Comes with ownership possibilities Learn to share chiropractic in your community Train in an established practice run on outstanding systems Great training and support for you with focus on exceptiional patient communication and care including chiropractic rehab and massage Send CV or resume to clarksvillespineandrehabinsightbbcom Contact Joseph Rogers Lousville Kentucky (812) 282-7500 Posted 1714

Career Opportunity ndash URGENT ASSOCIATE WANTED ndash PEORIA IL Work in a state of the art wellness center with upbeat and professional staff ready to support you Utilize chiropractic clinical nutrition and rehabilitation to manage a wide range of conditions Doctor must be bright outgoing enthusiastic and must have excellent clinical skills This is an opportunity you dont want to miss Designed for someone looking for a career not simply another job Extensive training and great income potential Invest in your future Send a resume to lfulleralignlifecom Posted 12414

Part Time DC needed for Gary IN office for DOT Certified Medical Exams and some Chiropractic beginning March 15 2014 NO STRESS NO BILLING No Overhead ndash No Headaches Easy hours (8 am - 5 pm - 2 dayswk) Continue in your own practice and make extra cash in our office or just work part-time for us Will tutor you and pay for your DOT Certification - work 2 daysweek ($25000) Will tutor you and pay for your DOT Certification ($50hr = $25000year for 2 daysweek) Contact Lynn Biese -Carroll DC at lbiesewirrcom or call (262) 515-2168 Posted 2614

Associate Needed ndash Bloomington Indiana Expanding practice in Bloomington Indiana is looking for full-time position to be filled Enthusiastic ambitious doctor is a must Must be proficient in Diversified and Low Force techniques rehab and physical therapy Practice is a very strong stable consistent referral based practice Salary and profit share of clinic are offered We will train and mentor in technique and all areas of patient compliance and success Send resume to Dr Fox 1710 West Third St Bloomington Indiana 47404 or email to jbfprodigynet Posted 21814

vACATION DOCTORS

Mobile Moje Chiropractic Dr Moje is available for vacation relief and office coverage Licensed in IN OH MI WI MN amp PA Specializing in maternity leave injuries and vacations Call or email for CV availability rates references and further information Contact Dr Moje at stephanmojegmailcom or (218) 205-6141 Posted 81613

indiana state ChirOPraCtiC assOCiatiOn Classifieds

Page 9: ISCA Spring Report 2014

spring 20149

sPring Means tiMe fOr isCa MeMBers and nOnMeMBers tO Meet in distriCts By Cathy Orosz Membership Director and ISCA Association Manager

Spring is here and the ISCA is ready to recruit

ldquoThe snow is cleared and we are ready to hit the ground runningrdquo says Dr Diane Vuotto Membership Chairwoman and District 5 Director ldquoISCA District Directors are ready to engage current and potential members in their area and they need your input

Each of the nine District Directors are currently planning special meetings throughout April and May to recruit new members as well as learn from current members on how the ISCA can serve them better

Dr Hilton will be taking to the road in District 6 for one-on-one meetings If you are interested in scheduling a meeting with Dr Hilton please contact him at drhiltonsbcglobalnet

District 9 will be meeting on Tuesday April 29 at 630 pm at Dr Scott Autonrsquos office at 1551 N Main St in Franklin To attend this meeting and learn more about efforts in District 9 please contact Dr Auton at scottautonyahoocom or (317) 346-0799

If you would like to be more involved the ISCA asks that you please consider volunteering your time and talents Please contact Cathy Orosz at (317) 673-4245 (800) 572-8002 or infoindianastatechirosorg to learn how you can become more involved in the Association

WELCOME NEW MEMBERS 2014

Dr Nancy Elwartowski-Cooper Carmel

Dr Kevin Forrest Indianapolis

Dr Anthony Forrest Indianapolis

Dr Julie Carleton Fishers

INDIANA STATECHIROPRACTICASSOCIATIONwwwindianastatechirosorg

spring 201410

Certified Medical Examiner Training WE NEED 20 PAID REGISTRANTS BY APRIL 10 IN ORDER

TO HOST THIS TRAINING Saturday May 3 and Sunday May 4 2014 Indianapolis Location TBD 800 AM to 6 pm Saturday May 3 and 8 AM to noon Sunday May 4 YOU CANNOT DO PHYSICAL EXAMS FOR TRUCK AND BUS DRIVERS ANY LONGER UNLESS YOU OBTAIN THIS CERTIFICATION Interested in becoming a Certified Medical Examiner (CME) and be listed on the National Reg-istry YOU MUST COMPLETE THIS TRAINING AND TESTING on Federal Motor Carrier Safety Ad-ministrationrsquos (FMCSA) physical qualification standards and guidelines If you intend to perform physical examinations and issue medical certificates for commercial motor vehicle (CMV) drivers to meet the requirements of Section 39141 of the Federal Motor Carrier Safety Regulations (FMCSRs) you must be certified and listed on the FMCSArsquos National Registry by May 21 2014 Upon completion of this program you will be eligible to take the Certification Test for $79 at an Indiana testing site The ISCA will provide you with info regarding multiple testing sites Program presented for the ISCA by Michael Megehee DC National Registry Certified Medical Examiner and President TeamCME LLC

Registration Name Clinic Address CityStateZip Phone Email Address Payment Method (Credit Card or Check) Credit Card Type Credit Card Expiration 3 Digit Code Name on Card Signature Questions Contact Cathy Orosz at infoindianastatechirosorg or call 317-673-4245 or toll-free at 800-572-8002 The ISCA needs a minimum of 20 registrants by Friday April 10 for this program to be offered Payment is needed upon regis-tration and no refunds will be granted

Mail Registrations to Indiana State Chiropractic Association 200 S Meridian St Ste 410 Indianapolis IN 46225 Or Fax to 317-686-2672 or email to infoindianastatechirosorg

The Cost of the 12-hour training is $400 for ISCA Members and $450 for Non Members

Because we have to pay for TeamCME in Advance we must have 20 paid registrants by April 10 in order to host this training MAKE YOUR RESERVATIONS TODAY

spring 201411

CONTACT INFORMATION

NAME_____________________________________________________________________

COMPANY __________________________________________________________________

MAILING ADDRESS__________________________________________________________

CITY STATE ZIP_____________________________________________________________

PHONE ________________________________ FAX________________________________

EMAIL_____________________________________________________________________

ADDITIONAL ATTENDEE NAMES________________________________________________

___________________________________________________________________________

PAYMENT OPTIONS

AMEX VISA MASTERCARD CHECK (MAKE PAYABLE TO ISCA BACKPAC)

CARDHOLDER_______________________________________________________________

CARD ____________________________________________________________________

EXP__________________________ 3 DIGIT SECURITY ___________________________

SIGNATURE_________________________________________________________________

MAIL ISCA 200 S Meridian St Suite 410 Indianapolis IN 46225FAX 3176862672 ATTN Cathy Orosz

ISCA REGIONAL VIDEO VIEWINGSNEED CONTINUING EDUCATION HOURS THERErsquoS STILL TIME

Donrsquot miss your opportunity to get your required continuing education credits prior to June 30 2014 Indiana Statute dictates that every Licensed Chiropractor in Indiana gets four hours of risk management each year by attending one of the ISCArsquos Regional Video Viewings

There are a limited number of seats at some locations so pre-registration is necessaryIf you choose to pay at the door Pre-Registration is REQUIRED Non-prior notice of attendance will be subject to the Non-Member rate above Call the ISCA office for availability at your location (317) 673-4245 If you need directions to a location please call the ISCA for host contact information

Proceeds of the viewings are contributed to the ISCA Political Action Committee and are non-business deductible

QUESTIONS Contact Cathy Orosz at 8005728002 3176734245 or email infoindianastatechirosorg Proceeds of the viewings are contributed to the ISCA Political Action Committee and are non-business deductible

Contributions to the ISCA Political Action Committee are non-business deductible

REGIONAL VIDEO RATES

$185 Member In Good Standing $250 Non-Member $165 GoldSilver Member Free Of Charge - Platinum Member

VIEWING DATES amp LOCATIONS

WEDNESDAY MAY 7 830 AM - 1230PM Dr Patrick Case 3027 Mishawa Ave South Bend IN

TUESDAY MAY 8 830 AM - 1230PM Dr Douglas Breger 2652 Charlestown Rd New Albany IN

SATURDAY MAY 10 830 AM - 1230PM Dr John Kostidis Call 2199244456 for location and availability Valparaiso IN

WEDNESDAY MAY 13 7 AM - 11 AM Dr Toby Harmon 2602 Newton St Jasper IN

THURSDAY MAY 15 9 AM - 1PM Dr Michael Hartle 3835 W Jefferson Blvd Fort Wayne IN

spring 201412

MediCaidMediCare UPdateBy Michael Phelps DC Secretary ISCA Board of Directors MedicaidMedicare Advising Committee

2013 saw yet another attempt to take chiropractic care out of Medicaid The ISCA amp its Legislative Committee was successful in stopping this attack on the chiropractic profession Thanks to the hard work of the ISCA Indiana remains one of the limited states where Medicaid covers all chiropractic services under our states scope of practice

January 1 2014 also saw the reinstatement of the 5 reduction in imbursement that we accepted several years ago

The ISCA is able to keep chiropractors in the Medicaid Program as well as other insurance as a paid provider through the hard work and dedication of volunteers If you are able to donate some time there are a number of committees and positions that need to be filled by doctors that want to make a difference If you know of DCs that are not members of the ISCA tell them about the good work we do for the profession and that we need all Doctors of Chiropractic in this state to be members Remember if youre not part of the solution youre part of the problem

As you know with the changes in health care coverage there are changes with respect to Medicare All chiropractors should be reporting PQRS for incentive payment eligibility Those who report satisfactorily for the 2013 amp 2014 program years may avoid the 2015 PQRS payment adjustment Additional information on how to avoid future PQRS payment adjustments can be found through supporting documentation available on the CMS website at httpwwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-InstructionsPQRS Chiropractors are fortunate as they only have to report on three measures

Measure 131 - Pain Assessment and Follow upMeasure 182 - Functional Outcome AssessmentMeasure 317 - Preventive Care and Screening (Screening for High Blood Pressure)

January 1 2014 saw an increase of approximately 9 in the reimbursement for chiropractic adjustments (98940 98941 amp 98942) This increase was due to a reassessment of the RVUs for CMT

The latest CERT report saw a decrease in the percentage of errors for chiropractors Chiropractic physicians need to continue to improve their documentation and coding of services in order to maintain this downward decline of errors

The Wisconsin Physicians Service (WPS) periodically analyzes provider coding patterns to identify deviations within a peer group For the J8 (Indiana and Michigan) Jurisdiction there has been a significantly higher than normal usage of the Code 98942 (CMT of five regions of the spine) There are approximately 35 DCs in the state of Michigan that are on the radar I am happy to report that there are no chiropractors in the state of Indiana under review

All that needs to happen for Chiropractic to fail is for good doctors to do nothing If you know of a chiropractor that is not a member of the ISCA urge them to join

MedicaidMedicare Update (contd on page 13)

spring 201413

MedicaidMedicare Update (contd from page 12)

SGR BILL PASSES HOUSE GOES TO SENATE FOR CONSIDERATIONWe learned that the United States House of Representatives passed House Bill 4302 The bill proposes to extend Medicarersquos Sustainable Growth Rate (SGR) current rate to April 15 2015 and would delay other Medicare deadlines The bill as currently drafted would postpone ICD-10-CM implementation until after October 1 2015 and restrict the Centers for Medicare amp Medicaid Services (CMS) from acting without congressional approval The bill now goes to the US Senate for debate and vote If it passes the Senate it would then be sent to President Obamarsquos desk to be signed or vetoed The ISCA will continue to monitor this situation and recommends preparing for ICD-10 implementation

PLEASE ALSO MARK YOUR CALENDAR WITH THESE DATES Medicare Secondary Payer (MSP) Seminar April 17 2014 from 100 pm to 400 pm Hilton Garden Inn Fort Wayne 8615 US Hwy 24 West Fort Wayne IN Click here to register

There is a Chiropractic Medicare Seminar on April 26 2014 in Mishawaka IN Click here for more information

HELPFUL LINKSNeed help in the transition to ICD-10 Go to the Road to 10 website by clicking here This site is primarily for the MD but has general information that pertains to all health care specialties

Stay up-to-date on changes in Medicare at the WPS Medicare website by clicking here This website is for all providers but sometimes offers information specific to chiropractors

INFORMATION REGARDING THE HOLDING OF APRIL 2014 CLAIMS FOR SERvICES PAID UNDER THE 2014 MEDICARE PHYSICIAN FEE SCHEDULE The 2014 Medicare Physician Fee Schedule (MPFS) final rule stipulated a negative update to the MPFS that was to be effective January 1 2014 That reduction was averted for three months with the passage of the Pathway for SGR Reform Act of 2013 which provided for a 05 percent update for services paid under the MPFS through March 31 2014 CMS is hopeful that there will be congressional action to prevent the negative update from taking effect on April 1 2014 CMS has instructed the Medicare Administrative Contractors to hold claims containing services paid under the MPFS for the first 10 business days of April (ie through April 14 2014) This hold would only affect MPFS claims with dates of service of April 1 2014 and later The hold should have minimal impact on provider cash flow because under current law clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt All claims for services delivered on or before March 31 2014 will be processed and paid under normal procedures regardless of any Congressional actions

spring 201414

insUranCe COMMittee UPdateBy Peter Furno DC ISCA Board of Directors District 4 Director and Insurance Committee Chairman

During 2013 the ISCA Insurance Committee addressed many issues and questions from its members with regard to insurance legalities of advertising and proposed associations with third party vendors offering incentives contrary to our practice statues Doctors with definitively legal questions were referred to their legal counsel for liability reasons Most questions directed to the insurance committee are answered within 24 hours

Because the ISCA continues to receive anecdotal complaints from the field claiming insurer reimbursement discrimination and other transgressions the insurance committee as a part of the ISCArsquos proactive efforts to address this problem has developed a survey to obtain information on various insurance problems or concerns impacting chiropractors in the field The ISCA is aggressively attempting to determine problems that are affecting large numbers of doctors and which may be indicating the development of a trend requiring attention by the ISCA and then the IDOI However although it is the intent to meet with the IDOI once the survey information is correlated so that the contentions of our doctors may be addressed officially without firm evidence of wrong doing by the insurance industry the ISCA cannot go forward Consequently it is imperative that all members who are having trouble submit their complaints to the ISCA together with supportive documentation so that this issue may be addressed

Now that the PPACA is law and will require ldquoevidence-basedrdquo treatment procedures to be utilized before reimbursements are made the intent of the Insurance Committee to make at least one presentation to decision-makers of an employer group regarding the cost-effectiveness and efficacy of chiropractic in the management of work related uncomplicated spine injuries in comparison to traditional medical care Heretofore the majority of employers had no idea of the cost-effectiveness of chiropractic care when compared to traditional medicine and simply allowed their work nurses and medical providers to direct care ndash which the research shows is one of the main reasons costs are so high

The Insurance Committee in an attempt to keep the ISCA membership updated will attempt to address at least two insurance queries weekly and present answers to the membership via the ISCA monthly eNews and Newsletter

Insurance Pearl Medicare and Chiropractic Billing Misconceptions It is worthwhile to address a few of the prevailing misconceptions Here are the nine truisms regarding Medicare and chiropractic

1 There is not a 12-visit limit to Medicare for chiropractic services The limits of care are based on the specific medical necessity of the primary subluxation and its secondary neuromusculoskeletal diagnosis

2 Medicare will pay for both acute and chronic conditions as long as there is documentation or expectation of functional improvement

3 Nonparticipating (nonpar) providers are required to bill for services All covered services under chiropractic (spinal manipulation) must be billed to Medicare

4 Nonpar providers are audited just as par providers are There is no protection from a Medicare audit by being nonpar

5 Nonpar providers must document services in the same manner as any provider of Medicare services Being par or nonpar is irrelevant in reference to documentation of chiropractic services

6 Chiropractors may not opt out of Medicare This is simply not an option for doctors of chiropractic Being nonpar is not opting out but designating oneself as a Medicare provider nonpar In simple terms chiropractors must belong to Medicare to treat Medicare patients

7 Advance Beneficiary Notices (ABNs) should not be used as routine documents for patients to sign on their initial visit However they must be used when there is a genuine belief or reasonable expectation that Medicare will deny or not pay for the service on a specific visit or series of visits In other words a blanket ABN at the beginning of care is not sufficient or compliant

8 Medicare claims are not difficult they are simply different from health insurance claims When not done in Medicares format claims are denied

9 Medicare payment is what it is I will refrain from stating it is good While we all would want higher reimbursements (Who doesnt) the average fees for chiropractic services for manipulation are $30-$36 per visit This is far better reimbursement than under many of the managed care plans chiropractors routinely fight to join Furthermore that dollar amount is for spinal manipulation only other services may be billed to the patient or covered by a secondary insurance plan

spring 201415

trUst BUt verifyBy Dr R A Foxworth FICC MCS-P

I was speaking with a doctor recently who was venting her frustration about not knowing who to believe or trust as an authority when it comes to being in practice today She goes to different seminars because she wants to improve herself personally and professionally She also wants to improve her practice by learning more about her productivity effectiveness documentation compliance and billing She shared that she doesnt simply attend the CEU required hours for her license she puts in seminar hours to improve her practice her clinical skills her compliance and her business insight

Her problem The conflicting information she receives from various experts at each seminar How she asked can they all be right if they all say different things As a result of her experience she wanted to know why a Discount Medical Plan Organization (DMPO) like ChiroHealthUSA was of value in todayrsquos practices Why she asked is this even necessary What are my resources

I passed her third-degree with flying colors by the way

I could appreciate her position because I am a bit of a skeptic myself In fact thats how all this started for me I was a chiropractor in practice just like you trying to maximize my insurance payments so I wasnt leaving money on the table while still working to come up with a way my uninsured patients could afford those fees

Because of my activity within my state (as a governor-appointed health expert as an active participant in my State Chiropractic Association and the state representative for the American Chiropractic Association) I knew there were rules to follow to avoid compliance issues when creating our fee schedule I did my research and initially started a Discount Medical Plan Organization (DMPO) for my state alone I knew this would legally protect my practice and my colleagues and that at the time was my only goal

And as skeptic I wouldnrsquot even take my own word for it when it came to believing that a Discount Medical Plan Organization (DMPO) was the simplest way to keep my fee schedules compliant legal and safe Thatrsquos why I became a Certified Medical Compliance Specialist (MCS-P) so skeptics like me could get a breath and feel at ease As an MCS-P Irsquom quite simply held to a higher standard I have to be able to quote chapter and verse about why any possible fee or activity is or isnrsquot compliant

We know therersquos a plethora of inaccurate information that gets disseminated in our profession Im sad to say that I had to agree with my frustrated colleague when she was venting about all the conflicting advice she was receiving Thatrsquos why ChiroHealthUSA has relationships with many MCS-Ps to help get accurate reliable information out there Many of the brightest minds in our profession agree with and recommend ChiroHealthUSA to their chiropractic colleagues

Looking back when I set up my first DMPO within my state I can see how shortsighted I was I now know that taking ChiroHealthUSA to a national audience to protect all chiropractic practices in the country was the vision I shouldve had at the start Im glad I had an encounter with one of my fellow MCS-Ps who gave me this bigger vision

Learn more about how ChiroHealthUSA can help your practice be more compliant You can attend a free webinar this Tuesday April 1 Register at wwwChiroHealthUSAcom today to find out more

Dr Foxworth is a certified Medical Compliance Specialist and President of ChirohealthUSA A practicing Chiropractor he remains ldquoin the trenchesrdquo facing challenges with billing coding documentation and compliance he has served as president of the Mississippi Chiropractic Association former Staff Chiropractor at

the gv Sonny Montgomery vA Medical Center and is a Fellow of the International College of Chiropractic you can contact Dr Foxworth at 1 (888) 719-9990 infochirohealthusacom or visit the ChirohealthUSA website at wwwchirohealthusacom join us for a free webinar that will give you all the details about how a DMPO can help you practice with more peace of mind go to wwwchirohealthusacom to register today

spring 201416

Were already there ndash ChirOPraCtiC and PUBliC health hand-in-handBy Caitlin Lukacs from the March 2014 issue of ACA news

Public health is a popular buzz phrase in the healthcare arena but what exactly is it and how does chiropractic fit into it ldquoPublic health describes the overall wellbeing of the populacerdquo explains Richard Bruns DC past chairman of the American Chiropractic Associationrsquos (ACA) Wellness and Health Promotion Committee and ACA chairman of the Board of Governors ldquoAll public health issues have future implications for individuals as well as the publicrdquo

Public health encompasses habits and social norms such as smoking alcohol consumption obesity and the use of seatbelts as well as environmental issues such as clean water air quality and how livestock and agricultural practices affect the environment adds Will Evans DC PhD MCHES provost of the University of Western States Public health also includes health education and health promotion

ldquoPublic health and chiropractic go hand-in-handrdquo explains Karen Konarski-Hart DC DABCO FACO vice president of ACArsquos Council of Delegates and chairman of the American Public Health Association (APHA)Wellness and Health Promotion Committee ldquoDCs donrsquot practice in a vacuum they are interested in all aspects of a patientrsquos life that affect his or her health and wellbeing as well as how that person interacts in the healthcare community at largerdquo

Whether they identify it as public health or not all chiropractic physicians address public health issues when dealing with their patients For example when a new patient comes into your office you begin with a detailed history and an initial examination that includes not only taking vital signs but discussing tobacco and alcohol use and other behaviors that affect that patientrsquos health explains Dr Evans ldquoThis allows you to create an individual health-risk assessment based on his or her environment family history lifestyle etc and address public health issues such as tobacco use at the same timerdquo he says

BROACHING THE SUBjECTIt can sometimes be difficult to initiate conversations with patients about issues such as smoking or weight loss ldquoThe best place to address such topics is in your initial report of findings to the patientrdquo suggests Dr Evans ldquoYoursquove examined the patient and determined the cause of the pain or complaint that brought him or her into your office in the first place and now yoursquove got an opportunity to say lsquoI see some lifestyle-related issues that could be contributing to your pain or that could lead to other complaints down the roadrsquordquo

Yoursquore in a position to identify potential problems for your

patients says Dr Konarski-Hart ldquoThey may be setting themselves up for diabetes or cardiovascular disease or maybe they arenrsquot getting enough exercise mdash all of these things should be discussed as part of good primary carerdquo

You never want to force patients to make changes so yoursquoll need to assess their openness to addressing lifestyle changes first Simply ask them if theyrsquod be willing to discuss a healthier weight for example If they are you can let them know that you have multiple resources and partners in place to help them move forward

Dr Evans determines his patientsrsquo willingness to make lifestyle modifications by using the Stages of Change a common model of health behavior change The Stages of Change are

Pre-contemplator stage ndash Patient has no intention of making any changes in the next six months

Contemplator stage ndash Patient is considering a change within the next six months

Preparation stage ndash Patient has decided on a change and is preparing to take some kind of action

Action stage ndash Patient has begun implementing the change

Maintenance stage ndash Patient has made a change and is now working to maintain it

Take the example of an overweight patient Because the average weight of an individual in the United States has increased over the past few years some people who are overweight or borderline overweight donrsquot even realize it says Dr Evans Broach the subject gently and suggest a few small goals such as parking farther away from the office or shopping center or wearing a pedometer and working to increase the number of steps taken in a day You could also teach that patient how to read food labels and discuss healthier meal options Itrsquos about identifying the risk communicating the risk determining where your patient falls in the Stages of Change and then prescribing appropriate modifications explains Dr Evans ldquoAnd donrsquot forget to follow up with that patient at his or her next appointment Itrsquos important that he or she doesnrsquot lose confidence in your recommendations or in you as a healthcare providerrdquo he adds

GET INvOLvEDIn addition to discussions with patients in the treatment

Were Already There ndash Chiropractic and Public health hand-in-hand(contd on page 17)

spring 201417

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 16)

room there are many ways to incorporate public health into your practice One of the easiest ways to get involved is to participate in an observance that already exists such as the APHArsquos Public Health Week held the first week of every April (wwwaphaorgprogramshealthweek) or ACArsquos National Chiropractic Health Month (NCHM) celebrated every October These organizations come up with a new theme each year and gather all of the resources you need to participate ldquoIt takes the thinking and planning aspect off of the individual doctorrdquo says Dr Konarski-Hart ldquoAll you need to do is follow the instructions laid out by the parent organizationrdquo Additionally when you throw your hat into the ring on a larger issue or observance you know that the public health community is focused on that issue at that time so you can reach out to your county or state health department or other local healthcare associations and join in their efforts which will help you to build mutually beneficial long-term relationships says Dr Konarski-Hart ldquoMany state groups are underfunded and understaffed and they welcome participation particularly from physiciansrdquo she notes

DCs can also create their own observances ldquoACA offers webinars teleseminars and patient handouts on a variety of public health issuesmdashperuse the offerings and pick a topic to focus on for a week or a monthrdquo says Dr Konarski-Hart She suggests having your clinic sponsor a wellness competition or challenge You could partner with a local exercise facility or health foods store as well as a school or senior center and make it a community event You could also organize an eat well exercise club in which members meet for a walk or bike ride and then share a healthy breakfast or lunch Your practice could sponsor a poster contest at a local school or community center ldquoHave the kids create posters focused on healthy lifestyle choices and then give out prizes of fun healthy exercise such as a day of horseback riding or ice skatingrdquo Dr Konarski-Hart says Additionally your practice could sponsor a marathon participant or a local amateur sports team to show that you support healthy activities and active lifestyles

Similarly be informed about the public health issues in your community Maybe you live in an area with a high population of smokers or perhaps there have been numerous injuries due to not wearing a seatbelt in recent years Do some background research on these topics and then get involved whether that means simply providing patient handouts in your waiting room giving a community health talk participating in health fairs or working with your local health department (and other relevant organizations) to pass pertinent legislation

Look for organizations in your area that are already offering public health resources or programs and set up

a partnership with them For example for the topic of overweightobesity you could offer your clinic as a weigh-in site for participants in Weight Watchers programs suggests Dr Evans or partner with a local gym to give discounts to chiropractic patients Dr Bruns recommends getting involved with the school lunch program to advocate for healthy options for students For smoking cessation work with the American Lung Association to put on an informational presentation at a local hospital or sponsor a 5k or a stair run to raise awareness (and funds) for lung cancer research For drug addiction set up a referral network with psychologists or addiction centers and either offer acupuncture in your office or refer out to an acupuncturist as it has been shown to help patients through the detox process You can also use your knowledge of nutrition and exercise to facilitate the journey through detox says Dr Bruns

Additionally you should make a point to support these other organizations when they host local events (even if yoursquore not an official partner) or reach out for financial support ldquoI always participate in the American Cancer Societyrsquos golf tournament and I display their materials in my office as wellrdquo says Dr Bruns He also participates in the fundraising efforts of the American Heart Association and the American Lung Association on a regular basis ldquoItrsquos good for your patients and your community to see that you care about and support other healthcare organizationsrdquo he says

Another option for public health involvement is to join the APHArsquos Chiropractic Health Care Section Yoursquoll be informed on public health happenings have access to the latest information and research see what DCs are doing nationally and in other states on particular issues and even have the chance to give input and be involved in decision-making

CONCUSSIONConcussion prevention and treatment is one public health topic that is relevant to every patient population in every region of the United States ldquoWersquore seeing more concussions lately due in part to the number of children participating in contact sports the excessive training involved in these sports and the fact that most people arenrsquot aware of the symptoms and long-term risks of concussionsrdquo says Dr Konarski-Hart Helmets donrsquot actually provide protection against concussions either ldquoThe padding will protect the skull from fracture but because your brain is loose inside your skull it is not protected from impact or traumardquo she explains And with todayrsquos cultural emphasis on pushing through the pain wersquore starting to see more and more professional athletes coming forward with serious emotional psychological and neurological issues that are linked to multiple concussions in their past

spring 201418

As an EMT herself Dr Konarski-Hart attended an EMT convention in the summer of 2013 and heard a presentation from the Childrenrsquos Hospital of Arkansas on injury prevention After speaking with the presenters she discovered that they were having trouble getting buy-in from the allopathic community and she offered her services as a DC Since then Dr Konarski-Hart and the Arkansas Chiropractic Physicians Association (ACPA) have been working with the childrenrsquos hospital on various statewide projects dealing with all aspects of injury prevention One such program focuses on concussions

ldquoThrough this partnership we learned that Arkansas has not finalized its concussion protocols yet and we were able to get someone from our ACPA legislative team involved in that process to ensure chiropracticrsquos inclusion as an involved professionrdquo says Dr Konarski-Hart

Because of DCsrsquo knowledge and training itrsquos important for them to get involved with the concussion issue says Dr Bruns ldquoKnowing what we know about concussions we are doing a tremendous service to athletes and their families by completing pre-participation physicals and screenings and watching for signs and symptoms during participation as wellrdquo he says And itrsquos not just athletes who are suffering from concussions mdash itrsquos children who fall off a bike or a swing set or an older adult who slips on the ice

Itrsquos crucial for DCs to help disseminate information about concussions Whether you see concussion symptoms in a patient in your office or work with local sports teams you have the knowledge to serve as a local expert on the topic DCs can assess injured parties work with school administrators to create concussion protocols and push for legislation on standard concussion treatment says Dr Bruns

Kids parents coaches trainers and doctors all need to be aware of concussions and the potential risks involved with sustaining one or more ldquoItrsquos a matter of understanding the potential risks before making a decision to play in a game or to have a player sit out a game for examplerdquo says Dr Konarski-Hart

WErsquoRE ALREADY THEREAs DCs we focus on the biomechanics structure and function of the human body and we have a unique approach in that we look at the whole person in terms of nutrition flexibility blood flow and muscle and nervous tissue function says Dr Bruns ldquoThe chiropractic profession recognizes the importance of healthful eating nutritional support avoiding the bad habits of smoking and drinking alcohol and has been counseling patients on healthy lifestyles since long before it was fashionablerdquo

According to Dr Konarski-Hart simply choosing to be a doctor of chiropractic means that yoursquore involved in public health on some level because your goal is to make your patient healthier and therefore make your community healthier In other words DCs are already an integral part of public health

With the new health care emphasis on wellness and prevention many healthcare providers legislators insurance companies and government policy developers are focusing on how to offer access to these services especially in medically underserved rural areas or small towns Chiropractic representatives need to be part of those discussions to point out that in many of these communities DCs are already there providing that assessment counseling and care This representation is one of the functions of the ACA and state chiropractic associations and why your membership and involvement with these organizations is so critical says Dr Konarski-Hart

aCa neWs extraCERTIFIED CHIROPRACTIC WELLNESS SPECIALIST PROGRAMIn 2011 ACA began a partnership with the National Wellness Institute (NWI) a well respected organization recognized both inside and outside the chiropractic profession to offer a wellness certification program for DCs The 40-hour program will enable students to integrate principles of wellness coaching health promotion and disease prevention to their current practices Once the program is completed DCs will become Certified Chiropractic Wellness Specialists ldquoThe program was developed and launched by Dr Evans Cheryl Hawk DC PhD CHES and Mike Perko PhDmdashdoctors who are at the forefront of health promotion illness prevention and wellnessrdquo says Dr Bruns Originally the certification consisted of four different modules and DCs had to travel to select cities to participate in the weekend seminars However ACA quickly realized that it was difficult for DCs to get to these courses and decided to turn the program into an online certification NWI has taken the lead on this conversion

ACA RESOURCES Bookmark wwwacatoday orgpublichealth on your computer for quick and easy access to patient handouts references and research for presentations a calendar of national public health observances and other resources that have all been vetted by the ACA APHAWellness and Health Promotion Committee for use in your office Published in the March 2014 ACA news

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 17)

spring 201419

ASSOCIATES WANTED

Associate Wanted Starting base annual salary range is 50-60K plus additional monthly $500-2K in productivity compensation Benefits include MalpracticeMedical insurance CE Our care model uses the latest in Chiropractic Massage Physical Therapy Acupuncture and Nutritional medicine services South Bend is home to Notre Dame and a short drive to Chicago and Lake Michigan This is a good place to raise a family with good schools and a low cost of living Sendfax a letter of interest and resume to apintodcyahoocom or fax (574) 254-1652 Posted 11514

Chicagoland Associate Doctor Needed Busy office with multiple long term associates Family practice Thirty minutes to downtown Chicago Full timepart time paid vacation $26hour starting pay with periodic raises Proficient in the Thompson leg-check technique We are looking for someone who is ready and willing to blend with a very upbeat fun and positive staff Interested applicants should email their resume to infotrimbolichironet or fax to (219) 836-2344 wwwtrimbolichironet Posted 12914

Opportunity for Doctor to grow own practice with buyout of 40 year family practice in 2-5 years Located in North Central Indiana with easy access to Indianapolis and Chicago Wonderful area to raise a family good schools low crime slower pace of life Contact pdyer4hotmailcom Posted 2614

Associate Needed We are currently searching for an associate doctor to help us at the Osmon Chiropractic Center in Bloomington IN This would be a tremendous opportunity for a new graduate or anyone considering a possible change of location You will be working in a beautiful 2500 square foot state of the art clinic with 1 other doctor and a professional staff of 8 to assist you There will be only a small amount of practice building activities on your part because we will provide you with a practice representative who will do that for you You will enjoy the security of a known income and practice without the stress of practice overhead and staff management All you need to do is learn our system of patient managementmdashthe same system we all use in the office and work together as a team to get and keep our community under chiropractic care It is an exciting place to practice Send resume and cover letter to drosmonhotmailcom and please feel free to visit our website at wwwDrOsmoncom Posted 3314

EQUIPMENT FOR SALE

For SalemdashFutura 3000GT automatic X-ray film processor two 8x10 cassettes two 7x14 cassettes two 14x17 cassettes Xray film cabinet new film xray I D Imprinter amp infra red light for sale $80000 Mikephelps55attnet or call (765) 345-0224 Posted 92413

PRACTICES FOR SALE

Free North Manchester practice Collected gt$300000 in 2012 Drs Kelsey giving practice records and X-ray to DC who buys their building 302 W MainHwy 114 Appraised for $165000 last monthmdashyou can buy it for $145000 Closing office on 103013 so you must act soon for this opportunity (260) 568-4419 or office 260-982-4646 Posted 100213

DCS WANTED

Kauffman Chiropractic PC is looking for a full-time position to be filled October 2013 Successful 25+ years established company with physical therapy massage therapy and rehabilitation Enthusiastic ambitious doctor who is willing to learn is a must Must be proficient in Diversified Thompson and Distraction techniques Nice salary is offered Email resume to chirodancomcastnet Posted 82713

Fantastic opportunity for energetic success-oriented doctor excited to grow with us professionally Comes with ownership possibilities Learn to share chiropractic in your community Train in an established practice run on outstanding systems Great training and support for you with focus on exceptiional patient communication and care including chiropractic rehab and massage Send CV or resume to clarksvillespineandrehabinsightbbcom Contact Joseph Rogers Lousville Kentucky (812) 282-7500 Posted 1714

Career Opportunity ndash URGENT ASSOCIATE WANTED ndash PEORIA IL Work in a state of the art wellness center with upbeat and professional staff ready to support you Utilize chiropractic clinical nutrition and rehabilitation to manage a wide range of conditions Doctor must be bright outgoing enthusiastic and must have excellent clinical skills This is an opportunity you dont want to miss Designed for someone looking for a career not simply another job Extensive training and great income potential Invest in your future Send a resume to lfulleralignlifecom Posted 12414

Part Time DC needed for Gary IN office for DOT Certified Medical Exams and some Chiropractic beginning March 15 2014 NO STRESS NO BILLING No Overhead ndash No Headaches Easy hours (8 am - 5 pm - 2 dayswk) Continue in your own practice and make extra cash in our office or just work part-time for us Will tutor you and pay for your DOT Certification - work 2 daysweek ($25000) Will tutor you and pay for your DOT Certification ($50hr = $25000year for 2 daysweek) Contact Lynn Biese -Carroll DC at lbiesewirrcom or call (262) 515-2168 Posted 2614

Associate Needed ndash Bloomington Indiana Expanding practice in Bloomington Indiana is looking for full-time position to be filled Enthusiastic ambitious doctor is a must Must be proficient in Diversified and Low Force techniques rehab and physical therapy Practice is a very strong stable consistent referral based practice Salary and profit share of clinic are offered We will train and mentor in technique and all areas of patient compliance and success Send resume to Dr Fox 1710 West Third St Bloomington Indiana 47404 or email to jbfprodigynet Posted 21814

vACATION DOCTORS

Mobile Moje Chiropractic Dr Moje is available for vacation relief and office coverage Licensed in IN OH MI WI MN amp PA Specializing in maternity leave injuries and vacations Call or email for CV availability rates references and further information Contact Dr Moje at stephanmojegmailcom or (218) 205-6141 Posted 81613

indiana state ChirOPraCtiC assOCiatiOn Classifieds

Page 10: ISCA Spring Report 2014

spring 201410

Certified Medical Examiner Training WE NEED 20 PAID REGISTRANTS BY APRIL 10 IN ORDER

TO HOST THIS TRAINING Saturday May 3 and Sunday May 4 2014 Indianapolis Location TBD 800 AM to 6 pm Saturday May 3 and 8 AM to noon Sunday May 4 YOU CANNOT DO PHYSICAL EXAMS FOR TRUCK AND BUS DRIVERS ANY LONGER UNLESS YOU OBTAIN THIS CERTIFICATION Interested in becoming a Certified Medical Examiner (CME) and be listed on the National Reg-istry YOU MUST COMPLETE THIS TRAINING AND TESTING on Federal Motor Carrier Safety Ad-ministrationrsquos (FMCSA) physical qualification standards and guidelines If you intend to perform physical examinations and issue medical certificates for commercial motor vehicle (CMV) drivers to meet the requirements of Section 39141 of the Federal Motor Carrier Safety Regulations (FMCSRs) you must be certified and listed on the FMCSArsquos National Registry by May 21 2014 Upon completion of this program you will be eligible to take the Certification Test for $79 at an Indiana testing site The ISCA will provide you with info regarding multiple testing sites Program presented for the ISCA by Michael Megehee DC National Registry Certified Medical Examiner and President TeamCME LLC

Registration Name Clinic Address CityStateZip Phone Email Address Payment Method (Credit Card or Check) Credit Card Type Credit Card Expiration 3 Digit Code Name on Card Signature Questions Contact Cathy Orosz at infoindianastatechirosorg or call 317-673-4245 or toll-free at 800-572-8002 The ISCA needs a minimum of 20 registrants by Friday April 10 for this program to be offered Payment is needed upon regis-tration and no refunds will be granted

Mail Registrations to Indiana State Chiropractic Association 200 S Meridian St Ste 410 Indianapolis IN 46225 Or Fax to 317-686-2672 or email to infoindianastatechirosorg

The Cost of the 12-hour training is $400 for ISCA Members and $450 for Non Members

Because we have to pay for TeamCME in Advance we must have 20 paid registrants by April 10 in order to host this training MAKE YOUR RESERVATIONS TODAY

spring 201411

CONTACT INFORMATION

NAME_____________________________________________________________________

COMPANY __________________________________________________________________

MAILING ADDRESS__________________________________________________________

CITY STATE ZIP_____________________________________________________________

PHONE ________________________________ FAX________________________________

EMAIL_____________________________________________________________________

ADDITIONAL ATTENDEE NAMES________________________________________________

___________________________________________________________________________

PAYMENT OPTIONS

AMEX VISA MASTERCARD CHECK (MAKE PAYABLE TO ISCA BACKPAC)

CARDHOLDER_______________________________________________________________

CARD ____________________________________________________________________

EXP__________________________ 3 DIGIT SECURITY ___________________________

SIGNATURE_________________________________________________________________

MAIL ISCA 200 S Meridian St Suite 410 Indianapolis IN 46225FAX 3176862672 ATTN Cathy Orosz

ISCA REGIONAL VIDEO VIEWINGSNEED CONTINUING EDUCATION HOURS THERErsquoS STILL TIME

Donrsquot miss your opportunity to get your required continuing education credits prior to June 30 2014 Indiana Statute dictates that every Licensed Chiropractor in Indiana gets four hours of risk management each year by attending one of the ISCArsquos Regional Video Viewings

There are a limited number of seats at some locations so pre-registration is necessaryIf you choose to pay at the door Pre-Registration is REQUIRED Non-prior notice of attendance will be subject to the Non-Member rate above Call the ISCA office for availability at your location (317) 673-4245 If you need directions to a location please call the ISCA for host contact information

Proceeds of the viewings are contributed to the ISCA Political Action Committee and are non-business deductible

QUESTIONS Contact Cathy Orosz at 8005728002 3176734245 or email infoindianastatechirosorg Proceeds of the viewings are contributed to the ISCA Political Action Committee and are non-business deductible

Contributions to the ISCA Political Action Committee are non-business deductible

REGIONAL VIDEO RATES

$185 Member In Good Standing $250 Non-Member $165 GoldSilver Member Free Of Charge - Platinum Member

VIEWING DATES amp LOCATIONS

WEDNESDAY MAY 7 830 AM - 1230PM Dr Patrick Case 3027 Mishawa Ave South Bend IN

TUESDAY MAY 8 830 AM - 1230PM Dr Douglas Breger 2652 Charlestown Rd New Albany IN

SATURDAY MAY 10 830 AM - 1230PM Dr John Kostidis Call 2199244456 for location and availability Valparaiso IN

WEDNESDAY MAY 13 7 AM - 11 AM Dr Toby Harmon 2602 Newton St Jasper IN

THURSDAY MAY 15 9 AM - 1PM Dr Michael Hartle 3835 W Jefferson Blvd Fort Wayne IN

spring 201412

MediCaidMediCare UPdateBy Michael Phelps DC Secretary ISCA Board of Directors MedicaidMedicare Advising Committee

2013 saw yet another attempt to take chiropractic care out of Medicaid The ISCA amp its Legislative Committee was successful in stopping this attack on the chiropractic profession Thanks to the hard work of the ISCA Indiana remains one of the limited states where Medicaid covers all chiropractic services under our states scope of practice

January 1 2014 also saw the reinstatement of the 5 reduction in imbursement that we accepted several years ago

The ISCA is able to keep chiropractors in the Medicaid Program as well as other insurance as a paid provider through the hard work and dedication of volunteers If you are able to donate some time there are a number of committees and positions that need to be filled by doctors that want to make a difference If you know of DCs that are not members of the ISCA tell them about the good work we do for the profession and that we need all Doctors of Chiropractic in this state to be members Remember if youre not part of the solution youre part of the problem

As you know with the changes in health care coverage there are changes with respect to Medicare All chiropractors should be reporting PQRS for incentive payment eligibility Those who report satisfactorily for the 2013 amp 2014 program years may avoid the 2015 PQRS payment adjustment Additional information on how to avoid future PQRS payment adjustments can be found through supporting documentation available on the CMS website at httpwwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-InstructionsPQRS Chiropractors are fortunate as they only have to report on three measures

Measure 131 - Pain Assessment and Follow upMeasure 182 - Functional Outcome AssessmentMeasure 317 - Preventive Care and Screening (Screening for High Blood Pressure)

January 1 2014 saw an increase of approximately 9 in the reimbursement for chiropractic adjustments (98940 98941 amp 98942) This increase was due to a reassessment of the RVUs for CMT

The latest CERT report saw a decrease in the percentage of errors for chiropractors Chiropractic physicians need to continue to improve their documentation and coding of services in order to maintain this downward decline of errors

The Wisconsin Physicians Service (WPS) periodically analyzes provider coding patterns to identify deviations within a peer group For the J8 (Indiana and Michigan) Jurisdiction there has been a significantly higher than normal usage of the Code 98942 (CMT of five regions of the spine) There are approximately 35 DCs in the state of Michigan that are on the radar I am happy to report that there are no chiropractors in the state of Indiana under review

All that needs to happen for Chiropractic to fail is for good doctors to do nothing If you know of a chiropractor that is not a member of the ISCA urge them to join

MedicaidMedicare Update (contd on page 13)

spring 201413

MedicaidMedicare Update (contd from page 12)

SGR BILL PASSES HOUSE GOES TO SENATE FOR CONSIDERATIONWe learned that the United States House of Representatives passed House Bill 4302 The bill proposes to extend Medicarersquos Sustainable Growth Rate (SGR) current rate to April 15 2015 and would delay other Medicare deadlines The bill as currently drafted would postpone ICD-10-CM implementation until after October 1 2015 and restrict the Centers for Medicare amp Medicaid Services (CMS) from acting without congressional approval The bill now goes to the US Senate for debate and vote If it passes the Senate it would then be sent to President Obamarsquos desk to be signed or vetoed The ISCA will continue to monitor this situation and recommends preparing for ICD-10 implementation

PLEASE ALSO MARK YOUR CALENDAR WITH THESE DATES Medicare Secondary Payer (MSP) Seminar April 17 2014 from 100 pm to 400 pm Hilton Garden Inn Fort Wayne 8615 US Hwy 24 West Fort Wayne IN Click here to register

There is a Chiropractic Medicare Seminar on April 26 2014 in Mishawaka IN Click here for more information

HELPFUL LINKSNeed help in the transition to ICD-10 Go to the Road to 10 website by clicking here This site is primarily for the MD but has general information that pertains to all health care specialties

Stay up-to-date on changes in Medicare at the WPS Medicare website by clicking here This website is for all providers but sometimes offers information specific to chiropractors

INFORMATION REGARDING THE HOLDING OF APRIL 2014 CLAIMS FOR SERvICES PAID UNDER THE 2014 MEDICARE PHYSICIAN FEE SCHEDULE The 2014 Medicare Physician Fee Schedule (MPFS) final rule stipulated a negative update to the MPFS that was to be effective January 1 2014 That reduction was averted for three months with the passage of the Pathway for SGR Reform Act of 2013 which provided for a 05 percent update for services paid under the MPFS through March 31 2014 CMS is hopeful that there will be congressional action to prevent the negative update from taking effect on April 1 2014 CMS has instructed the Medicare Administrative Contractors to hold claims containing services paid under the MPFS for the first 10 business days of April (ie through April 14 2014) This hold would only affect MPFS claims with dates of service of April 1 2014 and later The hold should have minimal impact on provider cash flow because under current law clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt All claims for services delivered on or before March 31 2014 will be processed and paid under normal procedures regardless of any Congressional actions

spring 201414

insUranCe COMMittee UPdateBy Peter Furno DC ISCA Board of Directors District 4 Director and Insurance Committee Chairman

During 2013 the ISCA Insurance Committee addressed many issues and questions from its members with regard to insurance legalities of advertising and proposed associations with third party vendors offering incentives contrary to our practice statues Doctors with definitively legal questions were referred to their legal counsel for liability reasons Most questions directed to the insurance committee are answered within 24 hours

Because the ISCA continues to receive anecdotal complaints from the field claiming insurer reimbursement discrimination and other transgressions the insurance committee as a part of the ISCArsquos proactive efforts to address this problem has developed a survey to obtain information on various insurance problems or concerns impacting chiropractors in the field The ISCA is aggressively attempting to determine problems that are affecting large numbers of doctors and which may be indicating the development of a trend requiring attention by the ISCA and then the IDOI However although it is the intent to meet with the IDOI once the survey information is correlated so that the contentions of our doctors may be addressed officially without firm evidence of wrong doing by the insurance industry the ISCA cannot go forward Consequently it is imperative that all members who are having trouble submit their complaints to the ISCA together with supportive documentation so that this issue may be addressed

Now that the PPACA is law and will require ldquoevidence-basedrdquo treatment procedures to be utilized before reimbursements are made the intent of the Insurance Committee to make at least one presentation to decision-makers of an employer group regarding the cost-effectiveness and efficacy of chiropractic in the management of work related uncomplicated spine injuries in comparison to traditional medical care Heretofore the majority of employers had no idea of the cost-effectiveness of chiropractic care when compared to traditional medicine and simply allowed their work nurses and medical providers to direct care ndash which the research shows is one of the main reasons costs are so high

The Insurance Committee in an attempt to keep the ISCA membership updated will attempt to address at least two insurance queries weekly and present answers to the membership via the ISCA monthly eNews and Newsletter

Insurance Pearl Medicare and Chiropractic Billing Misconceptions It is worthwhile to address a few of the prevailing misconceptions Here are the nine truisms regarding Medicare and chiropractic

1 There is not a 12-visit limit to Medicare for chiropractic services The limits of care are based on the specific medical necessity of the primary subluxation and its secondary neuromusculoskeletal diagnosis

2 Medicare will pay for both acute and chronic conditions as long as there is documentation or expectation of functional improvement

3 Nonparticipating (nonpar) providers are required to bill for services All covered services under chiropractic (spinal manipulation) must be billed to Medicare

4 Nonpar providers are audited just as par providers are There is no protection from a Medicare audit by being nonpar

5 Nonpar providers must document services in the same manner as any provider of Medicare services Being par or nonpar is irrelevant in reference to documentation of chiropractic services

6 Chiropractors may not opt out of Medicare This is simply not an option for doctors of chiropractic Being nonpar is not opting out but designating oneself as a Medicare provider nonpar In simple terms chiropractors must belong to Medicare to treat Medicare patients

7 Advance Beneficiary Notices (ABNs) should not be used as routine documents for patients to sign on their initial visit However they must be used when there is a genuine belief or reasonable expectation that Medicare will deny or not pay for the service on a specific visit or series of visits In other words a blanket ABN at the beginning of care is not sufficient or compliant

8 Medicare claims are not difficult they are simply different from health insurance claims When not done in Medicares format claims are denied

9 Medicare payment is what it is I will refrain from stating it is good While we all would want higher reimbursements (Who doesnt) the average fees for chiropractic services for manipulation are $30-$36 per visit This is far better reimbursement than under many of the managed care plans chiropractors routinely fight to join Furthermore that dollar amount is for spinal manipulation only other services may be billed to the patient or covered by a secondary insurance plan

spring 201415

trUst BUt verifyBy Dr R A Foxworth FICC MCS-P

I was speaking with a doctor recently who was venting her frustration about not knowing who to believe or trust as an authority when it comes to being in practice today She goes to different seminars because she wants to improve herself personally and professionally She also wants to improve her practice by learning more about her productivity effectiveness documentation compliance and billing She shared that she doesnt simply attend the CEU required hours for her license she puts in seminar hours to improve her practice her clinical skills her compliance and her business insight

Her problem The conflicting information she receives from various experts at each seminar How she asked can they all be right if they all say different things As a result of her experience she wanted to know why a Discount Medical Plan Organization (DMPO) like ChiroHealthUSA was of value in todayrsquos practices Why she asked is this even necessary What are my resources

I passed her third-degree with flying colors by the way

I could appreciate her position because I am a bit of a skeptic myself In fact thats how all this started for me I was a chiropractor in practice just like you trying to maximize my insurance payments so I wasnt leaving money on the table while still working to come up with a way my uninsured patients could afford those fees

Because of my activity within my state (as a governor-appointed health expert as an active participant in my State Chiropractic Association and the state representative for the American Chiropractic Association) I knew there were rules to follow to avoid compliance issues when creating our fee schedule I did my research and initially started a Discount Medical Plan Organization (DMPO) for my state alone I knew this would legally protect my practice and my colleagues and that at the time was my only goal

And as skeptic I wouldnrsquot even take my own word for it when it came to believing that a Discount Medical Plan Organization (DMPO) was the simplest way to keep my fee schedules compliant legal and safe Thatrsquos why I became a Certified Medical Compliance Specialist (MCS-P) so skeptics like me could get a breath and feel at ease As an MCS-P Irsquom quite simply held to a higher standard I have to be able to quote chapter and verse about why any possible fee or activity is or isnrsquot compliant

We know therersquos a plethora of inaccurate information that gets disseminated in our profession Im sad to say that I had to agree with my frustrated colleague when she was venting about all the conflicting advice she was receiving Thatrsquos why ChiroHealthUSA has relationships with many MCS-Ps to help get accurate reliable information out there Many of the brightest minds in our profession agree with and recommend ChiroHealthUSA to their chiropractic colleagues

Looking back when I set up my first DMPO within my state I can see how shortsighted I was I now know that taking ChiroHealthUSA to a national audience to protect all chiropractic practices in the country was the vision I shouldve had at the start Im glad I had an encounter with one of my fellow MCS-Ps who gave me this bigger vision

Learn more about how ChiroHealthUSA can help your practice be more compliant You can attend a free webinar this Tuesday April 1 Register at wwwChiroHealthUSAcom today to find out more

Dr Foxworth is a certified Medical Compliance Specialist and President of ChirohealthUSA A practicing Chiropractor he remains ldquoin the trenchesrdquo facing challenges with billing coding documentation and compliance he has served as president of the Mississippi Chiropractic Association former Staff Chiropractor at

the gv Sonny Montgomery vA Medical Center and is a Fellow of the International College of Chiropractic you can contact Dr Foxworth at 1 (888) 719-9990 infochirohealthusacom or visit the ChirohealthUSA website at wwwchirohealthusacom join us for a free webinar that will give you all the details about how a DMPO can help you practice with more peace of mind go to wwwchirohealthusacom to register today

spring 201416

Were already there ndash ChirOPraCtiC and PUBliC health hand-in-handBy Caitlin Lukacs from the March 2014 issue of ACA news

Public health is a popular buzz phrase in the healthcare arena but what exactly is it and how does chiropractic fit into it ldquoPublic health describes the overall wellbeing of the populacerdquo explains Richard Bruns DC past chairman of the American Chiropractic Associationrsquos (ACA) Wellness and Health Promotion Committee and ACA chairman of the Board of Governors ldquoAll public health issues have future implications for individuals as well as the publicrdquo

Public health encompasses habits and social norms such as smoking alcohol consumption obesity and the use of seatbelts as well as environmental issues such as clean water air quality and how livestock and agricultural practices affect the environment adds Will Evans DC PhD MCHES provost of the University of Western States Public health also includes health education and health promotion

ldquoPublic health and chiropractic go hand-in-handrdquo explains Karen Konarski-Hart DC DABCO FACO vice president of ACArsquos Council of Delegates and chairman of the American Public Health Association (APHA)Wellness and Health Promotion Committee ldquoDCs donrsquot practice in a vacuum they are interested in all aspects of a patientrsquos life that affect his or her health and wellbeing as well as how that person interacts in the healthcare community at largerdquo

Whether they identify it as public health or not all chiropractic physicians address public health issues when dealing with their patients For example when a new patient comes into your office you begin with a detailed history and an initial examination that includes not only taking vital signs but discussing tobacco and alcohol use and other behaviors that affect that patientrsquos health explains Dr Evans ldquoThis allows you to create an individual health-risk assessment based on his or her environment family history lifestyle etc and address public health issues such as tobacco use at the same timerdquo he says

BROACHING THE SUBjECTIt can sometimes be difficult to initiate conversations with patients about issues such as smoking or weight loss ldquoThe best place to address such topics is in your initial report of findings to the patientrdquo suggests Dr Evans ldquoYoursquove examined the patient and determined the cause of the pain or complaint that brought him or her into your office in the first place and now yoursquove got an opportunity to say lsquoI see some lifestyle-related issues that could be contributing to your pain or that could lead to other complaints down the roadrsquordquo

Yoursquore in a position to identify potential problems for your

patients says Dr Konarski-Hart ldquoThey may be setting themselves up for diabetes or cardiovascular disease or maybe they arenrsquot getting enough exercise mdash all of these things should be discussed as part of good primary carerdquo

You never want to force patients to make changes so yoursquoll need to assess their openness to addressing lifestyle changes first Simply ask them if theyrsquod be willing to discuss a healthier weight for example If they are you can let them know that you have multiple resources and partners in place to help them move forward

Dr Evans determines his patientsrsquo willingness to make lifestyle modifications by using the Stages of Change a common model of health behavior change The Stages of Change are

Pre-contemplator stage ndash Patient has no intention of making any changes in the next six months

Contemplator stage ndash Patient is considering a change within the next six months

Preparation stage ndash Patient has decided on a change and is preparing to take some kind of action

Action stage ndash Patient has begun implementing the change

Maintenance stage ndash Patient has made a change and is now working to maintain it

Take the example of an overweight patient Because the average weight of an individual in the United States has increased over the past few years some people who are overweight or borderline overweight donrsquot even realize it says Dr Evans Broach the subject gently and suggest a few small goals such as parking farther away from the office or shopping center or wearing a pedometer and working to increase the number of steps taken in a day You could also teach that patient how to read food labels and discuss healthier meal options Itrsquos about identifying the risk communicating the risk determining where your patient falls in the Stages of Change and then prescribing appropriate modifications explains Dr Evans ldquoAnd donrsquot forget to follow up with that patient at his or her next appointment Itrsquos important that he or she doesnrsquot lose confidence in your recommendations or in you as a healthcare providerrdquo he adds

GET INvOLvEDIn addition to discussions with patients in the treatment

Were Already There ndash Chiropractic and Public health hand-in-hand(contd on page 17)

spring 201417

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 16)

room there are many ways to incorporate public health into your practice One of the easiest ways to get involved is to participate in an observance that already exists such as the APHArsquos Public Health Week held the first week of every April (wwwaphaorgprogramshealthweek) or ACArsquos National Chiropractic Health Month (NCHM) celebrated every October These organizations come up with a new theme each year and gather all of the resources you need to participate ldquoIt takes the thinking and planning aspect off of the individual doctorrdquo says Dr Konarski-Hart ldquoAll you need to do is follow the instructions laid out by the parent organizationrdquo Additionally when you throw your hat into the ring on a larger issue or observance you know that the public health community is focused on that issue at that time so you can reach out to your county or state health department or other local healthcare associations and join in their efforts which will help you to build mutually beneficial long-term relationships says Dr Konarski-Hart ldquoMany state groups are underfunded and understaffed and they welcome participation particularly from physiciansrdquo she notes

DCs can also create their own observances ldquoACA offers webinars teleseminars and patient handouts on a variety of public health issuesmdashperuse the offerings and pick a topic to focus on for a week or a monthrdquo says Dr Konarski-Hart She suggests having your clinic sponsor a wellness competition or challenge You could partner with a local exercise facility or health foods store as well as a school or senior center and make it a community event You could also organize an eat well exercise club in which members meet for a walk or bike ride and then share a healthy breakfast or lunch Your practice could sponsor a poster contest at a local school or community center ldquoHave the kids create posters focused on healthy lifestyle choices and then give out prizes of fun healthy exercise such as a day of horseback riding or ice skatingrdquo Dr Konarski-Hart says Additionally your practice could sponsor a marathon participant or a local amateur sports team to show that you support healthy activities and active lifestyles

Similarly be informed about the public health issues in your community Maybe you live in an area with a high population of smokers or perhaps there have been numerous injuries due to not wearing a seatbelt in recent years Do some background research on these topics and then get involved whether that means simply providing patient handouts in your waiting room giving a community health talk participating in health fairs or working with your local health department (and other relevant organizations) to pass pertinent legislation

Look for organizations in your area that are already offering public health resources or programs and set up

a partnership with them For example for the topic of overweightobesity you could offer your clinic as a weigh-in site for participants in Weight Watchers programs suggests Dr Evans or partner with a local gym to give discounts to chiropractic patients Dr Bruns recommends getting involved with the school lunch program to advocate for healthy options for students For smoking cessation work with the American Lung Association to put on an informational presentation at a local hospital or sponsor a 5k or a stair run to raise awareness (and funds) for lung cancer research For drug addiction set up a referral network with psychologists or addiction centers and either offer acupuncture in your office or refer out to an acupuncturist as it has been shown to help patients through the detox process You can also use your knowledge of nutrition and exercise to facilitate the journey through detox says Dr Bruns

Additionally you should make a point to support these other organizations when they host local events (even if yoursquore not an official partner) or reach out for financial support ldquoI always participate in the American Cancer Societyrsquos golf tournament and I display their materials in my office as wellrdquo says Dr Bruns He also participates in the fundraising efforts of the American Heart Association and the American Lung Association on a regular basis ldquoItrsquos good for your patients and your community to see that you care about and support other healthcare organizationsrdquo he says

Another option for public health involvement is to join the APHArsquos Chiropractic Health Care Section Yoursquoll be informed on public health happenings have access to the latest information and research see what DCs are doing nationally and in other states on particular issues and even have the chance to give input and be involved in decision-making

CONCUSSIONConcussion prevention and treatment is one public health topic that is relevant to every patient population in every region of the United States ldquoWersquore seeing more concussions lately due in part to the number of children participating in contact sports the excessive training involved in these sports and the fact that most people arenrsquot aware of the symptoms and long-term risks of concussionsrdquo says Dr Konarski-Hart Helmets donrsquot actually provide protection against concussions either ldquoThe padding will protect the skull from fracture but because your brain is loose inside your skull it is not protected from impact or traumardquo she explains And with todayrsquos cultural emphasis on pushing through the pain wersquore starting to see more and more professional athletes coming forward with serious emotional psychological and neurological issues that are linked to multiple concussions in their past

spring 201418

As an EMT herself Dr Konarski-Hart attended an EMT convention in the summer of 2013 and heard a presentation from the Childrenrsquos Hospital of Arkansas on injury prevention After speaking with the presenters she discovered that they were having trouble getting buy-in from the allopathic community and she offered her services as a DC Since then Dr Konarski-Hart and the Arkansas Chiropractic Physicians Association (ACPA) have been working with the childrenrsquos hospital on various statewide projects dealing with all aspects of injury prevention One such program focuses on concussions

ldquoThrough this partnership we learned that Arkansas has not finalized its concussion protocols yet and we were able to get someone from our ACPA legislative team involved in that process to ensure chiropracticrsquos inclusion as an involved professionrdquo says Dr Konarski-Hart

Because of DCsrsquo knowledge and training itrsquos important for them to get involved with the concussion issue says Dr Bruns ldquoKnowing what we know about concussions we are doing a tremendous service to athletes and their families by completing pre-participation physicals and screenings and watching for signs and symptoms during participation as wellrdquo he says And itrsquos not just athletes who are suffering from concussions mdash itrsquos children who fall off a bike or a swing set or an older adult who slips on the ice

Itrsquos crucial for DCs to help disseminate information about concussions Whether you see concussion symptoms in a patient in your office or work with local sports teams you have the knowledge to serve as a local expert on the topic DCs can assess injured parties work with school administrators to create concussion protocols and push for legislation on standard concussion treatment says Dr Bruns

Kids parents coaches trainers and doctors all need to be aware of concussions and the potential risks involved with sustaining one or more ldquoItrsquos a matter of understanding the potential risks before making a decision to play in a game or to have a player sit out a game for examplerdquo says Dr Konarski-Hart

WErsquoRE ALREADY THEREAs DCs we focus on the biomechanics structure and function of the human body and we have a unique approach in that we look at the whole person in terms of nutrition flexibility blood flow and muscle and nervous tissue function says Dr Bruns ldquoThe chiropractic profession recognizes the importance of healthful eating nutritional support avoiding the bad habits of smoking and drinking alcohol and has been counseling patients on healthy lifestyles since long before it was fashionablerdquo

According to Dr Konarski-Hart simply choosing to be a doctor of chiropractic means that yoursquore involved in public health on some level because your goal is to make your patient healthier and therefore make your community healthier In other words DCs are already an integral part of public health

With the new health care emphasis on wellness and prevention many healthcare providers legislators insurance companies and government policy developers are focusing on how to offer access to these services especially in medically underserved rural areas or small towns Chiropractic representatives need to be part of those discussions to point out that in many of these communities DCs are already there providing that assessment counseling and care This representation is one of the functions of the ACA and state chiropractic associations and why your membership and involvement with these organizations is so critical says Dr Konarski-Hart

aCa neWs extraCERTIFIED CHIROPRACTIC WELLNESS SPECIALIST PROGRAMIn 2011 ACA began a partnership with the National Wellness Institute (NWI) a well respected organization recognized both inside and outside the chiropractic profession to offer a wellness certification program for DCs The 40-hour program will enable students to integrate principles of wellness coaching health promotion and disease prevention to their current practices Once the program is completed DCs will become Certified Chiropractic Wellness Specialists ldquoThe program was developed and launched by Dr Evans Cheryl Hawk DC PhD CHES and Mike Perko PhDmdashdoctors who are at the forefront of health promotion illness prevention and wellnessrdquo says Dr Bruns Originally the certification consisted of four different modules and DCs had to travel to select cities to participate in the weekend seminars However ACA quickly realized that it was difficult for DCs to get to these courses and decided to turn the program into an online certification NWI has taken the lead on this conversion

ACA RESOURCES Bookmark wwwacatoday orgpublichealth on your computer for quick and easy access to patient handouts references and research for presentations a calendar of national public health observances and other resources that have all been vetted by the ACA APHAWellness and Health Promotion Committee for use in your office Published in the March 2014 ACA news

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 17)

spring 201419

ASSOCIATES WANTED

Associate Wanted Starting base annual salary range is 50-60K plus additional monthly $500-2K in productivity compensation Benefits include MalpracticeMedical insurance CE Our care model uses the latest in Chiropractic Massage Physical Therapy Acupuncture and Nutritional medicine services South Bend is home to Notre Dame and a short drive to Chicago and Lake Michigan This is a good place to raise a family with good schools and a low cost of living Sendfax a letter of interest and resume to apintodcyahoocom or fax (574) 254-1652 Posted 11514

Chicagoland Associate Doctor Needed Busy office with multiple long term associates Family practice Thirty minutes to downtown Chicago Full timepart time paid vacation $26hour starting pay with periodic raises Proficient in the Thompson leg-check technique We are looking for someone who is ready and willing to blend with a very upbeat fun and positive staff Interested applicants should email their resume to infotrimbolichironet or fax to (219) 836-2344 wwwtrimbolichironet Posted 12914

Opportunity for Doctor to grow own practice with buyout of 40 year family practice in 2-5 years Located in North Central Indiana with easy access to Indianapolis and Chicago Wonderful area to raise a family good schools low crime slower pace of life Contact pdyer4hotmailcom Posted 2614

Associate Needed We are currently searching for an associate doctor to help us at the Osmon Chiropractic Center in Bloomington IN This would be a tremendous opportunity for a new graduate or anyone considering a possible change of location You will be working in a beautiful 2500 square foot state of the art clinic with 1 other doctor and a professional staff of 8 to assist you There will be only a small amount of practice building activities on your part because we will provide you with a practice representative who will do that for you You will enjoy the security of a known income and practice without the stress of practice overhead and staff management All you need to do is learn our system of patient managementmdashthe same system we all use in the office and work together as a team to get and keep our community under chiropractic care It is an exciting place to practice Send resume and cover letter to drosmonhotmailcom and please feel free to visit our website at wwwDrOsmoncom Posted 3314

EQUIPMENT FOR SALE

For SalemdashFutura 3000GT automatic X-ray film processor two 8x10 cassettes two 7x14 cassettes two 14x17 cassettes Xray film cabinet new film xray I D Imprinter amp infra red light for sale $80000 Mikephelps55attnet or call (765) 345-0224 Posted 92413

PRACTICES FOR SALE

Free North Manchester practice Collected gt$300000 in 2012 Drs Kelsey giving practice records and X-ray to DC who buys their building 302 W MainHwy 114 Appraised for $165000 last monthmdashyou can buy it for $145000 Closing office on 103013 so you must act soon for this opportunity (260) 568-4419 or office 260-982-4646 Posted 100213

DCS WANTED

Kauffman Chiropractic PC is looking for a full-time position to be filled October 2013 Successful 25+ years established company with physical therapy massage therapy and rehabilitation Enthusiastic ambitious doctor who is willing to learn is a must Must be proficient in Diversified Thompson and Distraction techniques Nice salary is offered Email resume to chirodancomcastnet Posted 82713

Fantastic opportunity for energetic success-oriented doctor excited to grow with us professionally Comes with ownership possibilities Learn to share chiropractic in your community Train in an established practice run on outstanding systems Great training and support for you with focus on exceptiional patient communication and care including chiropractic rehab and massage Send CV or resume to clarksvillespineandrehabinsightbbcom Contact Joseph Rogers Lousville Kentucky (812) 282-7500 Posted 1714

Career Opportunity ndash URGENT ASSOCIATE WANTED ndash PEORIA IL Work in a state of the art wellness center with upbeat and professional staff ready to support you Utilize chiropractic clinical nutrition and rehabilitation to manage a wide range of conditions Doctor must be bright outgoing enthusiastic and must have excellent clinical skills This is an opportunity you dont want to miss Designed for someone looking for a career not simply another job Extensive training and great income potential Invest in your future Send a resume to lfulleralignlifecom Posted 12414

Part Time DC needed for Gary IN office for DOT Certified Medical Exams and some Chiropractic beginning March 15 2014 NO STRESS NO BILLING No Overhead ndash No Headaches Easy hours (8 am - 5 pm - 2 dayswk) Continue in your own practice and make extra cash in our office or just work part-time for us Will tutor you and pay for your DOT Certification - work 2 daysweek ($25000) Will tutor you and pay for your DOT Certification ($50hr = $25000year for 2 daysweek) Contact Lynn Biese -Carroll DC at lbiesewirrcom or call (262) 515-2168 Posted 2614

Associate Needed ndash Bloomington Indiana Expanding practice in Bloomington Indiana is looking for full-time position to be filled Enthusiastic ambitious doctor is a must Must be proficient in Diversified and Low Force techniques rehab and physical therapy Practice is a very strong stable consistent referral based practice Salary and profit share of clinic are offered We will train and mentor in technique and all areas of patient compliance and success Send resume to Dr Fox 1710 West Third St Bloomington Indiana 47404 or email to jbfprodigynet Posted 21814

vACATION DOCTORS

Mobile Moje Chiropractic Dr Moje is available for vacation relief and office coverage Licensed in IN OH MI WI MN amp PA Specializing in maternity leave injuries and vacations Call or email for CV availability rates references and further information Contact Dr Moje at stephanmojegmailcom or (218) 205-6141 Posted 81613

indiana state ChirOPraCtiC assOCiatiOn Classifieds

Page 11: ISCA Spring Report 2014

spring 201411

CONTACT INFORMATION

NAME_____________________________________________________________________

COMPANY __________________________________________________________________

MAILING ADDRESS__________________________________________________________

CITY STATE ZIP_____________________________________________________________

PHONE ________________________________ FAX________________________________

EMAIL_____________________________________________________________________

ADDITIONAL ATTENDEE NAMES________________________________________________

___________________________________________________________________________

PAYMENT OPTIONS

AMEX VISA MASTERCARD CHECK (MAKE PAYABLE TO ISCA BACKPAC)

CARDHOLDER_______________________________________________________________

CARD ____________________________________________________________________

EXP__________________________ 3 DIGIT SECURITY ___________________________

SIGNATURE_________________________________________________________________

MAIL ISCA 200 S Meridian St Suite 410 Indianapolis IN 46225FAX 3176862672 ATTN Cathy Orosz

ISCA REGIONAL VIDEO VIEWINGSNEED CONTINUING EDUCATION HOURS THERErsquoS STILL TIME

Donrsquot miss your opportunity to get your required continuing education credits prior to June 30 2014 Indiana Statute dictates that every Licensed Chiropractor in Indiana gets four hours of risk management each year by attending one of the ISCArsquos Regional Video Viewings

There are a limited number of seats at some locations so pre-registration is necessaryIf you choose to pay at the door Pre-Registration is REQUIRED Non-prior notice of attendance will be subject to the Non-Member rate above Call the ISCA office for availability at your location (317) 673-4245 If you need directions to a location please call the ISCA for host contact information

Proceeds of the viewings are contributed to the ISCA Political Action Committee and are non-business deductible

QUESTIONS Contact Cathy Orosz at 8005728002 3176734245 or email infoindianastatechirosorg Proceeds of the viewings are contributed to the ISCA Political Action Committee and are non-business deductible

Contributions to the ISCA Political Action Committee are non-business deductible

REGIONAL VIDEO RATES

$185 Member In Good Standing $250 Non-Member $165 GoldSilver Member Free Of Charge - Platinum Member

VIEWING DATES amp LOCATIONS

WEDNESDAY MAY 7 830 AM - 1230PM Dr Patrick Case 3027 Mishawa Ave South Bend IN

TUESDAY MAY 8 830 AM - 1230PM Dr Douglas Breger 2652 Charlestown Rd New Albany IN

SATURDAY MAY 10 830 AM - 1230PM Dr John Kostidis Call 2199244456 for location and availability Valparaiso IN

WEDNESDAY MAY 13 7 AM - 11 AM Dr Toby Harmon 2602 Newton St Jasper IN

THURSDAY MAY 15 9 AM - 1PM Dr Michael Hartle 3835 W Jefferson Blvd Fort Wayne IN

spring 201412

MediCaidMediCare UPdateBy Michael Phelps DC Secretary ISCA Board of Directors MedicaidMedicare Advising Committee

2013 saw yet another attempt to take chiropractic care out of Medicaid The ISCA amp its Legislative Committee was successful in stopping this attack on the chiropractic profession Thanks to the hard work of the ISCA Indiana remains one of the limited states where Medicaid covers all chiropractic services under our states scope of practice

January 1 2014 also saw the reinstatement of the 5 reduction in imbursement that we accepted several years ago

The ISCA is able to keep chiropractors in the Medicaid Program as well as other insurance as a paid provider through the hard work and dedication of volunteers If you are able to donate some time there are a number of committees and positions that need to be filled by doctors that want to make a difference If you know of DCs that are not members of the ISCA tell them about the good work we do for the profession and that we need all Doctors of Chiropractic in this state to be members Remember if youre not part of the solution youre part of the problem

As you know with the changes in health care coverage there are changes with respect to Medicare All chiropractors should be reporting PQRS for incentive payment eligibility Those who report satisfactorily for the 2013 amp 2014 program years may avoid the 2015 PQRS payment adjustment Additional information on how to avoid future PQRS payment adjustments can be found through supporting documentation available on the CMS website at httpwwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-InstructionsPQRS Chiropractors are fortunate as they only have to report on three measures

Measure 131 - Pain Assessment and Follow upMeasure 182 - Functional Outcome AssessmentMeasure 317 - Preventive Care and Screening (Screening for High Blood Pressure)

January 1 2014 saw an increase of approximately 9 in the reimbursement for chiropractic adjustments (98940 98941 amp 98942) This increase was due to a reassessment of the RVUs for CMT

The latest CERT report saw a decrease in the percentage of errors for chiropractors Chiropractic physicians need to continue to improve their documentation and coding of services in order to maintain this downward decline of errors

The Wisconsin Physicians Service (WPS) periodically analyzes provider coding patterns to identify deviations within a peer group For the J8 (Indiana and Michigan) Jurisdiction there has been a significantly higher than normal usage of the Code 98942 (CMT of five regions of the spine) There are approximately 35 DCs in the state of Michigan that are on the radar I am happy to report that there are no chiropractors in the state of Indiana under review

All that needs to happen for Chiropractic to fail is for good doctors to do nothing If you know of a chiropractor that is not a member of the ISCA urge them to join

MedicaidMedicare Update (contd on page 13)

spring 201413

MedicaidMedicare Update (contd from page 12)

SGR BILL PASSES HOUSE GOES TO SENATE FOR CONSIDERATIONWe learned that the United States House of Representatives passed House Bill 4302 The bill proposes to extend Medicarersquos Sustainable Growth Rate (SGR) current rate to April 15 2015 and would delay other Medicare deadlines The bill as currently drafted would postpone ICD-10-CM implementation until after October 1 2015 and restrict the Centers for Medicare amp Medicaid Services (CMS) from acting without congressional approval The bill now goes to the US Senate for debate and vote If it passes the Senate it would then be sent to President Obamarsquos desk to be signed or vetoed The ISCA will continue to monitor this situation and recommends preparing for ICD-10 implementation

PLEASE ALSO MARK YOUR CALENDAR WITH THESE DATES Medicare Secondary Payer (MSP) Seminar April 17 2014 from 100 pm to 400 pm Hilton Garden Inn Fort Wayne 8615 US Hwy 24 West Fort Wayne IN Click here to register

There is a Chiropractic Medicare Seminar on April 26 2014 in Mishawaka IN Click here for more information

HELPFUL LINKSNeed help in the transition to ICD-10 Go to the Road to 10 website by clicking here This site is primarily for the MD but has general information that pertains to all health care specialties

Stay up-to-date on changes in Medicare at the WPS Medicare website by clicking here This website is for all providers but sometimes offers information specific to chiropractors

INFORMATION REGARDING THE HOLDING OF APRIL 2014 CLAIMS FOR SERvICES PAID UNDER THE 2014 MEDICARE PHYSICIAN FEE SCHEDULE The 2014 Medicare Physician Fee Schedule (MPFS) final rule stipulated a negative update to the MPFS that was to be effective January 1 2014 That reduction was averted for three months with the passage of the Pathway for SGR Reform Act of 2013 which provided for a 05 percent update for services paid under the MPFS through March 31 2014 CMS is hopeful that there will be congressional action to prevent the negative update from taking effect on April 1 2014 CMS has instructed the Medicare Administrative Contractors to hold claims containing services paid under the MPFS for the first 10 business days of April (ie through April 14 2014) This hold would only affect MPFS claims with dates of service of April 1 2014 and later The hold should have minimal impact on provider cash flow because under current law clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt All claims for services delivered on or before March 31 2014 will be processed and paid under normal procedures regardless of any Congressional actions

spring 201414

insUranCe COMMittee UPdateBy Peter Furno DC ISCA Board of Directors District 4 Director and Insurance Committee Chairman

During 2013 the ISCA Insurance Committee addressed many issues and questions from its members with regard to insurance legalities of advertising and proposed associations with third party vendors offering incentives contrary to our practice statues Doctors with definitively legal questions were referred to their legal counsel for liability reasons Most questions directed to the insurance committee are answered within 24 hours

Because the ISCA continues to receive anecdotal complaints from the field claiming insurer reimbursement discrimination and other transgressions the insurance committee as a part of the ISCArsquos proactive efforts to address this problem has developed a survey to obtain information on various insurance problems or concerns impacting chiropractors in the field The ISCA is aggressively attempting to determine problems that are affecting large numbers of doctors and which may be indicating the development of a trend requiring attention by the ISCA and then the IDOI However although it is the intent to meet with the IDOI once the survey information is correlated so that the contentions of our doctors may be addressed officially without firm evidence of wrong doing by the insurance industry the ISCA cannot go forward Consequently it is imperative that all members who are having trouble submit their complaints to the ISCA together with supportive documentation so that this issue may be addressed

Now that the PPACA is law and will require ldquoevidence-basedrdquo treatment procedures to be utilized before reimbursements are made the intent of the Insurance Committee to make at least one presentation to decision-makers of an employer group regarding the cost-effectiveness and efficacy of chiropractic in the management of work related uncomplicated spine injuries in comparison to traditional medical care Heretofore the majority of employers had no idea of the cost-effectiveness of chiropractic care when compared to traditional medicine and simply allowed their work nurses and medical providers to direct care ndash which the research shows is one of the main reasons costs are so high

The Insurance Committee in an attempt to keep the ISCA membership updated will attempt to address at least two insurance queries weekly and present answers to the membership via the ISCA monthly eNews and Newsletter

Insurance Pearl Medicare and Chiropractic Billing Misconceptions It is worthwhile to address a few of the prevailing misconceptions Here are the nine truisms regarding Medicare and chiropractic

1 There is not a 12-visit limit to Medicare for chiropractic services The limits of care are based on the specific medical necessity of the primary subluxation and its secondary neuromusculoskeletal diagnosis

2 Medicare will pay for both acute and chronic conditions as long as there is documentation or expectation of functional improvement

3 Nonparticipating (nonpar) providers are required to bill for services All covered services under chiropractic (spinal manipulation) must be billed to Medicare

4 Nonpar providers are audited just as par providers are There is no protection from a Medicare audit by being nonpar

5 Nonpar providers must document services in the same manner as any provider of Medicare services Being par or nonpar is irrelevant in reference to documentation of chiropractic services

6 Chiropractors may not opt out of Medicare This is simply not an option for doctors of chiropractic Being nonpar is not opting out but designating oneself as a Medicare provider nonpar In simple terms chiropractors must belong to Medicare to treat Medicare patients

7 Advance Beneficiary Notices (ABNs) should not be used as routine documents for patients to sign on their initial visit However they must be used when there is a genuine belief or reasonable expectation that Medicare will deny or not pay for the service on a specific visit or series of visits In other words a blanket ABN at the beginning of care is not sufficient or compliant

8 Medicare claims are not difficult they are simply different from health insurance claims When not done in Medicares format claims are denied

9 Medicare payment is what it is I will refrain from stating it is good While we all would want higher reimbursements (Who doesnt) the average fees for chiropractic services for manipulation are $30-$36 per visit This is far better reimbursement than under many of the managed care plans chiropractors routinely fight to join Furthermore that dollar amount is for spinal manipulation only other services may be billed to the patient or covered by a secondary insurance plan

spring 201415

trUst BUt verifyBy Dr R A Foxworth FICC MCS-P

I was speaking with a doctor recently who was venting her frustration about not knowing who to believe or trust as an authority when it comes to being in practice today She goes to different seminars because she wants to improve herself personally and professionally She also wants to improve her practice by learning more about her productivity effectiveness documentation compliance and billing She shared that she doesnt simply attend the CEU required hours for her license she puts in seminar hours to improve her practice her clinical skills her compliance and her business insight

Her problem The conflicting information she receives from various experts at each seminar How she asked can they all be right if they all say different things As a result of her experience she wanted to know why a Discount Medical Plan Organization (DMPO) like ChiroHealthUSA was of value in todayrsquos practices Why she asked is this even necessary What are my resources

I passed her third-degree with flying colors by the way

I could appreciate her position because I am a bit of a skeptic myself In fact thats how all this started for me I was a chiropractor in practice just like you trying to maximize my insurance payments so I wasnt leaving money on the table while still working to come up with a way my uninsured patients could afford those fees

Because of my activity within my state (as a governor-appointed health expert as an active participant in my State Chiropractic Association and the state representative for the American Chiropractic Association) I knew there were rules to follow to avoid compliance issues when creating our fee schedule I did my research and initially started a Discount Medical Plan Organization (DMPO) for my state alone I knew this would legally protect my practice and my colleagues and that at the time was my only goal

And as skeptic I wouldnrsquot even take my own word for it when it came to believing that a Discount Medical Plan Organization (DMPO) was the simplest way to keep my fee schedules compliant legal and safe Thatrsquos why I became a Certified Medical Compliance Specialist (MCS-P) so skeptics like me could get a breath and feel at ease As an MCS-P Irsquom quite simply held to a higher standard I have to be able to quote chapter and verse about why any possible fee or activity is or isnrsquot compliant

We know therersquos a plethora of inaccurate information that gets disseminated in our profession Im sad to say that I had to agree with my frustrated colleague when she was venting about all the conflicting advice she was receiving Thatrsquos why ChiroHealthUSA has relationships with many MCS-Ps to help get accurate reliable information out there Many of the brightest minds in our profession agree with and recommend ChiroHealthUSA to their chiropractic colleagues

Looking back when I set up my first DMPO within my state I can see how shortsighted I was I now know that taking ChiroHealthUSA to a national audience to protect all chiropractic practices in the country was the vision I shouldve had at the start Im glad I had an encounter with one of my fellow MCS-Ps who gave me this bigger vision

Learn more about how ChiroHealthUSA can help your practice be more compliant You can attend a free webinar this Tuesday April 1 Register at wwwChiroHealthUSAcom today to find out more

Dr Foxworth is a certified Medical Compliance Specialist and President of ChirohealthUSA A practicing Chiropractor he remains ldquoin the trenchesrdquo facing challenges with billing coding documentation and compliance he has served as president of the Mississippi Chiropractic Association former Staff Chiropractor at

the gv Sonny Montgomery vA Medical Center and is a Fellow of the International College of Chiropractic you can contact Dr Foxworth at 1 (888) 719-9990 infochirohealthusacom or visit the ChirohealthUSA website at wwwchirohealthusacom join us for a free webinar that will give you all the details about how a DMPO can help you practice with more peace of mind go to wwwchirohealthusacom to register today

spring 201416

Were already there ndash ChirOPraCtiC and PUBliC health hand-in-handBy Caitlin Lukacs from the March 2014 issue of ACA news

Public health is a popular buzz phrase in the healthcare arena but what exactly is it and how does chiropractic fit into it ldquoPublic health describes the overall wellbeing of the populacerdquo explains Richard Bruns DC past chairman of the American Chiropractic Associationrsquos (ACA) Wellness and Health Promotion Committee and ACA chairman of the Board of Governors ldquoAll public health issues have future implications for individuals as well as the publicrdquo

Public health encompasses habits and social norms such as smoking alcohol consumption obesity and the use of seatbelts as well as environmental issues such as clean water air quality and how livestock and agricultural practices affect the environment adds Will Evans DC PhD MCHES provost of the University of Western States Public health also includes health education and health promotion

ldquoPublic health and chiropractic go hand-in-handrdquo explains Karen Konarski-Hart DC DABCO FACO vice president of ACArsquos Council of Delegates and chairman of the American Public Health Association (APHA)Wellness and Health Promotion Committee ldquoDCs donrsquot practice in a vacuum they are interested in all aspects of a patientrsquos life that affect his or her health and wellbeing as well as how that person interacts in the healthcare community at largerdquo

Whether they identify it as public health or not all chiropractic physicians address public health issues when dealing with their patients For example when a new patient comes into your office you begin with a detailed history and an initial examination that includes not only taking vital signs but discussing tobacco and alcohol use and other behaviors that affect that patientrsquos health explains Dr Evans ldquoThis allows you to create an individual health-risk assessment based on his or her environment family history lifestyle etc and address public health issues such as tobacco use at the same timerdquo he says

BROACHING THE SUBjECTIt can sometimes be difficult to initiate conversations with patients about issues such as smoking or weight loss ldquoThe best place to address such topics is in your initial report of findings to the patientrdquo suggests Dr Evans ldquoYoursquove examined the patient and determined the cause of the pain or complaint that brought him or her into your office in the first place and now yoursquove got an opportunity to say lsquoI see some lifestyle-related issues that could be contributing to your pain or that could lead to other complaints down the roadrsquordquo

Yoursquore in a position to identify potential problems for your

patients says Dr Konarski-Hart ldquoThey may be setting themselves up for diabetes or cardiovascular disease or maybe they arenrsquot getting enough exercise mdash all of these things should be discussed as part of good primary carerdquo

You never want to force patients to make changes so yoursquoll need to assess their openness to addressing lifestyle changes first Simply ask them if theyrsquod be willing to discuss a healthier weight for example If they are you can let them know that you have multiple resources and partners in place to help them move forward

Dr Evans determines his patientsrsquo willingness to make lifestyle modifications by using the Stages of Change a common model of health behavior change The Stages of Change are

Pre-contemplator stage ndash Patient has no intention of making any changes in the next six months

Contemplator stage ndash Patient is considering a change within the next six months

Preparation stage ndash Patient has decided on a change and is preparing to take some kind of action

Action stage ndash Patient has begun implementing the change

Maintenance stage ndash Patient has made a change and is now working to maintain it

Take the example of an overweight patient Because the average weight of an individual in the United States has increased over the past few years some people who are overweight or borderline overweight donrsquot even realize it says Dr Evans Broach the subject gently and suggest a few small goals such as parking farther away from the office or shopping center or wearing a pedometer and working to increase the number of steps taken in a day You could also teach that patient how to read food labels and discuss healthier meal options Itrsquos about identifying the risk communicating the risk determining where your patient falls in the Stages of Change and then prescribing appropriate modifications explains Dr Evans ldquoAnd donrsquot forget to follow up with that patient at his or her next appointment Itrsquos important that he or she doesnrsquot lose confidence in your recommendations or in you as a healthcare providerrdquo he adds

GET INvOLvEDIn addition to discussions with patients in the treatment

Were Already There ndash Chiropractic and Public health hand-in-hand(contd on page 17)

spring 201417

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 16)

room there are many ways to incorporate public health into your practice One of the easiest ways to get involved is to participate in an observance that already exists such as the APHArsquos Public Health Week held the first week of every April (wwwaphaorgprogramshealthweek) or ACArsquos National Chiropractic Health Month (NCHM) celebrated every October These organizations come up with a new theme each year and gather all of the resources you need to participate ldquoIt takes the thinking and planning aspect off of the individual doctorrdquo says Dr Konarski-Hart ldquoAll you need to do is follow the instructions laid out by the parent organizationrdquo Additionally when you throw your hat into the ring on a larger issue or observance you know that the public health community is focused on that issue at that time so you can reach out to your county or state health department or other local healthcare associations and join in their efforts which will help you to build mutually beneficial long-term relationships says Dr Konarski-Hart ldquoMany state groups are underfunded and understaffed and they welcome participation particularly from physiciansrdquo she notes

DCs can also create their own observances ldquoACA offers webinars teleseminars and patient handouts on a variety of public health issuesmdashperuse the offerings and pick a topic to focus on for a week or a monthrdquo says Dr Konarski-Hart She suggests having your clinic sponsor a wellness competition or challenge You could partner with a local exercise facility or health foods store as well as a school or senior center and make it a community event You could also organize an eat well exercise club in which members meet for a walk or bike ride and then share a healthy breakfast or lunch Your practice could sponsor a poster contest at a local school or community center ldquoHave the kids create posters focused on healthy lifestyle choices and then give out prizes of fun healthy exercise such as a day of horseback riding or ice skatingrdquo Dr Konarski-Hart says Additionally your practice could sponsor a marathon participant or a local amateur sports team to show that you support healthy activities and active lifestyles

Similarly be informed about the public health issues in your community Maybe you live in an area with a high population of smokers or perhaps there have been numerous injuries due to not wearing a seatbelt in recent years Do some background research on these topics and then get involved whether that means simply providing patient handouts in your waiting room giving a community health talk participating in health fairs or working with your local health department (and other relevant organizations) to pass pertinent legislation

Look for organizations in your area that are already offering public health resources or programs and set up

a partnership with them For example for the topic of overweightobesity you could offer your clinic as a weigh-in site for participants in Weight Watchers programs suggests Dr Evans or partner with a local gym to give discounts to chiropractic patients Dr Bruns recommends getting involved with the school lunch program to advocate for healthy options for students For smoking cessation work with the American Lung Association to put on an informational presentation at a local hospital or sponsor a 5k or a stair run to raise awareness (and funds) for lung cancer research For drug addiction set up a referral network with psychologists or addiction centers and either offer acupuncture in your office or refer out to an acupuncturist as it has been shown to help patients through the detox process You can also use your knowledge of nutrition and exercise to facilitate the journey through detox says Dr Bruns

Additionally you should make a point to support these other organizations when they host local events (even if yoursquore not an official partner) or reach out for financial support ldquoI always participate in the American Cancer Societyrsquos golf tournament and I display their materials in my office as wellrdquo says Dr Bruns He also participates in the fundraising efforts of the American Heart Association and the American Lung Association on a regular basis ldquoItrsquos good for your patients and your community to see that you care about and support other healthcare organizationsrdquo he says

Another option for public health involvement is to join the APHArsquos Chiropractic Health Care Section Yoursquoll be informed on public health happenings have access to the latest information and research see what DCs are doing nationally and in other states on particular issues and even have the chance to give input and be involved in decision-making

CONCUSSIONConcussion prevention and treatment is one public health topic that is relevant to every patient population in every region of the United States ldquoWersquore seeing more concussions lately due in part to the number of children participating in contact sports the excessive training involved in these sports and the fact that most people arenrsquot aware of the symptoms and long-term risks of concussionsrdquo says Dr Konarski-Hart Helmets donrsquot actually provide protection against concussions either ldquoThe padding will protect the skull from fracture but because your brain is loose inside your skull it is not protected from impact or traumardquo she explains And with todayrsquos cultural emphasis on pushing through the pain wersquore starting to see more and more professional athletes coming forward with serious emotional psychological and neurological issues that are linked to multiple concussions in their past

spring 201418

As an EMT herself Dr Konarski-Hart attended an EMT convention in the summer of 2013 and heard a presentation from the Childrenrsquos Hospital of Arkansas on injury prevention After speaking with the presenters she discovered that they were having trouble getting buy-in from the allopathic community and she offered her services as a DC Since then Dr Konarski-Hart and the Arkansas Chiropractic Physicians Association (ACPA) have been working with the childrenrsquos hospital on various statewide projects dealing with all aspects of injury prevention One such program focuses on concussions

ldquoThrough this partnership we learned that Arkansas has not finalized its concussion protocols yet and we were able to get someone from our ACPA legislative team involved in that process to ensure chiropracticrsquos inclusion as an involved professionrdquo says Dr Konarski-Hart

Because of DCsrsquo knowledge and training itrsquos important for them to get involved with the concussion issue says Dr Bruns ldquoKnowing what we know about concussions we are doing a tremendous service to athletes and their families by completing pre-participation physicals and screenings and watching for signs and symptoms during participation as wellrdquo he says And itrsquos not just athletes who are suffering from concussions mdash itrsquos children who fall off a bike or a swing set or an older adult who slips on the ice

Itrsquos crucial for DCs to help disseminate information about concussions Whether you see concussion symptoms in a patient in your office or work with local sports teams you have the knowledge to serve as a local expert on the topic DCs can assess injured parties work with school administrators to create concussion protocols and push for legislation on standard concussion treatment says Dr Bruns

Kids parents coaches trainers and doctors all need to be aware of concussions and the potential risks involved with sustaining one or more ldquoItrsquos a matter of understanding the potential risks before making a decision to play in a game or to have a player sit out a game for examplerdquo says Dr Konarski-Hart

WErsquoRE ALREADY THEREAs DCs we focus on the biomechanics structure and function of the human body and we have a unique approach in that we look at the whole person in terms of nutrition flexibility blood flow and muscle and nervous tissue function says Dr Bruns ldquoThe chiropractic profession recognizes the importance of healthful eating nutritional support avoiding the bad habits of smoking and drinking alcohol and has been counseling patients on healthy lifestyles since long before it was fashionablerdquo

According to Dr Konarski-Hart simply choosing to be a doctor of chiropractic means that yoursquore involved in public health on some level because your goal is to make your patient healthier and therefore make your community healthier In other words DCs are already an integral part of public health

With the new health care emphasis on wellness and prevention many healthcare providers legislators insurance companies and government policy developers are focusing on how to offer access to these services especially in medically underserved rural areas or small towns Chiropractic representatives need to be part of those discussions to point out that in many of these communities DCs are already there providing that assessment counseling and care This representation is one of the functions of the ACA and state chiropractic associations and why your membership and involvement with these organizations is so critical says Dr Konarski-Hart

aCa neWs extraCERTIFIED CHIROPRACTIC WELLNESS SPECIALIST PROGRAMIn 2011 ACA began a partnership with the National Wellness Institute (NWI) a well respected organization recognized both inside and outside the chiropractic profession to offer a wellness certification program for DCs The 40-hour program will enable students to integrate principles of wellness coaching health promotion and disease prevention to their current practices Once the program is completed DCs will become Certified Chiropractic Wellness Specialists ldquoThe program was developed and launched by Dr Evans Cheryl Hawk DC PhD CHES and Mike Perko PhDmdashdoctors who are at the forefront of health promotion illness prevention and wellnessrdquo says Dr Bruns Originally the certification consisted of four different modules and DCs had to travel to select cities to participate in the weekend seminars However ACA quickly realized that it was difficult for DCs to get to these courses and decided to turn the program into an online certification NWI has taken the lead on this conversion

ACA RESOURCES Bookmark wwwacatoday orgpublichealth on your computer for quick and easy access to patient handouts references and research for presentations a calendar of national public health observances and other resources that have all been vetted by the ACA APHAWellness and Health Promotion Committee for use in your office Published in the March 2014 ACA news

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 17)

spring 201419

ASSOCIATES WANTED

Associate Wanted Starting base annual salary range is 50-60K plus additional monthly $500-2K in productivity compensation Benefits include MalpracticeMedical insurance CE Our care model uses the latest in Chiropractic Massage Physical Therapy Acupuncture and Nutritional medicine services South Bend is home to Notre Dame and a short drive to Chicago and Lake Michigan This is a good place to raise a family with good schools and a low cost of living Sendfax a letter of interest and resume to apintodcyahoocom or fax (574) 254-1652 Posted 11514

Chicagoland Associate Doctor Needed Busy office with multiple long term associates Family practice Thirty minutes to downtown Chicago Full timepart time paid vacation $26hour starting pay with periodic raises Proficient in the Thompson leg-check technique We are looking for someone who is ready and willing to blend with a very upbeat fun and positive staff Interested applicants should email their resume to infotrimbolichironet or fax to (219) 836-2344 wwwtrimbolichironet Posted 12914

Opportunity for Doctor to grow own practice with buyout of 40 year family practice in 2-5 years Located in North Central Indiana with easy access to Indianapolis and Chicago Wonderful area to raise a family good schools low crime slower pace of life Contact pdyer4hotmailcom Posted 2614

Associate Needed We are currently searching for an associate doctor to help us at the Osmon Chiropractic Center in Bloomington IN This would be a tremendous opportunity for a new graduate or anyone considering a possible change of location You will be working in a beautiful 2500 square foot state of the art clinic with 1 other doctor and a professional staff of 8 to assist you There will be only a small amount of practice building activities on your part because we will provide you with a practice representative who will do that for you You will enjoy the security of a known income and practice without the stress of practice overhead and staff management All you need to do is learn our system of patient managementmdashthe same system we all use in the office and work together as a team to get and keep our community under chiropractic care It is an exciting place to practice Send resume and cover letter to drosmonhotmailcom and please feel free to visit our website at wwwDrOsmoncom Posted 3314

EQUIPMENT FOR SALE

For SalemdashFutura 3000GT automatic X-ray film processor two 8x10 cassettes two 7x14 cassettes two 14x17 cassettes Xray film cabinet new film xray I D Imprinter amp infra red light for sale $80000 Mikephelps55attnet or call (765) 345-0224 Posted 92413

PRACTICES FOR SALE

Free North Manchester practice Collected gt$300000 in 2012 Drs Kelsey giving practice records and X-ray to DC who buys their building 302 W MainHwy 114 Appraised for $165000 last monthmdashyou can buy it for $145000 Closing office on 103013 so you must act soon for this opportunity (260) 568-4419 or office 260-982-4646 Posted 100213

DCS WANTED

Kauffman Chiropractic PC is looking for a full-time position to be filled October 2013 Successful 25+ years established company with physical therapy massage therapy and rehabilitation Enthusiastic ambitious doctor who is willing to learn is a must Must be proficient in Diversified Thompson and Distraction techniques Nice salary is offered Email resume to chirodancomcastnet Posted 82713

Fantastic opportunity for energetic success-oriented doctor excited to grow with us professionally Comes with ownership possibilities Learn to share chiropractic in your community Train in an established practice run on outstanding systems Great training and support for you with focus on exceptiional patient communication and care including chiropractic rehab and massage Send CV or resume to clarksvillespineandrehabinsightbbcom Contact Joseph Rogers Lousville Kentucky (812) 282-7500 Posted 1714

Career Opportunity ndash URGENT ASSOCIATE WANTED ndash PEORIA IL Work in a state of the art wellness center with upbeat and professional staff ready to support you Utilize chiropractic clinical nutrition and rehabilitation to manage a wide range of conditions Doctor must be bright outgoing enthusiastic and must have excellent clinical skills This is an opportunity you dont want to miss Designed for someone looking for a career not simply another job Extensive training and great income potential Invest in your future Send a resume to lfulleralignlifecom Posted 12414

Part Time DC needed for Gary IN office for DOT Certified Medical Exams and some Chiropractic beginning March 15 2014 NO STRESS NO BILLING No Overhead ndash No Headaches Easy hours (8 am - 5 pm - 2 dayswk) Continue in your own practice and make extra cash in our office or just work part-time for us Will tutor you and pay for your DOT Certification - work 2 daysweek ($25000) Will tutor you and pay for your DOT Certification ($50hr = $25000year for 2 daysweek) Contact Lynn Biese -Carroll DC at lbiesewirrcom or call (262) 515-2168 Posted 2614

Associate Needed ndash Bloomington Indiana Expanding practice in Bloomington Indiana is looking for full-time position to be filled Enthusiastic ambitious doctor is a must Must be proficient in Diversified and Low Force techniques rehab and physical therapy Practice is a very strong stable consistent referral based practice Salary and profit share of clinic are offered We will train and mentor in technique and all areas of patient compliance and success Send resume to Dr Fox 1710 West Third St Bloomington Indiana 47404 or email to jbfprodigynet Posted 21814

vACATION DOCTORS

Mobile Moje Chiropractic Dr Moje is available for vacation relief and office coverage Licensed in IN OH MI WI MN amp PA Specializing in maternity leave injuries and vacations Call or email for CV availability rates references and further information Contact Dr Moje at stephanmojegmailcom or (218) 205-6141 Posted 81613

indiana state ChirOPraCtiC assOCiatiOn Classifieds

Page 12: ISCA Spring Report 2014

spring 201412

MediCaidMediCare UPdateBy Michael Phelps DC Secretary ISCA Board of Directors MedicaidMedicare Advising Committee

2013 saw yet another attempt to take chiropractic care out of Medicaid The ISCA amp its Legislative Committee was successful in stopping this attack on the chiropractic profession Thanks to the hard work of the ISCA Indiana remains one of the limited states where Medicaid covers all chiropractic services under our states scope of practice

January 1 2014 also saw the reinstatement of the 5 reduction in imbursement that we accepted several years ago

The ISCA is able to keep chiropractors in the Medicaid Program as well as other insurance as a paid provider through the hard work and dedication of volunteers If you are able to donate some time there are a number of committees and positions that need to be filled by doctors that want to make a difference If you know of DCs that are not members of the ISCA tell them about the good work we do for the profession and that we need all Doctors of Chiropractic in this state to be members Remember if youre not part of the solution youre part of the problem

As you know with the changes in health care coverage there are changes with respect to Medicare All chiropractors should be reporting PQRS for incentive payment eligibility Those who report satisfactorily for the 2013 amp 2014 program years may avoid the 2015 PQRS payment adjustment Additional information on how to avoid future PQRS payment adjustments can be found through supporting documentation available on the CMS website at httpwwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-InstructionsPQRS Chiropractors are fortunate as they only have to report on three measures

Measure 131 - Pain Assessment and Follow upMeasure 182 - Functional Outcome AssessmentMeasure 317 - Preventive Care and Screening (Screening for High Blood Pressure)

January 1 2014 saw an increase of approximately 9 in the reimbursement for chiropractic adjustments (98940 98941 amp 98942) This increase was due to a reassessment of the RVUs for CMT

The latest CERT report saw a decrease in the percentage of errors for chiropractors Chiropractic physicians need to continue to improve their documentation and coding of services in order to maintain this downward decline of errors

The Wisconsin Physicians Service (WPS) periodically analyzes provider coding patterns to identify deviations within a peer group For the J8 (Indiana and Michigan) Jurisdiction there has been a significantly higher than normal usage of the Code 98942 (CMT of five regions of the spine) There are approximately 35 DCs in the state of Michigan that are on the radar I am happy to report that there are no chiropractors in the state of Indiana under review

All that needs to happen for Chiropractic to fail is for good doctors to do nothing If you know of a chiropractor that is not a member of the ISCA urge them to join

MedicaidMedicare Update (contd on page 13)

spring 201413

MedicaidMedicare Update (contd from page 12)

SGR BILL PASSES HOUSE GOES TO SENATE FOR CONSIDERATIONWe learned that the United States House of Representatives passed House Bill 4302 The bill proposes to extend Medicarersquos Sustainable Growth Rate (SGR) current rate to April 15 2015 and would delay other Medicare deadlines The bill as currently drafted would postpone ICD-10-CM implementation until after October 1 2015 and restrict the Centers for Medicare amp Medicaid Services (CMS) from acting without congressional approval The bill now goes to the US Senate for debate and vote If it passes the Senate it would then be sent to President Obamarsquos desk to be signed or vetoed The ISCA will continue to monitor this situation and recommends preparing for ICD-10 implementation

PLEASE ALSO MARK YOUR CALENDAR WITH THESE DATES Medicare Secondary Payer (MSP) Seminar April 17 2014 from 100 pm to 400 pm Hilton Garden Inn Fort Wayne 8615 US Hwy 24 West Fort Wayne IN Click here to register

There is a Chiropractic Medicare Seminar on April 26 2014 in Mishawaka IN Click here for more information

HELPFUL LINKSNeed help in the transition to ICD-10 Go to the Road to 10 website by clicking here This site is primarily for the MD but has general information that pertains to all health care specialties

Stay up-to-date on changes in Medicare at the WPS Medicare website by clicking here This website is for all providers but sometimes offers information specific to chiropractors

INFORMATION REGARDING THE HOLDING OF APRIL 2014 CLAIMS FOR SERvICES PAID UNDER THE 2014 MEDICARE PHYSICIAN FEE SCHEDULE The 2014 Medicare Physician Fee Schedule (MPFS) final rule stipulated a negative update to the MPFS that was to be effective January 1 2014 That reduction was averted for three months with the passage of the Pathway for SGR Reform Act of 2013 which provided for a 05 percent update for services paid under the MPFS through March 31 2014 CMS is hopeful that there will be congressional action to prevent the negative update from taking effect on April 1 2014 CMS has instructed the Medicare Administrative Contractors to hold claims containing services paid under the MPFS for the first 10 business days of April (ie through April 14 2014) This hold would only affect MPFS claims with dates of service of April 1 2014 and later The hold should have minimal impact on provider cash flow because under current law clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt All claims for services delivered on or before March 31 2014 will be processed and paid under normal procedures regardless of any Congressional actions

spring 201414

insUranCe COMMittee UPdateBy Peter Furno DC ISCA Board of Directors District 4 Director and Insurance Committee Chairman

During 2013 the ISCA Insurance Committee addressed many issues and questions from its members with regard to insurance legalities of advertising and proposed associations with third party vendors offering incentives contrary to our practice statues Doctors with definitively legal questions were referred to their legal counsel for liability reasons Most questions directed to the insurance committee are answered within 24 hours

Because the ISCA continues to receive anecdotal complaints from the field claiming insurer reimbursement discrimination and other transgressions the insurance committee as a part of the ISCArsquos proactive efforts to address this problem has developed a survey to obtain information on various insurance problems or concerns impacting chiropractors in the field The ISCA is aggressively attempting to determine problems that are affecting large numbers of doctors and which may be indicating the development of a trend requiring attention by the ISCA and then the IDOI However although it is the intent to meet with the IDOI once the survey information is correlated so that the contentions of our doctors may be addressed officially without firm evidence of wrong doing by the insurance industry the ISCA cannot go forward Consequently it is imperative that all members who are having trouble submit their complaints to the ISCA together with supportive documentation so that this issue may be addressed

Now that the PPACA is law and will require ldquoevidence-basedrdquo treatment procedures to be utilized before reimbursements are made the intent of the Insurance Committee to make at least one presentation to decision-makers of an employer group regarding the cost-effectiveness and efficacy of chiropractic in the management of work related uncomplicated spine injuries in comparison to traditional medical care Heretofore the majority of employers had no idea of the cost-effectiveness of chiropractic care when compared to traditional medicine and simply allowed their work nurses and medical providers to direct care ndash which the research shows is one of the main reasons costs are so high

The Insurance Committee in an attempt to keep the ISCA membership updated will attempt to address at least two insurance queries weekly and present answers to the membership via the ISCA monthly eNews and Newsletter

Insurance Pearl Medicare and Chiropractic Billing Misconceptions It is worthwhile to address a few of the prevailing misconceptions Here are the nine truisms regarding Medicare and chiropractic

1 There is not a 12-visit limit to Medicare for chiropractic services The limits of care are based on the specific medical necessity of the primary subluxation and its secondary neuromusculoskeletal diagnosis

2 Medicare will pay for both acute and chronic conditions as long as there is documentation or expectation of functional improvement

3 Nonparticipating (nonpar) providers are required to bill for services All covered services under chiropractic (spinal manipulation) must be billed to Medicare

4 Nonpar providers are audited just as par providers are There is no protection from a Medicare audit by being nonpar

5 Nonpar providers must document services in the same manner as any provider of Medicare services Being par or nonpar is irrelevant in reference to documentation of chiropractic services

6 Chiropractors may not opt out of Medicare This is simply not an option for doctors of chiropractic Being nonpar is not opting out but designating oneself as a Medicare provider nonpar In simple terms chiropractors must belong to Medicare to treat Medicare patients

7 Advance Beneficiary Notices (ABNs) should not be used as routine documents for patients to sign on their initial visit However they must be used when there is a genuine belief or reasonable expectation that Medicare will deny or not pay for the service on a specific visit or series of visits In other words a blanket ABN at the beginning of care is not sufficient or compliant

8 Medicare claims are not difficult they are simply different from health insurance claims When not done in Medicares format claims are denied

9 Medicare payment is what it is I will refrain from stating it is good While we all would want higher reimbursements (Who doesnt) the average fees for chiropractic services for manipulation are $30-$36 per visit This is far better reimbursement than under many of the managed care plans chiropractors routinely fight to join Furthermore that dollar amount is for spinal manipulation only other services may be billed to the patient or covered by a secondary insurance plan

spring 201415

trUst BUt verifyBy Dr R A Foxworth FICC MCS-P

I was speaking with a doctor recently who was venting her frustration about not knowing who to believe or trust as an authority when it comes to being in practice today She goes to different seminars because she wants to improve herself personally and professionally She also wants to improve her practice by learning more about her productivity effectiveness documentation compliance and billing She shared that she doesnt simply attend the CEU required hours for her license she puts in seminar hours to improve her practice her clinical skills her compliance and her business insight

Her problem The conflicting information she receives from various experts at each seminar How she asked can they all be right if they all say different things As a result of her experience she wanted to know why a Discount Medical Plan Organization (DMPO) like ChiroHealthUSA was of value in todayrsquos practices Why she asked is this even necessary What are my resources

I passed her third-degree with flying colors by the way

I could appreciate her position because I am a bit of a skeptic myself In fact thats how all this started for me I was a chiropractor in practice just like you trying to maximize my insurance payments so I wasnt leaving money on the table while still working to come up with a way my uninsured patients could afford those fees

Because of my activity within my state (as a governor-appointed health expert as an active participant in my State Chiropractic Association and the state representative for the American Chiropractic Association) I knew there were rules to follow to avoid compliance issues when creating our fee schedule I did my research and initially started a Discount Medical Plan Organization (DMPO) for my state alone I knew this would legally protect my practice and my colleagues and that at the time was my only goal

And as skeptic I wouldnrsquot even take my own word for it when it came to believing that a Discount Medical Plan Organization (DMPO) was the simplest way to keep my fee schedules compliant legal and safe Thatrsquos why I became a Certified Medical Compliance Specialist (MCS-P) so skeptics like me could get a breath and feel at ease As an MCS-P Irsquom quite simply held to a higher standard I have to be able to quote chapter and verse about why any possible fee or activity is or isnrsquot compliant

We know therersquos a plethora of inaccurate information that gets disseminated in our profession Im sad to say that I had to agree with my frustrated colleague when she was venting about all the conflicting advice she was receiving Thatrsquos why ChiroHealthUSA has relationships with many MCS-Ps to help get accurate reliable information out there Many of the brightest minds in our profession agree with and recommend ChiroHealthUSA to their chiropractic colleagues

Looking back when I set up my first DMPO within my state I can see how shortsighted I was I now know that taking ChiroHealthUSA to a national audience to protect all chiropractic practices in the country was the vision I shouldve had at the start Im glad I had an encounter with one of my fellow MCS-Ps who gave me this bigger vision

Learn more about how ChiroHealthUSA can help your practice be more compliant You can attend a free webinar this Tuesday April 1 Register at wwwChiroHealthUSAcom today to find out more

Dr Foxworth is a certified Medical Compliance Specialist and President of ChirohealthUSA A practicing Chiropractor he remains ldquoin the trenchesrdquo facing challenges with billing coding documentation and compliance he has served as president of the Mississippi Chiropractic Association former Staff Chiropractor at

the gv Sonny Montgomery vA Medical Center and is a Fellow of the International College of Chiropractic you can contact Dr Foxworth at 1 (888) 719-9990 infochirohealthusacom or visit the ChirohealthUSA website at wwwchirohealthusacom join us for a free webinar that will give you all the details about how a DMPO can help you practice with more peace of mind go to wwwchirohealthusacom to register today

spring 201416

Were already there ndash ChirOPraCtiC and PUBliC health hand-in-handBy Caitlin Lukacs from the March 2014 issue of ACA news

Public health is a popular buzz phrase in the healthcare arena but what exactly is it and how does chiropractic fit into it ldquoPublic health describes the overall wellbeing of the populacerdquo explains Richard Bruns DC past chairman of the American Chiropractic Associationrsquos (ACA) Wellness and Health Promotion Committee and ACA chairman of the Board of Governors ldquoAll public health issues have future implications for individuals as well as the publicrdquo

Public health encompasses habits and social norms such as smoking alcohol consumption obesity and the use of seatbelts as well as environmental issues such as clean water air quality and how livestock and agricultural practices affect the environment adds Will Evans DC PhD MCHES provost of the University of Western States Public health also includes health education and health promotion

ldquoPublic health and chiropractic go hand-in-handrdquo explains Karen Konarski-Hart DC DABCO FACO vice president of ACArsquos Council of Delegates and chairman of the American Public Health Association (APHA)Wellness and Health Promotion Committee ldquoDCs donrsquot practice in a vacuum they are interested in all aspects of a patientrsquos life that affect his or her health and wellbeing as well as how that person interacts in the healthcare community at largerdquo

Whether they identify it as public health or not all chiropractic physicians address public health issues when dealing with their patients For example when a new patient comes into your office you begin with a detailed history and an initial examination that includes not only taking vital signs but discussing tobacco and alcohol use and other behaviors that affect that patientrsquos health explains Dr Evans ldquoThis allows you to create an individual health-risk assessment based on his or her environment family history lifestyle etc and address public health issues such as tobacco use at the same timerdquo he says

BROACHING THE SUBjECTIt can sometimes be difficult to initiate conversations with patients about issues such as smoking or weight loss ldquoThe best place to address such topics is in your initial report of findings to the patientrdquo suggests Dr Evans ldquoYoursquove examined the patient and determined the cause of the pain or complaint that brought him or her into your office in the first place and now yoursquove got an opportunity to say lsquoI see some lifestyle-related issues that could be contributing to your pain or that could lead to other complaints down the roadrsquordquo

Yoursquore in a position to identify potential problems for your

patients says Dr Konarski-Hart ldquoThey may be setting themselves up for diabetes or cardiovascular disease or maybe they arenrsquot getting enough exercise mdash all of these things should be discussed as part of good primary carerdquo

You never want to force patients to make changes so yoursquoll need to assess their openness to addressing lifestyle changes first Simply ask them if theyrsquod be willing to discuss a healthier weight for example If they are you can let them know that you have multiple resources and partners in place to help them move forward

Dr Evans determines his patientsrsquo willingness to make lifestyle modifications by using the Stages of Change a common model of health behavior change The Stages of Change are

Pre-contemplator stage ndash Patient has no intention of making any changes in the next six months

Contemplator stage ndash Patient is considering a change within the next six months

Preparation stage ndash Patient has decided on a change and is preparing to take some kind of action

Action stage ndash Patient has begun implementing the change

Maintenance stage ndash Patient has made a change and is now working to maintain it

Take the example of an overweight patient Because the average weight of an individual in the United States has increased over the past few years some people who are overweight or borderline overweight donrsquot even realize it says Dr Evans Broach the subject gently and suggest a few small goals such as parking farther away from the office or shopping center or wearing a pedometer and working to increase the number of steps taken in a day You could also teach that patient how to read food labels and discuss healthier meal options Itrsquos about identifying the risk communicating the risk determining where your patient falls in the Stages of Change and then prescribing appropriate modifications explains Dr Evans ldquoAnd donrsquot forget to follow up with that patient at his or her next appointment Itrsquos important that he or she doesnrsquot lose confidence in your recommendations or in you as a healthcare providerrdquo he adds

GET INvOLvEDIn addition to discussions with patients in the treatment

Were Already There ndash Chiropractic and Public health hand-in-hand(contd on page 17)

spring 201417

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 16)

room there are many ways to incorporate public health into your practice One of the easiest ways to get involved is to participate in an observance that already exists such as the APHArsquos Public Health Week held the first week of every April (wwwaphaorgprogramshealthweek) or ACArsquos National Chiropractic Health Month (NCHM) celebrated every October These organizations come up with a new theme each year and gather all of the resources you need to participate ldquoIt takes the thinking and planning aspect off of the individual doctorrdquo says Dr Konarski-Hart ldquoAll you need to do is follow the instructions laid out by the parent organizationrdquo Additionally when you throw your hat into the ring on a larger issue or observance you know that the public health community is focused on that issue at that time so you can reach out to your county or state health department or other local healthcare associations and join in their efforts which will help you to build mutually beneficial long-term relationships says Dr Konarski-Hart ldquoMany state groups are underfunded and understaffed and they welcome participation particularly from physiciansrdquo she notes

DCs can also create their own observances ldquoACA offers webinars teleseminars and patient handouts on a variety of public health issuesmdashperuse the offerings and pick a topic to focus on for a week or a monthrdquo says Dr Konarski-Hart She suggests having your clinic sponsor a wellness competition or challenge You could partner with a local exercise facility or health foods store as well as a school or senior center and make it a community event You could also organize an eat well exercise club in which members meet for a walk or bike ride and then share a healthy breakfast or lunch Your practice could sponsor a poster contest at a local school or community center ldquoHave the kids create posters focused on healthy lifestyle choices and then give out prizes of fun healthy exercise such as a day of horseback riding or ice skatingrdquo Dr Konarski-Hart says Additionally your practice could sponsor a marathon participant or a local amateur sports team to show that you support healthy activities and active lifestyles

Similarly be informed about the public health issues in your community Maybe you live in an area with a high population of smokers or perhaps there have been numerous injuries due to not wearing a seatbelt in recent years Do some background research on these topics and then get involved whether that means simply providing patient handouts in your waiting room giving a community health talk participating in health fairs or working with your local health department (and other relevant organizations) to pass pertinent legislation

Look for organizations in your area that are already offering public health resources or programs and set up

a partnership with them For example for the topic of overweightobesity you could offer your clinic as a weigh-in site for participants in Weight Watchers programs suggests Dr Evans or partner with a local gym to give discounts to chiropractic patients Dr Bruns recommends getting involved with the school lunch program to advocate for healthy options for students For smoking cessation work with the American Lung Association to put on an informational presentation at a local hospital or sponsor a 5k or a stair run to raise awareness (and funds) for lung cancer research For drug addiction set up a referral network with psychologists or addiction centers and either offer acupuncture in your office or refer out to an acupuncturist as it has been shown to help patients through the detox process You can also use your knowledge of nutrition and exercise to facilitate the journey through detox says Dr Bruns

Additionally you should make a point to support these other organizations when they host local events (even if yoursquore not an official partner) or reach out for financial support ldquoI always participate in the American Cancer Societyrsquos golf tournament and I display their materials in my office as wellrdquo says Dr Bruns He also participates in the fundraising efforts of the American Heart Association and the American Lung Association on a regular basis ldquoItrsquos good for your patients and your community to see that you care about and support other healthcare organizationsrdquo he says

Another option for public health involvement is to join the APHArsquos Chiropractic Health Care Section Yoursquoll be informed on public health happenings have access to the latest information and research see what DCs are doing nationally and in other states on particular issues and even have the chance to give input and be involved in decision-making

CONCUSSIONConcussion prevention and treatment is one public health topic that is relevant to every patient population in every region of the United States ldquoWersquore seeing more concussions lately due in part to the number of children participating in contact sports the excessive training involved in these sports and the fact that most people arenrsquot aware of the symptoms and long-term risks of concussionsrdquo says Dr Konarski-Hart Helmets donrsquot actually provide protection against concussions either ldquoThe padding will protect the skull from fracture but because your brain is loose inside your skull it is not protected from impact or traumardquo she explains And with todayrsquos cultural emphasis on pushing through the pain wersquore starting to see more and more professional athletes coming forward with serious emotional psychological and neurological issues that are linked to multiple concussions in their past

spring 201418

As an EMT herself Dr Konarski-Hart attended an EMT convention in the summer of 2013 and heard a presentation from the Childrenrsquos Hospital of Arkansas on injury prevention After speaking with the presenters she discovered that they were having trouble getting buy-in from the allopathic community and she offered her services as a DC Since then Dr Konarski-Hart and the Arkansas Chiropractic Physicians Association (ACPA) have been working with the childrenrsquos hospital on various statewide projects dealing with all aspects of injury prevention One such program focuses on concussions

ldquoThrough this partnership we learned that Arkansas has not finalized its concussion protocols yet and we were able to get someone from our ACPA legislative team involved in that process to ensure chiropracticrsquos inclusion as an involved professionrdquo says Dr Konarski-Hart

Because of DCsrsquo knowledge and training itrsquos important for them to get involved with the concussion issue says Dr Bruns ldquoKnowing what we know about concussions we are doing a tremendous service to athletes and their families by completing pre-participation physicals and screenings and watching for signs and symptoms during participation as wellrdquo he says And itrsquos not just athletes who are suffering from concussions mdash itrsquos children who fall off a bike or a swing set or an older adult who slips on the ice

Itrsquos crucial for DCs to help disseminate information about concussions Whether you see concussion symptoms in a patient in your office or work with local sports teams you have the knowledge to serve as a local expert on the topic DCs can assess injured parties work with school administrators to create concussion protocols and push for legislation on standard concussion treatment says Dr Bruns

Kids parents coaches trainers and doctors all need to be aware of concussions and the potential risks involved with sustaining one or more ldquoItrsquos a matter of understanding the potential risks before making a decision to play in a game or to have a player sit out a game for examplerdquo says Dr Konarski-Hart

WErsquoRE ALREADY THEREAs DCs we focus on the biomechanics structure and function of the human body and we have a unique approach in that we look at the whole person in terms of nutrition flexibility blood flow and muscle and nervous tissue function says Dr Bruns ldquoThe chiropractic profession recognizes the importance of healthful eating nutritional support avoiding the bad habits of smoking and drinking alcohol and has been counseling patients on healthy lifestyles since long before it was fashionablerdquo

According to Dr Konarski-Hart simply choosing to be a doctor of chiropractic means that yoursquore involved in public health on some level because your goal is to make your patient healthier and therefore make your community healthier In other words DCs are already an integral part of public health

With the new health care emphasis on wellness and prevention many healthcare providers legislators insurance companies and government policy developers are focusing on how to offer access to these services especially in medically underserved rural areas or small towns Chiropractic representatives need to be part of those discussions to point out that in many of these communities DCs are already there providing that assessment counseling and care This representation is one of the functions of the ACA and state chiropractic associations and why your membership and involvement with these organizations is so critical says Dr Konarski-Hart

aCa neWs extraCERTIFIED CHIROPRACTIC WELLNESS SPECIALIST PROGRAMIn 2011 ACA began a partnership with the National Wellness Institute (NWI) a well respected organization recognized both inside and outside the chiropractic profession to offer a wellness certification program for DCs The 40-hour program will enable students to integrate principles of wellness coaching health promotion and disease prevention to their current practices Once the program is completed DCs will become Certified Chiropractic Wellness Specialists ldquoThe program was developed and launched by Dr Evans Cheryl Hawk DC PhD CHES and Mike Perko PhDmdashdoctors who are at the forefront of health promotion illness prevention and wellnessrdquo says Dr Bruns Originally the certification consisted of four different modules and DCs had to travel to select cities to participate in the weekend seminars However ACA quickly realized that it was difficult for DCs to get to these courses and decided to turn the program into an online certification NWI has taken the lead on this conversion

ACA RESOURCES Bookmark wwwacatoday orgpublichealth on your computer for quick and easy access to patient handouts references and research for presentations a calendar of national public health observances and other resources that have all been vetted by the ACA APHAWellness and Health Promotion Committee for use in your office Published in the March 2014 ACA news

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 17)

spring 201419

ASSOCIATES WANTED

Associate Wanted Starting base annual salary range is 50-60K plus additional monthly $500-2K in productivity compensation Benefits include MalpracticeMedical insurance CE Our care model uses the latest in Chiropractic Massage Physical Therapy Acupuncture and Nutritional medicine services South Bend is home to Notre Dame and a short drive to Chicago and Lake Michigan This is a good place to raise a family with good schools and a low cost of living Sendfax a letter of interest and resume to apintodcyahoocom or fax (574) 254-1652 Posted 11514

Chicagoland Associate Doctor Needed Busy office with multiple long term associates Family practice Thirty minutes to downtown Chicago Full timepart time paid vacation $26hour starting pay with periodic raises Proficient in the Thompson leg-check technique We are looking for someone who is ready and willing to blend with a very upbeat fun and positive staff Interested applicants should email their resume to infotrimbolichironet or fax to (219) 836-2344 wwwtrimbolichironet Posted 12914

Opportunity for Doctor to grow own practice with buyout of 40 year family practice in 2-5 years Located in North Central Indiana with easy access to Indianapolis and Chicago Wonderful area to raise a family good schools low crime slower pace of life Contact pdyer4hotmailcom Posted 2614

Associate Needed We are currently searching for an associate doctor to help us at the Osmon Chiropractic Center in Bloomington IN This would be a tremendous opportunity for a new graduate or anyone considering a possible change of location You will be working in a beautiful 2500 square foot state of the art clinic with 1 other doctor and a professional staff of 8 to assist you There will be only a small amount of practice building activities on your part because we will provide you with a practice representative who will do that for you You will enjoy the security of a known income and practice without the stress of practice overhead and staff management All you need to do is learn our system of patient managementmdashthe same system we all use in the office and work together as a team to get and keep our community under chiropractic care It is an exciting place to practice Send resume and cover letter to drosmonhotmailcom and please feel free to visit our website at wwwDrOsmoncom Posted 3314

EQUIPMENT FOR SALE

For SalemdashFutura 3000GT automatic X-ray film processor two 8x10 cassettes two 7x14 cassettes two 14x17 cassettes Xray film cabinet new film xray I D Imprinter amp infra red light for sale $80000 Mikephelps55attnet or call (765) 345-0224 Posted 92413

PRACTICES FOR SALE

Free North Manchester practice Collected gt$300000 in 2012 Drs Kelsey giving practice records and X-ray to DC who buys their building 302 W MainHwy 114 Appraised for $165000 last monthmdashyou can buy it for $145000 Closing office on 103013 so you must act soon for this opportunity (260) 568-4419 or office 260-982-4646 Posted 100213

DCS WANTED

Kauffman Chiropractic PC is looking for a full-time position to be filled October 2013 Successful 25+ years established company with physical therapy massage therapy and rehabilitation Enthusiastic ambitious doctor who is willing to learn is a must Must be proficient in Diversified Thompson and Distraction techniques Nice salary is offered Email resume to chirodancomcastnet Posted 82713

Fantastic opportunity for energetic success-oriented doctor excited to grow with us professionally Comes with ownership possibilities Learn to share chiropractic in your community Train in an established practice run on outstanding systems Great training and support for you with focus on exceptiional patient communication and care including chiropractic rehab and massage Send CV or resume to clarksvillespineandrehabinsightbbcom Contact Joseph Rogers Lousville Kentucky (812) 282-7500 Posted 1714

Career Opportunity ndash URGENT ASSOCIATE WANTED ndash PEORIA IL Work in a state of the art wellness center with upbeat and professional staff ready to support you Utilize chiropractic clinical nutrition and rehabilitation to manage a wide range of conditions Doctor must be bright outgoing enthusiastic and must have excellent clinical skills This is an opportunity you dont want to miss Designed for someone looking for a career not simply another job Extensive training and great income potential Invest in your future Send a resume to lfulleralignlifecom Posted 12414

Part Time DC needed for Gary IN office for DOT Certified Medical Exams and some Chiropractic beginning March 15 2014 NO STRESS NO BILLING No Overhead ndash No Headaches Easy hours (8 am - 5 pm - 2 dayswk) Continue in your own practice and make extra cash in our office or just work part-time for us Will tutor you and pay for your DOT Certification - work 2 daysweek ($25000) Will tutor you and pay for your DOT Certification ($50hr = $25000year for 2 daysweek) Contact Lynn Biese -Carroll DC at lbiesewirrcom or call (262) 515-2168 Posted 2614

Associate Needed ndash Bloomington Indiana Expanding practice in Bloomington Indiana is looking for full-time position to be filled Enthusiastic ambitious doctor is a must Must be proficient in Diversified and Low Force techniques rehab and physical therapy Practice is a very strong stable consistent referral based practice Salary and profit share of clinic are offered We will train and mentor in technique and all areas of patient compliance and success Send resume to Dr Fox 1710 West Third St Bloomington Indiana 47404 or email to jbfprodigynet Posted 21814

vACATION DOCTORS

Mobile Moje Chiropractic Dr Moje is available for vacation relief and office coverage Licensed in IN OH MI WI MN amp PA Specializing in maternity leave injuries and vacations Call or email for CV availability rates references and further information Contact Dr Moje at stephanmojegmailcom or (218) 205-6141 Posted 81613

indiana state ChirOPraCtiC assOCiatiOn Classifieds

Page 13: ISCA Spring Report 2014

spring 201413

MedicaidMedicare Update (contd from page 12)

SGR BILL PASSES HOUSE GOES TO SENATE FOR CONSIDERATIONWe learned that the United States House of Representatives passed House Bill 4302 The bill proposes to extend Medicarersquos Sustainable Growth Rate (SGR) current rate to April 15 2015 and would delay other Medicare deadlines The bill as currently drafted would postpone ICD-10-CM implementation until after October 1 2015 and restrict the Centers for Medicare amp Medicaid Services (CMS) from acting without congressional approval The bill now goes to the US Senate for debate and vote If it passes the Senate it would then be sent to President Obamarsquos desk to be signed or vetoed The ISCA will continue to monitor this situation and recommends preparing for ICD-10 implementation

PLEASE ALSO MARK YOUR CALENDAR WITH THESE DATES Medicare Secondary Payer (MSP) Seminar April 17 2014 from 100 pm to 400 pm Hilton Garden Inn Fort Wayne 8615 US Hwy 24 West Fort Wayne IN Click here to register

There is a Chiropractic Medicare Seminar on April 26 2014 in Mishawaka IN Click here for more information

HELPFUL LINKSNeed help in the transition to ICD-10 Go to the Road to 10 website by clicking here This site is primarily for the MD but has general information that pertains to all health care specialties

Stay up-to-date on changes in Medicare at the WPS Medicare website by clicking here This website is for all providers but sometimes offers information specific to chiropractors

INFORMATION REGARDING THE HOLDING OF APRIL 2014 CLAIMS FOR SERvICES PAID UNDER THE 2014 MEDICARE PHYSICIAN FEE SCHEDULE The 2014 Medicare Physician Fee Schedule (MPFS) final rule stipulated a negative update to the MPFS that was to be effective January 1 2014 That reduction was averted for three months with the passage of the Pathway for SGR Reform Act of 2013 which provided for a 05 percent update for services paid under the MPFS through March 31 2014 CMS is hopeful that there will be congressional action to prevent the negative update from taking effect on April 1 2014 CMS has instructed the Medicare Administrative Contractors to hold claims containing services paid under the MPFS for the first 10 business days of April (ie through April 14 2014) This hold would only affect MPFS claims with dates of service of April 1 2014 and later The hold should have minimal impact on provider cash flow because under current law clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt All claims for services delivered on or before March 31 2014 will be processed and paid under normal procedures regardless of any Congressional actions

spring 201414

insUranCe COMMittee UPdateBy Peter Furno DC ISCA Board of Directors District 4 Director and Insurance Committee Chairman

During 2013 the ISCA Insurance Committee addressed many issues and questions from its members with regard to insurance legalities of advertising and proposed associations with third party vendors offering incentives contrary to our practice statues Doctors with definitively legal questions were referred to their legal counsel for liability reasons Most questions directed to the insurance committee are answered within 24 hours

Because the ISCA continues to receive anecdotal complaints from the field claiming insurer reimbursement discrimination and other transgressions the insurance committee as a part of the ISCArsquos proactive efforts to address this problem has developed a survey to obtain information on various insurance problems or concerns impacting chiropractors in the field The ISCA is aggressively attempting to determine problems that are affecting large numbers of doctors and which may be indicating the development of a trend requiring attention by the ISCA and then the IDOI However although it is the intent to meet with the IDOI once the survey information is correlated so that the contentions of our doctors may be addressed officially without firm evidence of wrong doing by the insurance industry the ISCA cannot go forward Consequently it is imperative that all members who are having trouble submit their complaints to the ISCA together with supportive documentation so that this issue may be addressed

Now that the PPACA is law and will require ldquoevidence-basedrdquo treatment procedures to be utilized before reimbursements are made the intent of the Insurance Committee to make at least one presentation to decision-makers of an employer group regarding the cost-effectiveness and efficacy of chiropractic in the management of work related uncomplicated spine injuries in comparison to traditional medical care Heretofore the majority of employers had no idea of the cost-effectiveness of chiropractic care when compared to traditional medicine and simply allowed their work nurses and medical providers to direct care ndash which the research shows is one of the main reasons costs are so high

The Insurance Committee in an attempt to keep the ISCA membership updated will attempt to address at least two insurance queries weekly and present answers to the membership via the ISCA monthly eNews and Newsletter

Insurance Pearl Medicare and Chiropractic Billing Misconceptions It is worthwhile to address a few of the prevailing misconceptions Here are the nine truisms regarding Medicare and chiropractic

1 There is not a 12-visit limit to Medicare for chiropractic services The limits of care are based on the specific medical necessity of the primary subluxation and its secondary neuromusculoskeletal diagnosis

2 Medicare will pay for both acute and chronic conditions as long as there is documentation or expectation of functional improvement

3 Nonparticipating (nonpar) providers are required to bill for services All covered services under chiropractic (spinal manipulation) must be billed to Medicare

4 Nonpar providers are audited just as par providers are There is no protection from a Medicare audit by being nonpar

5 Nonpar providers must document services in the same manner as any provider of Medicare services Being par or nonpar is irrelevant in reference to documentation of chiropractic services

6 Chiropractors may not opt out of Medicare This is simply not an option for doctors of chiropractic Being nonpar is not opting out but designating oneself as a Medicare provider nonpar In simple terms chiropractors must belong to Medicare to treat Medicare patients

7 Advance Beneficiary Notices (ABNs) should not be used as routine documents for patients to sign on their initial visit However they must be used when there is a genuine belief or reasonable expectation that Medicare will deny or not pay for the service on a specific visit or series of visits In other words a blanket ABN at the beginning of care is not sufficient or compliant

8 Medicare claims are not difficult they are simply different from health insurance claims When not done in Medicares format claims are denied

9 Medicare payment is what it is I will refrain from stating it is good While we all would want higher reimbursements (Who doesnt) the average fees for chiropractic services for manipulation are $30-$36 per visit This is far better reimbursement than under many of the managed care plans chiropractors routinely fight to join Furthermore that dollar amount is for spinal manipulation only other services may be billed to the patient or covered by a secondary insurance plan

spring 201415

trUst BUt verifyBy Dr R A Foxworth FICC MCS-P

I was speaking with a doctor recently who was venting her frustration about not knowing who to believe or trust as an authority when it comes to being in practice today She goes to different seminars because she wants to improve herself personally and professionally She also wants to improve her practice by learning more about her productivity effectiveness documentation compliance and billing She shared that she doesnt simply attend the CEU required hours for her license she puts in seminar hours to improve her practice her clinical skills her compliance and her business insight

Her problem The conflicting information she receives from various experts at each seminar How she asked can they all be right if they all say different things As a result of her experience she wanted to know why a Discount Medical Plan Organization (DMPO) like ChiroHealthUSA was of value in todayrsquos practices Why she asked is this even necessary What are my resources

I passed her third-degree with flying colors by the way

I could appreciate her position because I am a bit of a skeptic myself In fact thats how all this started for me I was a chiropractor in practice just like you trying to maximize my insurance payments so I wasnt leaving money on the table while still working to come up with a way my uninsured patients could afford those fees

Because of my activity within my state (as a governor-appointed health expert as an active participant in my State Chiropractic Association and the state representative for the American Chiropractic Association) I knew there were rules to follow to avoid compliance issues when creating our fee schedule I did my research and initially started a Discount Medical Plan Organization (DMPO) for my state alone I knew this would legally protect my practice and my colleagues and that at the time was my only goal

And as skeptic I wouldnrsquot even take my own word for it when it came to believing that a Discount Medical Plan Organization (DMPO) was the simplest way to keep my fee schedules compliant legal and safe Thatrsquos why I became a Certified Medical Compliance Specialist (MCS-P) so skeptics like me could get a breath and feel at ease As an MCS-P Irsquom quite simply held to a higher standard I have to be able to quote chapter and verse about why any possible fee or activity is or isnrsquot compliant

We know therersquos a plethora of inaccurate information that gets disseminated in our profession Im sad to say that I had to agree with my frustrated colleague when she was venting about all the conflicting advice she was receiving Thatrsquos why ChiroHealthUSA has relationships with many MCS-Ps to help get accurate reliable information out there Many of the brightest minds in our profession agree with and recommend ChiroHealthUSA to their chiropractic colleagues

Looking back when I set up my first DMPO within my state I can see how shortsighted I was I now know that taking ChiroHealthUSA to a national audience to protect all chiropractic practices in the country was the vision I shouldve had at the start Im glad I had an encounter with one of my fellow MCS-Ps who gave me this bigger vision

Learn more about how ChiroHealthUSA can help your practice be more compliant You can attend a free webinar this Tuesday April 1 Register at wwwChiroHealthUSAcom today to find out more

Dr Foxworth is a certified Medical Compliance Specialist and President of ChirohealthUSA A practicing Chiropractor he remains ldquoin the trenchesrdquo facing challenges with billing coding documentation and compliance he has served as president of the Mississippi Chiropractic Association former Staff Chiropractor at

the gv Sonny Montgomery vA Medical Center and is a Fellow of the International College of Chiropractic you can contact Dr Foxworth at 1 (888) 719-9990 infochirohealthusacom or visit the ChirohealthUSA website at wwwchirohealthusacom join us for a free webinar that will give you all the details about how a DMPO can help you practice with more peace of mind go to wwwchirohealthusacom to register today

spring 201416

Were already there ndash ChirOPraCtiC and PUBliC health hand-in-handBy Caitlin Lukacs from the March 2014 issue of ACA news

Public health is a popular buzz phrase in the healthcare arena but what exactly is it and how does chiropractic fit into it ldquoPublic health describes the overall wellbeing of the populacerdquo explains Richard Bruns DC past chairman of the American Chiropractic Associationrsquos (ACA) Wellness and Health Promotion Committee and ACA chairman of the Board of Governors ldquoAll public health issues have future implications for individuals as well as the publicrdquo

Public health encompasses habits and social norms such as smoking alcohol consumption obesity and the use of seatbelts as well as environmental issues such as clean water air quality and how livestock and agricultural practices affect the environment adds Will Evans DC PhD MCHES provost of the University of Western States Public health also includes health education and health promotion

ldquoPublic health and chiropractic go hand-in-handrdquo explains Karen Konarski-Hart DC DABCO FACO vice president of ACArsquos Council of Delegates and chairman of the American Public Health Association (APHA)Wellness and Health Promotion Committee ldquoDCs donrsquot practice in a vacuum they are interested in all aspects of a patientrsquos life that affect his or her health and wellbeing as well as how that person interacts in the healthcare community at largerdquo

Whether they identify it as public health or not all chiropractic physicians address public health issues when dealing with their patients For example when a new patient comes into your office you begin with a detailed history and an initial examination that includes not only taking vital signs but discussing tobacco and alcohol use and other behaviors that affect that patientrsquos health explains Dr Evans ldquoThis allows you to create an individual health-risk assessment based on his or her environment family history lifestyle etc and address public health issues such as tobacco use at the same timerdquo he says

BROACHING THE SUBjECTIt can sometimes be difficult to initiate conversations with patients about issues such as smoking or weight loss ldquoThe best place to address such topics is in your initial report of findings to the patientrdquo suggests Dr Evans ldquoYoursquove examined the patient and determined the cause of the pain or complaint that brought him or her into your office in the first place and now yoursquove got an opportunity to say lsquoI see some lifestyle-related issues that could be contributing to your pain or that could lead to other complaints down the roadrsquordquo

Yoursquore in a position to identify potential problems for your

patients says Dr Konarski-Hart ldquoThey may be setting themselves up for diabetes or cardiovascular disease or maybe they arenrsquot getting enough exercise mdash all of these things should be discussed as part of good primary carerdquo

You never want to force patients to make changes so yoursquoll need to assess their openness to addressing lifestyle changes first Simply ask them if theyrsquod be willing to discuss a healthier weight for example If they are you can let them know that you have multiple resources and partners in place to help them move forward

Dr Evans determines his patientsrsquo willingness to make lifestyle modifications by using the Stages of Change a common model of health behavior change The Stages of Change are

Pre-contemplator stage ndash Patient has no intention of making any changes in the next six months

Contemplator stage ndash Patient is considering a change within the next six months

Preparation stage ndash Patient has decided on a change and is preparing to take some kind of action

Action stage ndash Patient has begun implementing the change

Maintenance stage ndash Patient has made a change and is now working to maintain it

Take the example of an overweight patient Because the average weight of an individual in the United States has increased over the past few years some people who are overweight or borderline overweight donrsquot even realize it says Dr Evans Broach the subject gently and suggest a few small goals such as parking farther away from the office or shopping center or wearing a pedometer and working to increase the number of steps taken in a day You could also teach that patient how to read food labels and discuss healthier meal options Itrsquos about identifying the risk communicating the risk determining where your patient falls in the Stages of Change and then prescribing appropriate modifications explains Dr Evans ldquoAnd donrsquot forget to follow up with that patient at his or her next appointment Itrsquos important that he or she doesnrsquot lose confidence in your recommendations or in you as a healthcare providerrdquo he adds

GET INvOLvEDIn addition to discussions with patients in the treatment

Were Already There ndash Chiropractic and Public health hand-in-hand(contd on page 17)

spring 201417

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 16)

room there are many ways to incorporate public health into your practice One of the easiest ways to get involved is to participate in an observance that already exists such as the APHArsquos Public Health Week held the first week of every April (wwwaphaorgprogramshealthweek) or ACArsquos National Chiropractic Health Month (NCHM) celebrated every October These organizations come up with a new theme each year and gather all of the resources you need to participate ldquoIt takes the thinking and planning aspect off of the individual doctorrdquo says Dr Konarski-Hart ldquoAll you need to do is follow the instructions laid out by the parent organizationrdquo Additionally when you throw your hat into the ring on a larger issue or observance you know that the public health community is focused on that issue at that time so you can reach out to your county or state health department or other local healthcare associations and join in their efforts which will help you to build mutually beneficial long-term relationships says Dr Konarski-Hart ldquoMany state groups are underfunded and understaffed and they welcome participation particularly from physiciansrdquo she notes

DCs can also create their own observances ldquoACA offers webinars teleseminars and patient handouts on a variety of public health issuesmdashperuse the offerings and pick a topic to focus on for a week or a monthrdquo says Dr Konarski-Hart She suggests having your clinic sponsor a wellness competition or challenge You could partner with a local exercise facility or health foods store as well as a school or senior center and make it a community event You could also organize an eat well exercise club in which members meet for a walk or bike ride and then share a healthy breakfast or lunch Your practice could sponsor a poster contest at a local school or community center ldquoHave the kids create posters focused on healthy lifestyle choices and then give out prizes of fun healthy exercise such as a day of horseback riding or ice skatingrdquo Dr Konarski-Hart says Additionally your practice could sponsor a marathon participant or a local amateur sports team to show that you support healthy activities and active lifestyles

Similarly be informed about the public health issues in your community Maybe you live in an area with a high population of smokers or perhaps there have been numerous injuries due to not wearing a seatbelt in recent years Do some background research on these topics and then get involved whether that means simply providing patient handouts in your waiting room giving a community health talk participating in health fairs or working with your local health department (and other relevant organizations) to pass pertinent legislation

Look for organizations in your area that are already offering public health resources or programs and set up

a partnership with them For example for the topic of overweightobesity you could offer your clinic as a weigh-in site for participants in Weight Watchers programs suggests Dr Evans or partner with a local gym to give discounts to chiropractic patients Dr Bruns recommends getting involved with the school lunch program to advocate for healthy options for students For smoking cessation work with the American Lung Association to put on an informational presentation at a local hospital or sponsor a 5k or a stair run to raise awareness (and funds) for lung cancer research For drug addiction set up a referral network with psychologists or addiction centers and either offer acupuncture in your office or refer out to an acupuncturist as it has been shown to help patients through the detox process You can also use your knowledge of nutrition and exercise to facilitate the journey through detox says Dr Bruns

Additionally you should make a point to support these other organizations when they host local events (even if yoursquore not an official partner) or reach out for financial support ldquoI always participate in the American Cancer Societyrsquos golf tournament and I display their materials in my office as wellrdquo says Dr Bruns He also participates in the fundraising efforts of the American Heart Association and the American Lung Association on a regular basis ldquoItrsquos good for your patients and your community to see that you care about and support other healthcare organizationsrdquo he says

Another option for public health involvement is to join the APHArsquos Chiropractic Health Care Section Yoursquoll be informed on public health happenings have access to the latest information and research see what DCs are doing nationally and in other states on particular issues and even have the chance to give input and be involved in decision-making

CONCUSSIONConcussion prevention and treatment is one public health topic that is relevant to every patient population in every region of the United States ldquoWersquore seeing more concussions lately due in part to the number of children participating in contact sports the excessive training involved in these sports and the fact that most people arenrsquot aware of the symptoms and long-term risks of concussionsrdquo says Dr Konarski-Hart Helmets donrsquot actually provide protection against concussions either ldquoThe padding will protect the skull from fracture but because your brain is loose inside your skull it is not protected from impact or traumardquo she explains And with todayrsquos cultural emphasis on pushing through the pain wersquore starting to see more and more professional athletes coming forward with serious emotional psychological and neurological issues that are linked to multiple concussions in their past

spring 201418

As an EMT herself Dr Konarski-Hart attended an EMT convention in the summer of 2013 and heard a presentation from the Childrenrsquos Hospital of Arkansas on injury prevention After speaking with the presenters she discovered that they were having trouble getting buy-in from the allopathic community and she offered her services as a DC Since then Dr Konarski-Hart and the Arkansas Chiropractic Physicians Association (ACPA) have been working with the childrenrsquos hospital on various statewide projects dealing with all aspects of injury prevention One such program focuses on concussions

ldquoThrough this partnership we learned that Arkansas has not finalized its concussion protocols yet and we were able to get someone from our ACPA legislative team involved in that process to ensure chiropracticrsquos inclusion as an involved professionrdquo says Dr Konarski-Hart

Because of DCsrsquo knowledge and training itrsquos important for them to get involved with the concussion issue says Dr Bruns ldquoKnowing what we know about concussions we are doing a tremendous service to athletes and their families by completing pre-participation physicals and screenings and watching for signs and symptoms during participation as wellrdquo he says And itrsquos not just athletes who are suffering from concussions mdash itrsquos children who fall off a bike or a swing set or an older adult who slips on the ice

Itrsquos crucial for DCs to help disseminate information about concussions Whether you see concussion symptoms in a patient in your office or work with local sports teams you have the knowledge to serve as a local expert on the topic DCs can assess injured parties work with school administrators to create concussion protocols and push for legislation on standard concussion treatment says Dr Bruns

Kids parents coaches trainers and doctors all need to be aware of concussions and the potential risks involved with sustaining one or more ldquoItrsquos a matter of understanding the potential risks before making a decision to play in a game or to have a player sit out a game for examplerdquo says Dr Konarski-Hart

WErsquoRE ALREADY THEREAs DCs we focus on the biomechanics structure and function of the human body and we have a unique approach in that we look at the whole person in terms of nutrition flexibility blood flow and muscle and nervous tissue function says Dr Bruns ldquoThe chiropractic profession recognizes the importance of healthful eating nutritional support avoiding the bad habits of smoking and drinking alcohol and has been counseling patients on healthy lifestyles since long before it was fashionablerdquo

According to Dr Konarski-Hart simply choosing to be a doctor of chiropractic means that yoursquore involved in public health on some level because your goal is to make your patient healthier and therefore make your community healthier In other words DCs are already an integral part of public health

With the new health care emphasis on wellness and prevention many healthcare providers legislators insurance companies and government policy developers are focusing on how to offer access to these services especially in medically underserved rural areas or small towns Chiropractic representatives need to be part of those discussions to point out that in many of these communities DCs are already there providing that assessment counseling and care This representation is one of the functions of the ACA and state chiropractic associations and why your membership and involvement with these organizations is so critical says Dr Konarski-Hart

aCa neWs extraCERTIFIED CHIROPRACTIC WELLNESS SPECIALIST PROGRAMIn 2011 ACA began a partnership with the National Wellness Institute (NWI) a well respected organization recognized both inside and outside the chiropractic profession to offer a wellness certification program for DCs The 40-hour program will enable students to integrate principles of wellness coaching health promotion and disease prevention to their current practices Once the program is completed DCs will become Certified Chiropractic Wellness Specialists ldquoThe program was developed and launched by Dr Evans Cheryl Hawk DC PhD CHES and Mike Perko PhDmdashdoctors who are at the forefront of health promotion illness prevention and wellnessrdquo says Dr Bruns Originally the certification consisted of four different modules and DCs had to travel to select cities to participate in the weekend seminars However ACA quickly realized that it was difficult for DCs to get to these courses and decided to turn the program into an online certification NWI has taken the lead on this conversion

ACA RESOURCES Bookmark wwwacatoday orgpublichealth on your computer for quick and easy access to patient handouts references and research for presentations a calendar of national public health observances and other resources that have all been vetted by the ACA APHAWellness and Health Promotion Committee for use in your office Published in the March 2014 ACA news

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 17)

spring 201419

ASSOCIATES WANTED

Associate Wanted Starting base annual salary range is 50-60K plus additional monthly $500-2K in productivity compensation Benefits include MalpracticeMedical insurance CE Our care model uses the latest in Chiropractic Massage Physical Therapy Acupuncture and Nutritional medicine services South Bend is home to Notre Dame and a short drive to Chicago and Lake Michigan This is a good place to raise a family with good schools and a low cost of living Sendfax a letter of interest and resume to apintodcyahoocom or fax (574) 254-1652 Posted 11514

Chicagoland Associate Doctor Needed Busy office with multiple long term associates Family practice Thirty minutes to downtown Chicago Full timepart time paid vacation $26hour starting pay with periodic raises Proficient in the Thompson leg-check technique We are looking for someone who is ready and willing to blend with a very upbeat fun and positive staff Interested applicants should email their resume to infotrimbolichironet or fax to (219) 836-2344 wwwtrimbolichironet Posted 12914

Opportunity for Doctor to grow own practice with buyout of 40 year family practice in 2-5 years Located in North Central Indiana with easy access to Indianapolis and Chicago Wonderful area to raise a family good schools low crime slower pace of life Contact pdyer4hotmailcom Posted 2614

Associate Needed We are currently searching for an associate doctor to help us at the Osmon Chiropractic Center in Bloomington IN This would be a tremendous opportunity for a new graduate or anyone considering a possible change of location You will be working in a beautiful 2500 square foot state of the art clinic with 1 other doctor and a professional staff of 8 to assist you There will be only a small amount of practice building activities on your part because we will provide you with a practice representative who will do that for you You will enjoy the security of a known income and practice without the stress of practice overhead and staff management All you need to do is learn our system of patient managementmdashthe same system we all use in the office and work together as a team to get and keep our community under chiropractic care It is an exciting place to practice Send resume and cover letter to drosmonhotmailcom and please feel free to visit our website at wwwDrOsmoncom Posted 3314

EQUIPMENT FOR SALE

For SalemdashFutura 3000GT automatic X-ray film processor two 8x10 cassettes two 7x14 cassettes two 14x17 cassettes Xray film cabinet new film xray I D Imprinter amp infra red light for sale $80000 Mikephelps55attnet or call (765) 345-0224 Posted 92413

PRACTICES FOR SALE

Free North Manchester practice Collected gt$300000 in 2012 Drs Kelsey giving practice records and X-ray to DC who buys their building 302 W MainHwy 114 Appraised for $165000 last monthmdashyou can buy it for $145000 Closing office on 103013 so you must act soon for this opportunity (260) 568-4419 or office 260-982-4646 Posted 100213

DCS WANTED

Kauffman Chiropractic PC is looking for a full-time position to be filled October 2013 Successful 25+ years established company with physical therapy massage therapy and rehabilitation Enthusiastic ambitious doctor who is willing to learn is a must Must be proficient in Diversified Thompson and Distraction techniques Nice salary is offered Email resume to chirodancomcastnet Posted 82713

Fantastic opportunity for energetic success-oriented doctor excited to grow with us professionally Comes with ownership possibilities Learn to share chiropractic in your community Train in an established practice run on outstanding systems Great training and support for you with focus on exceptiional patient communication and care including chiropractic rehab and massage Send CV or resume to clarksvillespineandrehabinsightbbcom Contact Joseph Rogers Lousville Kentucky (812) 282-7500 Posted 1714

Career Opportunity ndash URGENT ASSOCIATE WANTED ndash PEORIA IL Work in a state of the art wellness center with upbeat and professional staff ready to support you Utilize chiropractic clinical nutrition and rehabilitation to manage a wide range of conditions Doctor must be bright outgoing enthusiastic and must have excellent clinical skills This is an opportunity you dont want to miss Designed for someone looking for a career not simply another job Extensive training and great income potential Invest in your future Send a resume to lfulleralignlifecom Posted 12414

Part Time DC needed for Gary IN office for DOT Certified Medical Exams and some Chiropractic beginning March 15 2014 NO STRESS NO BILLING No Overhead ndash No Headaches Easy hours (8 am - 5 pm - 2 dayswk) Continue in your own practice and make extra cash in our office or just work part-time for us Will tutor you and pay for your DOT Certification - work 2 daysweek ($25000) Will tutor you and pay for your DOT Certification ($50hr = $25000year for 2 daysweek) Contact Lynn Biese -Carroll DC at lbiesewirrcom or call (262) 515-2168 Posted 2614

Associate Needed ndash Bloomington Indiana Expanding practice in Bloomington Indiana is looking for full-time position to be filled Enthusiastic ambitious doctor is a must Must be proficient in Diversified and Low Force techniques rehab and physical therapy Practice is a very strong stable consistent referral based practice Salary and profit share of clinic are offered We will train and mentor in technique and all areas of patient compliance and success Send resume to Dr Fox 1710 West Third St Bloomington Indiana 47404 or email to jbfprodigynet Posted 21814

vACATION DOCTORS

Mobile Moje Chiropractic Dr Moje is available for vacation relief and office coverage Licensed in IN OH MI WI MN amp PA Specializing in maternity leave injuries and vacations Call or email for CV availability rates references and further information Contact Dr Moje at stephanmojegmailcom or (218) 205-6141 Posted 81613

indiana state ChirOPraCtiC assOCiatiOn Classifieds

Page 14: ISCA Spring Report 2014

spring 201414

insUranCe COMMittee UPdateBy Peter Furno DC ISCA Board of Directors District 4 Director and Insurance Committee Chairman

During 2013 the ISCA Insurance Committee addressed many issues and questions from its members with regard to insurance legalities of advertising and proposed associations with third party vendors offering incentives contrary to our practice statues Doctors with definitively legal questions were referred to their legal counsel for liability reasons Most questions directed to the insurance committee are answered within 24 hours

Because the ISCA continues to receive anecdotal complaints from the field claiming insurer reimbursement discrimination and other transgressions the insurance committee as a part of the ISCArsquos proactive efforts to address this problem has developed a survey to obtain information on various insurance problems or concerns impacting chiropractors in the field The ISCA is aggressively attempting to determine problems that are affecting large numbers of doctors and which may be indicating the development of a trend requiring attention by the ISCA and then the IDOI However although it is the intent to meet with the IDOI once the survey information is correlated so that the contentions of our doctors may be addressed officially without firm evidence of wrong doing by the insurance industry the ISCA cannot go forward Consequently it is imperative that all members who are having trouble submit their complaints to the ISCA together with supportive documentation so that this issue may be addressed

Now that the PPACA is law and will require ldquoevidence-basedrdquo treatment procedures to be utilized before reimbursements are made the intent of the Insurance Committee to make at least one presentation to decision-makers of an employer group regarding the cost-effectiveness and efficacy of chiropractic in the management of work related uncomplicated spine injuries in comparison to traditional medical care Heretofore the majority of employers had no idea of the cost-effectiveness of chiropractic care when compared to traditional medicine and simply allowed their work nurses and medical providers to direct care ndash which the research shows is one of the main reasons costs are so high

The Insurance Committee in an attempt to keep the ISCA membership updated will attempt to address at least two insurance queries weekly and present answers to the membership via the ISCA monthly eNews and Newsletter

Insurance Pearl Medicare and Chiropractic Billing Misconceptions It is worthwhile to address a few of the prevailing misconceptions Here are the nine truisms regarding Medicare and chiropractic

1 There is not a 12-visit limit to Medicare for chiropractic services The limits of care are based on the specific medical necessity of the primary subluxation and its secondary neuromusculoskeletal diagnosis

2 Medicare will pay for both acute and chronic conditions as long as there is documentation or expectation of functional improvement

3 Nonparticipating (nonpar) providers are required to bill for services All covered services under chiropractic (spinal manipulation) must be billed to Medicare

4 Nonpar providers are audited just as par providers are There is no protection from a Medicare audit by being nonpar

5 Nonpar providers must document services in the same manner as any provider of Medicare services Being par or nonpar is irrelevant in reference to documentation of chiropractic services

6 Chiropractors may not opt out of Medicare This is simply not an option for doctors of chiropractic Being nonpar is not opting out but designating oneself as a Medicare provider nonpar In simple terms chiropractors must belong to Medicare to treat Medicare patients

7 Advance Beneficiary Notices (ABNs) should not be used as routine documents for patients to sign on their initial visit However they must be used when there is a genuine belief or reasonable expectation that Medicare will deny or not pay for the service on a specific visit or series of visits In other words a blanket ABN at the beginning of care is not sufficient or compliant

8 Medicare claims are not difficult they are simply different from health insurance claims When not done in Medicares format claims are denied

9 Medicare payment is what it is I will refrain from stating it is good While we all would want higher reimbursements (Who doesnt) the average fees for chiropractic services for manipulation are $30-$36 per visit This is far better reimbursement than under many of the managed care plans chiropractors routinely fight to join Furthermore that dollar amount is for spinal manipulation only other services may be billed to the patient or covered by a secondary insurance plan

spring 201415

trUst BUt verifyBy Dr R A Foxworth FICC MCS-P

I was speaking with a doctor recently who was venting her frustration about not knowing who to believe or trust as an authority when it comes to being in practice today She goes to different seminars because she wants to improve herself personally and professionally She also wants to improve her practice by learning more about her productivity effectiveness documentation compliance and billing She shared that she doesnt simply attend the CEU required hours for her license she puts in seminar hours to improve her practice her clinical skills her compliance and her business insight

Her problem The conflicting information she receives from various experts at each seminar How she asked can they all be right if they all say different things As a result of her experience she wanted to know why a Discount Medical Plan Organization (DMPO) like ChiroHealthUSA was of value in todayrsquos practices Why she asked is this even necessary What are my resources

I passed her third-degree with flying colors by the way

I could appreciate her position because I am a bit of a skeptic myself In fact thats how all this started for me I was a chiropractor in practice just like you trying to maximize my insurance payments so I wasnt leaving money on the table while still working to come up with a way my uninsured patients could afford those fees

Because of my activity within my state (as a governor-appointed health expert as an active participant in my State Chiropractic Association and the state representative for the American Chiropractic Association) I knew there were rules to follow to avoid compliance issues when creating our fee schedule I did my research and initially started a Discount Medical Plan Organization (DMPO) for my state alone I knew this would legally protect my practice and my colleagues and that at the time was my only goal

And as skeptic I wouldnrsquot even take my own word for it when it came to believing that a Discount Medical Plan Organization (DMPO) was the simplest way to keep my fee schedules compliant legal and safe Thatrsquos why I became a Certified Medical Compliance Specialist (MCS-P) so skeptics like me could get a breath and feel at ease As an MCS-P Irsquom quite simply held to a higher standard I have to be able to quote chapter and verse about why any possible fee or activity is or isnrsquot compliant

We know therersquos a plethora of inaccurate information that gets disseminated in our profession Im sad to say that I had to agree with my frustrated colleague when she was venting about all the conflicting advice she was receiving Thatrsquos why ChiroHealthUSA has relationships with many MCS-Ps to help get accurate reliable information out there Many of the brightest minds in our profession agree with and recommend ChiroHealthUSA to their chiropractic colleagues

Looking back when I set up my first DMPO within my state I can see how shortsighted I was I now know that taking ChiroHealthUSA to a national audience to protect all chiropractic practices in the country was the vision I shouldve had at the start Im glad I had an encounter with one of my fellow MCS-Ps who gave me this bigger vision

Learn more about how ChiroHealthUSA can help your practice be more compliant You can attend a free webinar this Tuesday April 1 Register at wwwChiroHealthUSAcom today to find out more

Dr Foxworth is a certified Medical Compliance Specialist and President of ChirohealthUSA A practicing Chiropractor he remains ldquoin the trenchesrdquo facing challenges with billing coding documentation and compliance he has served as president of the Mississippi Chiropractic Association former Staff Chiropractor at

the gv Sonny Montgomery vA Medical Center and is a Fellow of the International College of Chiropractic you can contact Dr Foxworth at 1 (888) 719-9990 infochirohealthusacom or visit the ChirohealthUSA website at wwwchirohealthusacom join us for a free webinar that will give you all the details about how a DMPO can help you practice with more peace of mind go to wwwchirohealthusacom to register today

spring 201416

Were already there ndash ChirOPraCtiC and PUBliC health hand-in-handBy Caitlin Lukacs from the March 2014 issue of ACA news

Public health is a popular buzz phrase in the healthcare arena but what exactly is it and how does chiropractic fit into it ldquoPublic health describes the overall wellbeing of the populacerdquo explains Richard Bruns DC past chairman of the American Chiropractic Associationrsquos (ACA) Wellness and Health Promotion Committee and ACA chairman of the Board of Governors ldquoAll public health issues have future implications for individuals as well as the publicrdquo

Public health encompasses habits and social norms such as smoking alcohol consumption obesity and the use of seatbelts as well as environmental issues such as clean water air quality and how livestock and agricultural practices affect the environment adds Will Evans DC PhD MCHES provost of the University of Western States Public health also includes health education and health promotion

ldquoPublic health and chiropractic go hand-in-handrdquo explains Karen Konarski-Hart DC DABCO FACO vice president of ACArsquos Council of Delegates and chairman of the American Public Health Association (APHA)Wellness and Health Promotion Committee ldquoDCs donrsquot practice in a vacuum they are interested in all aspects of a patientrsquos life that affect his or her health and wellbeing as well as how that person interacts in the healthcare community at largerdquo

Whether they identify it as public health or not all chiropractic physicians address public health issues when dealing with their patients For example when a new patient comes into your office you begin with a detailed history and an initial examination that includes not only taking vital signs but discussing tobacco and alcohol use and other behaviors that affect that patientrsquos health explains Dr Evans ldquoThis allows you to create an individual health-risk assessment based on his or her environment family history lifestyle etc and address public health issues such as tobacco use at the same timerdquo he says

BROACHING THE SUBjECTIt can sometimes be difficult to initiate conversations with patients about issues such as smoking or weight loss ldquoThe best place to address such topics is in your initial report of findings to the patientrdquo suggests Dr Evans ldquoYoursquove examined the patient and determined the cause of the pain or complaint that brought him or her into your office in the first place and now yoursquove got an opportunity to say lsquoI see some lifestyle-related issues that could be contributing to your pain or that could lead to other complaints down the roadrsquordquo

Yoursquore in a position to identify potential problems for your

patients says Dr Konarski-Hart ldquoThey may be setting themselves up for diabetes or cardiovascular disease or maybe they arenrsquot getting enough exercise mdash all of these things should be discussed as part of good primary carerdquo

You never want to force patients to make changes so yoursquoll need to assess their openness to addressing lifestyle changes first Simply ask them if theyrsquod be willing to discuss a healthier weight for example If they are you can let them know that you have multiple resources and partners in place to help them move forward

Dr Evans determines his patientsrsquo willingness to make lifestyle modifications by using the Stages of Change a common model of health behavior change The Stages of Change are

Pre-contemplator stage ndash Patient has no intention of making any changes in the next six months

Contemplator stage ndash Patient is considering a change within the next six months

Preparation stage ndash Patient has decided on a change and is preparing to take some kind of action

Action stage ndash Patient has begun implementing the change

Maintenance stage ndash Patient has made a change and is now working to maintain it

Take the example of an overweight patient Because the average weight of an individual in the United States has increased over the past few years some people who are overweight or borderline overweight donrsquot even realize it says Dr Evans Broach the subject gently and suggest a few small goals such as parking farther away from the office or shopping center or wearing a pedometer and working to increase the number of steps taken in a day You could also teach that patient how to read food labels and discuss healthier meal options Itrsquos about identifying the risk communicating the risk determining where your patient falls in the Stages of Change and then prescribing appropriate modifications explains Dr Evans ldquoAnd donrsquot forget to follow up with that patient at his or her next appointment Itrsquos important that he or she doesnrsquot lose confidence in your recommendations or in you as a healthcare providerrdquo he adds

GET INvOLvEDIn addition to discussions with patients in the treatment

Were Already There ndash Chiropractic and Public health hand-in-hand(contd on page 17)

spring 201417

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 16)

room there are many ways to incorporate public health into your practice One of the easiest ways to get involved is to participate in an observance that already exists such as the APHArsquos Public Health Week held the first week of every April (wwwaphaorgprogramshealthweek) or ACArsquos National Chiropractic Health Month (NCHM) celebrated every October These organizations come up with a new theme each year and gather all of the resources you need to participate ldquoIt takes the thinking and planning aspect off of the individual doctorrdquo says Dr Konarski-Hart ldquoAll you need to do is follow the instructions laid out by the parent organizationrdquo Additionally when you throw your hat into the ring on a larger issue or observance you know that the public health community is focused on that issue at that time so you can reach out to your county or state health department or other local healthcare associations and join in their efforts which will help you to build mutually beneficial long-term relationships says Dr Konarski-Hart ldquoMany state groups are underfunded and understaffed and they welcome participation particularly from physiciansrdquo she notes

DCs can also create their own observances ldquoACA offers webinars teleseminars and patient handouts on a variety of public health issuesmdashperuse the offerings and pick a topic to focus on for a week or a monthrdquo says Dr Konarski-Hart She suggests having your clinic sponsor a wellness competition or challenge You could partner with a local exercise facility or health foods store as well as a school or senior center and make it a community event You could also organize an eat well exercise club in which members meet for a walk or bike ride and then share a healthy breakfast or lunch Your practice could sponsor a poster contest at a local school or community center ldquoHave the kids create posters focused on healthy lifestyle choices and then give out prizes of fun healthy exercise such as a day of horseback riding or ice skatingrdquo Dr Konarski-Hart says Additionally your practice could sponsor a marathon participant or a local amateur sports team to show that you support healthy activities and active lifestyles

Similarly be informed about the public health issues in your community Maybe you live in an area with a high population of smokers or perhaps there have been numerous injuries due to not wearing a seatbelt in recent years Do some background research on these topics and then get involved whether that means simply providing patient handouts in your waiting room giving a community health talk participating in health fairs or working with your local health department (and other relevant organizations) to pass pertinent legislation

Look for organizations in your area that are already offering public health resources or programs and set up

a partnership with them For example for the topic of overweightobesity you could offer your clinic as a weigh-in site for participants in Weight Watchers programs suggests Dr Evans or partner with a local gym to give discounts to chiropractic patients Dr Bruns recommends getting involved with the school lunch program to advocate for healthy options for students For smoking cessation work with the American Lung Association to put on an informational presentation at a local hospital or sponsor a 5k or a stair run to raise awareness (and funds) for lung cancer research For drug addiction set up a referral network with psychologists or addiction centers and either offer acupuncture in your office or refer out to an acupuncturist as it has been shown to help patients through the detox process You can also use your knowledge of nutrition and exercise to facilitate the journey through detox says Dr Bruns

Additionally you should make a point to support these other organizations when they host local events (even if yoursquore not an official partner) or reach out for financial support ldquoI always participate in the American Cancer Societyrsquos golf tournament and I display their materials in my office as wellrdquo says Dr Bruns He also participates in the fundraising efforts of the American Heart Association and the American Lung Association on a regular basis ldquoItrsquos good for your patients and your community to see that you care about and support other healthcare organizationsrdquo he says

Another option for public health involvement is to join the APHArsquos Chiropractic Health Care Section Yoursquoll be informed on public health happenings have access to the latest information and research see what DCs are doing nationally and in other states on particular issues and even have the chance to give input and be involved in decision-making

CONCUSSIONConcussion prevention and treatment is one public health topic that is relevant to every patient population in every region of the United States ldquoWersquore seeing more concussions lately due in part to the number of children participating in contact sports the excessive training involved in these sports and the fact that most people arenrsquot aware of the symptoms and long-term risks of concussionsrdquo says Dr Konarski-Hart Helmets donrsquot actually provide protection against concussions either ldquoThe padding will protect the skull from fracture but because your brain is loose inside your skull it is not protected from impact or traumardquo she explains And with todayrsquos cultural emphasis on pushing through the pain wersquore starting to see more and more professional athletes coming forward with serious emotional psychological and neurological issues that are linked to multiple concussions in their past

spring 201418

As an EMT herself Dr Konarski-Hart attended an EMT convention in the summer of 2013 and heard a presentation from the Childrenrsquos Hospital of Arkansas on injury prevention After speaking with the presenters she discovered that they were having trouble getting buy-in from the allopathic community and she offered her services as a DC Since then Dr Konarski-Hart and the Arkansas Chiropractic Physicians Association (ACPA) have been working with the childrenrsquos hospital on various statewide projects dealing with all aspects of injury prevention One such program focuses on concussions

ldquoThrough this partnership we learned that Arkansas has not finalized its concussion protocols yet and we were able to get someone from our ACPA legislative team involved in that process to ensure chiropracticrsquos inclusion as an involved professionrdquo says Dr Konarski-Hart

Because of DCsrsquo knowledge and training itrsquos important for them to get involved with the concussion issue says Dr Bruns ldquoKnowing what we know about concussions we are doing a tremendous service to athletes and their families by completing pre-participation physicals and screenings and watching for signs and symptoms during participation as wellrdquo he says And itrsquos not just athletes who are suffering from concussions mdash itrsquos children who fall off a bike or a swing set or an older adult who slips on the ice

Itrsquos crucial for DCs to help disseminate information about concussions Whether you see concussion symptoms in a patient in your office or work with local sports teams you have the knowledge to serve as a local expert on the topic DCs can assess injured parties work with school administrators to create concussion protocols and push for legislation on standard concussion treatment says Dr Bruns

Kids parents coaches trainers and doctors all need to be aware of concussions and the potential risks involved with sustaining one or more ldquoItrsquos a matter of understanding the potential risks before making a decision to play in a game or to have a player sit out a game for examplerdquo says Dr Konarski-Hart

WErsquoRE ALREADY THEREAs DCs we focus on the biomechanics structure and function of the human body and we have a unique approach in that we look at the whole person in terms of nutrition flexibility blood flow and muscle and nervous tissue function says Dr Bruns ldquoThe chiropractic profession recognizes the importance of healthful eating nutritional support avoiding the bad habits of smoking and drinking alcohol and has been counseling patients on healthy lifestyles since long before it was fashionablerdquo

According to Dr Konarski-Hart simply choosing to be a doctor of chiropractic means that yoursquore involved in public health on some level because your goal is to make your patient healthier and therefore make your community healthier In other words DCs are already an integral part of public health

With the new health care emphasis on wellness and prevention many healthcare providers legislators insurance companies and government policy developers are focusing on how to offer access to these services especially in medically underserved rural areas or small towns Chiropractic representatives need to be part of those discussions to point out that in many of these communities DCs are already there providing that assessment counseling and care This representation is one of the functions of the ACA and state chiropractic associations and why your membership and involvement with these organizations is so critical says Dr Konarski-Hart

aCa neWs extraCERTIFIED CHIROPRACTIC WELLNESS SPECIALIST PROGRAMIn 2011 ACA began a partnership with the National Wellness Institute (NWI) a well respected organization recognized both inside and outside the chiropractic profession to offer a wellness certification program for DCs The 40-hour program will enable students to integrate principles of wellness coaching health promotion and disease prevention to their current practices Once the program is completed DCs will become Certified Chiropractic Wellness Specialists ldquoThe program was developed and launched by Dr Evans Cheryl Hawk DC PhD CHES and Mike Perko PhDmdashdoctors who are at the forefront of health promotion illness prevention and wellnessrdquo says Dr Bruns Originally the certification consisted of four different modules and DCs had to travel to select cities to participate in the weekend seminars However ACA quickly realized that it was difficult for DCs to get to these courses and decided to turn the program into an online certification NWI has taken the lead on this conversion

ACA RESOURCES Bookmark wwwacatoday orgpublichealth on your computer for quick and easy access to patient handouts references and research for presentations a calendar of national public health observances and other resources that have all been vetted by the ACA APHAWellness and Health Promotion Committee for use in your office Published in the March 2014 ACA news

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 17)

spring 201419

ASSOCIATES WANTED

Associate Wanted Starting base annual salary range is 50-60K plus additional monthly $500-2K in productivity compensation Benefits include MalpracticeMedical insurance CE Our care model uses the latest in Chiropractic Massage Physical Therapy Acupuncture and Nutritional medicine services South Bend is home to Notre Dame and a short drive to Chicago and Lake Michigan This is a good place to raise a family with good schools and a low cost of living Sendfax a letter of interest and resume to apintodcyahoocom or fax (574) 254-1652 Posted 11514

Chicagoland Associate Doctor Needed Busy office with multiple long term associates Family practice Thirty minutes to downtown Chicago Full timepart time paid vacation $26hour starting pay with periodic raises Proficient in the Thompson leg-check technique We are looking for someone who is ready and willing to blend with a very upbeat fun and positive staff Interested applicants should email their resume to infotrimbolichironet or fax to (219) 836-2344 wwwtrimbolichironet Posted 12914

Opportunity for Doctor to grow own practice with buyout of 40 year family practice in 2-5 years Located in North Central Indiana with easy access to Indianapolis and Chicago Wonderful area to raise a family good schools low crime slower pace of life Contact pdyer4hotmailcom Posted 2614

Associate Needed We are currently searching for an associate doctor to help us at the Osmon Chiropractic Center in Bloomington IN This would be a tremendous opportunity for a new graduate or anyone considering a possible change of location You will be working in a beautiful 2500 square foot state of the art clinic with 1 other doctor and a professional staff of 8 to assist you There will be only a small amount of practice building activities on your part because we will provide you with a practice representative who will do that for you You will enjoy the security of a known income and practice without the stress of practice overhead and staff management All you need to do is learn our system of patient managementmdashthe same system we all use in the office and work together as a team to get and keep our community under chiropractic care It is an exciting place to practice Send resume and cover letter to drosmonhotmailcom and please feel free to visit our website at wwwDrOsmoncom Posted 3314

EQUIPMENT FOR SALE

For SalemdashFutura 3000GT automatic X-ray film processor two 8x10 cassettes two 7x14 cassettes two 14x17 cassettes Xray film cabinet new film xray I D Imprinter amp infra red light for sale $80000 Mikephelps55attnet or call (765) 345-0224 Posted 92413

PRACTICES FOR SALE

Free North Manchester practice Collected gt$300000 in 2012 Drs Kelsey giving practice records and X-ray to DC who buys their building 302 W MainHwy 114 Appraised for $165000 last monthmdashyou can buy it for $145000 Closing office on 103013 so you must act soon for this opportunity (260) 568-4419 or office 260-982-4646 Posted 100213

DCS WANTED

Kauffman Chiropractic PC is looking for a full-time position to be filled October 2013 Successful 25+ years established company with physical therapy massage therapy and rehabilitation Enthusiastic ambitious doctor who is willing to learn is a must Must be proficient in Diversified Thompson and Distraction techniques Nice salary is offered Email resume to chirodancomcastnet Posted 82713

Fantastic opportunity for energetic success-oriented doctor excited to grow with us professionally Comes with ownership possibilities Learn to share chiropractic in your community Train in an established practice run on outstanding systems Great training and support for you with focus on exceptiional patient communication and care including chiropractic rehab and massage Send CV or resume to clarksvillespineandrehabinsightbbcom Contact Joseph Rogers Lousville Kentucky (812) 282-7500 Posted 1714

Career Opportunity ndash URGENT ASSOCIATE WANTED ndash PEORIA IL Work in a state of the art wellness center with upbeat and professional staff ready to support you Utilize chiropractic clinical nutrition and rehabilitation to manage a wide range of conditions Doctor must be bright outgoing enthusiastic and must have excellent clinical skills This is an opportunity you dont want to miss Designed for someone looking for a career not simply another job Extensive training and great income potential Invest in your future Send a resume to lfulleralignlifecom Posted 12414

Part Time DC needed for Gary IN office for DOT Certified Medical Exams and some Chiropractic beginning March 15 2014 NO STRESS NO BILLING No Overhead ndash No Headaches Easy hours (8 am - 5 pm - 2 dayswk) Continue in your own practice and make extra cash in our office or just work part-time for us Will tutor you and pay for your DOT Certification - work 2 daysweek ($25000) Will tutor you and pay for your DOT Certification ($50hr = $25000year for 2 daysweek) Contact Lynn Biese -Carroll DC at lbiesewirrcom or call (262) 515-2168 Posted 2614

Associate Needed ndash Bloomington Indiana Expanding practice in Bloomington Indiana is looking for full-time position to be filled Enthusiastic ambitious doctor is a must Must be proficient in Diversified and Low Force techniques rehab and physical therapy Practice is a very strong stable consistent referral based practice Salary and profit share of clinic are offered We will train and mentor in technique and all areas of patient compliance and success Send resume to Dr Fox 1710 West Third St Bloomington Indiana 47404 or email to jbfprodigynet Posted 21814

vACATION DOCTORS

Mobile Moje Chiropractic Dr Moje is available for vacation relief and office coverage Licensed in IN OH MI WI MN amp PA Specializing in maternity leave injuries and vacations Call or email for CV availability rates references and further information Contact Dr Moje at stephanmojegmailcom or (218) 205-6141 Posted 81613

indiana state ChirOPraCtiC assOCiatiOn Classifieds

Page 15: ISCA Spring Report 2014

spring 201415

trUst BUt verifyBy Dr R A Foxworth FICC MCS-P

I was speaking with a doctor recently who was venting her frustration about not knowing who to believe or trust as an authority when it comes to being in practice today She goes to different seminars because she wants to improve herself personally and professionally She also wants to improve her practice by learning more about her productivity effectiveness documentation compliance and billing She shared that she doesnt simply attend the CEU required hours for her license she puts in seminar hours to improve her practice her clinical skills her compliance and her business insight

Her problem The conflicting information she receives from various experts at each seminar How she asked can they all be right if they all say different things As a result of her experience she wanted to know why a Discount Medical Plan Organization (DMPO) like ChiroHealthUSA was of value in todayrsquos practices Why she asked is this even necessary What are my resources

I passed her third-degree with flying colors by the way

I could appreciate her position because I am a bit of a skeptic myself In fact thats how all this started for me I was a chiropractor in practice just like you trying to maximize my insurance payments so I wasnt leaving money on the table while still working to come up with a way my uninsured patients could afford those fees

Because of my activity within my state (as a governor-appointed health expert as an active participant in my State Chiropractic Association and the state representative for the American Chiropractic Association) I knew there were rules to follow to avoid compliance issues when creating our fee schedule I did my research and initially started a Discount Medical Plan Organization (DMPO) for my state alone I knew this would legally protect my practice and my colleagues and that at the time was my only goal

And as skeptic I wouldnrsquot even take my own word for it when it came to believing that a Discount Medical Plan Organization (DMPO) was the simplest way to keep my fee schedules compliant legal and safe Thatrsquos why I became a Certified Medical Compliance Specialist (MCS-P) so skeptics like me could get a breath and feel at ease As an MCS-P Irsquom quite simply held to a higher standard I have to be able to quote chapter and verse about why any possible fee or activity is or isnrsquot compliant

We know therersquos a plethora of inaccurate information that gets disseminated in our profession Im sad to say that I had to agree with my frustrated colleague when she was venting about all the conflicting advice she was receiving Thatrsquos why ChiroHealthUSA has relationships with many MCS-Ps to help get accurate reliable information out there Many of the brightest minds in our profession agree with and recommend ChiroHealthUSA to their chiropractic colleagues

Looking back when I set up my first DMPO within my state I can see how shortsighted I was I now know that taking ChiroHealthUSA to a national audience to protect all chiropractic practices in the country was the vision I shouldve had at the start Im glad I had an encounter with one of my fellow MCS-Ps who gave me this bigger vision

Learn more about how ChiroHealthUSA can help your practice be more compliant You can attend a free webinar this Tuesday April 1 Register at wwwChiroHealthUSAcom today to find out more

Dr Foxworth is a certified Medical Compliance Specialist and President of ChirohealthUSA A practicing Chiropractor he remains ldquoin the trenchesrdquo facing challenges with billing coding documentation and compliance he has served as president of the Mississippi Chiropractic Association former Staff Chiropractor at

the gv Sonny Montgomery vA Medical Center and is a Fellow of the International College of Chiropractic you can contact Dr Foxworth at 1 (888) 719-9990 infochirohealthusacom or visit the ChirohealthUSA website at wwwchirohealthusacom join us for a free webinar that will give you all the details about how a DMPO can help you practice with more peace of mind go to wwwchirohealthusacom to register today

spring 201416

Were already there ndash ChirOPraCtiC and PUBliC health hand-in-handBy Caitlin Lukacs from the March 2014 issue of ACA news

Public health is a popular buzz phrase in the healthcare arena but what exactly is it and how does chiropractic fit into it ldquoPublic health describes the overall wellbeing of the populacerdquo explains Richard Bruns DC past chairman of the American Chiropractic Associationrsquos (ACA) Wellness and Health Promotion Committee and ACA chairman of the Board of Governors ldquoAll public health issues have future implications for individuals as well as the publicrdquo

Public health encompasses habits and social norms such as smoking alcohol consumption obesity and the use of seatbelts as well as environmental issues such as clean water air quality and how livestock and agricultural practices affect the environment adds Will Evans DC PhD MCHES provost of the University of Western States Public health also includes health education and health promotion

ldquoPublic health and chiropractic go hand-in-handrdquo explains Karen Konarski-Hart DC DABCO FACO vice president of ACArsquos Council of Delegates and chairman of the American Public Health Association (APHA)Wellness and Health Promotion Committee ldquoDCs donrsquot practice in a vacuum they are interested in all aspects of a patientrsquos life that affect his or her health and wellbeing as well as how that person interacts in the healthcare community at largerdquo

Whether they identify it as public health or not all chiropractic physicians address public health issues when dealing with their patients For example when a new patient comes into your office you begin with a detailed history and an initial examination that includes not only taking vital signs but discussing tobacco and alcohol use and other behaviors that affect that patientrsquos health explains Dr Evans ldquoThis allows you to create an individual health-risk assessment based on his or her environment family history lifestyle etc and address public health issues such as tobacco use at the same timerdquo he says

BROACHING THE SUBjECTIt can sometimes be difficult to initiate conversations with patients about issues such as smoking or weight loss ldquoThe best place to address such topics is in your initial report of findings to the patientrdquo suggests Dr Evans ldquoYoursquove examined the patient and determined the cause of the pain or complaint that brought him or her into your office in the first place and now yoursquove got an opportunity to say lsquoI see some lifestyle-related issues that could be contributing to your pain or that could lead to other complaints down the roadrsquordquo

Yoursquore in a position to identify potential problems for your

patients says Dr Konarski-Hart ldquoThey may be setting themselves up for diabetes or cardiovascular disease or maybe they arenrsquot getting enough exercise mdash all of these things should be discussed as part of good primary carerdquo

You never want to force patients to make changes so yoursquoll need to assess their openness to addressing lifestyle changes first Simply ask them if theyrsquod be willing to discuss a healthier weight for example If they are you can let them know that you have multiple resources and partners in place to help them move forward

Dr Evans determines his patientsrsquo willingness to make lifestyle modifications by using the Stages of Change a common model of health behavior change The Stages of Change are

Pre-contemplator stage ndash Patient has no intention of making any changes in the next six months

Contemplator stage ndash Patient is considering a change within the next six months

Preparation stage ndash Patient has decided on a change and is preparing to take some kind of action

Action stage ndash Patient has begun implementing the change

Maintenance stage ndash Patient has made a change and is now working to maintain it

Take the example of an overweight patient Because the average weight of an individual in the United States has increased over the past few years some people who are overweight or borderline overweight donrsquot even realize it says Dr Evans Broach the subject gently and suggest a few small goals such as parking farther away from the office or shopping center or wearing a pedometer and working to increase the number of steps taken in a day You could also teach that patient how to read food labels and discuss healthier meal options Itrsquos about identifying the risk communicating the risk determining where your patient falls in the Stages of Change and then prescribing appropriate modifications explains Dr Evans ldquoAnd donrsquot forget to follow up with that patient at his or her next appointment Itrsquos important that he or she doesnrsquot lose confidence in your recommendations or in you as a healthcare providerrdquo he adds

GET INvOLvEDIn addition to discussions with patients in the treatment

Were Already There ndash Chiropractic and Public health hand-in-hand(contd on page 17)

spring 201417

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 16)

room there are many ways to incorporate public health into your practice One of the easiest ways to get involved is to participate in an observance that already exists such as the APHArsquos Public Health Week held the first week of every April (wwwaphaorgprogramshealthweek) or ACArsquos National Chiropractic Health Month (NCHM) celebrated every October These organizations come up with a new theme each year and gather all of the resources you need to participate ldquoIt takes the thinking and planning aspect off of the individual doctorrdquo says Dr Konarski-Hart ldquoAll you need to do is follow the instructions laid out by the parent organizationrdquo Additionally when you throw your hat into the ring on a larger issue or observance you know that the public health community is focused on that issue at that time so you can reach out to your county or state health department or other local healthcare associations and join in their efforts which will help you to build mutually beneficial long-term relationships says Dr Konarski-Hart ldquoMany state groups are underfunded and understaffed and they welcome participation particularly from physiciansrdquo she notes

DCs can also create their own observances ldquoACA offers webinars teleseminars and patient handouts on a variety of public health issuesmdashperuse the offerings and pick a topic to focus on for a week or a monthrdquo says Dr Konarski-Hart She suggests having your clinic sponsor a wellness competition or challenge You could partner with a local exercise facility or health foods store as well as a school or senior center and make it a community event You could also organize an eat well exercise club in which members meet for a walk or bike ride and then share a healthy breakfast or lunch Your practice could sponsor a poster contest at a local school or community center ldquoHave the kids create posters focused on healthy lifestyle choices and then give out prizes of fun healthy exercise such as a day of horseback riding or ice skatingrdquo Dr Konarski-Hart says Additionally your practice could sponsor a marathon participant or a local amateur sports team to show that you support healthy activities and active lifestyles

Similarly be informed about the public health issues in your community Maybe you live in an area with a high population of smokers or perhaps there have been numerous injuries due to not wearing a seatbelt in recent years Do some background research on these topics and then get involved whether that means simply providing patient handouts in your waiting room giving a community health talk participating in health fairs or working with your local health department (and other relevant organizations) to pass pertinent legislation

Look for organizations in your area that are already offering public health resources or programs and set up

a partnership with them For example for the topic of overweightobesity you could offer your clinic as a weigh-in site for participants in Weight Watchers programs suggests Dr Evans or partner with a local gym to give discounts to chiropractic patients Dr Bruns recommends getting involved with the school lunch program to advocate for healthy options for students For smoking cessation work with the American Lung Association to put on an informational presentation at a local hospital or sponsor a 5k or a stair run to raise awareness (and funds) for lung cancer research For drug addiction set up a referral network with psychologists or addiction centers and either offer acupuncture in your office or refer out to an acupuncturist as it has been shown to help patients through the detox process You can also use your knowledge of nutrition and exercise to facilitate the journey through detox says Dr Bruns

Additionally you should make a point to support these other organizations when they host local events (even if yoursquore not an official partner) or reach out for financial support ldquoI always participate in the American Cancer Societyrsquos golf tournament and I display their materials in my office as wellrdquo says Dr Bruns He also participates in the fundraising efforts of the American Heart Association and the American Lung Association on a regular basis ldquoItrsquos good for your patients and your community to see that you care about and support other healthcare organizationsrdquo he says

Another option for public health involvement is to join the APHArsquos Chiropractic Health Care Section Yoursquoll be informed on public health happenings have access to the latest information and research see what DCs are doing nationally and in other states on particular issues and even have the chance to give input and be involved in decision-making

CONCUSSIONConcussion prevention and treatment is one public health topic that is relevant to every patient population in every region of the United States ldquoWersquore seeing more concussions lately due in part to the number of children participating in contact sports the excessive training involved in these sports and the fact that most people arenrsquot aware of the symptoms and long-term risks of concussionsrdquo says Dr Konarski-Hart Helmets donrsquot actually provide protection against concussions either ldquoThe padding will protect the skull from fracture but because your brain is loose inside your skull it is not protected from impact or traumardquo she explains And with todayrsquos cultural emphasis on pushing through the pain wersquore starting to see more and more professional athletes coming forward with serious emotional psychological and neurological issues that are linked to multiple concussions in their past

spring 201418

As an EMT herself Dr Konarski-Hart attended an EMT convention in the summer of 2013 and heard a presentation from the Childrenrsquos Hospital of Arkansas on injury prevention After speaking with the presenters she discovered that they were having trouble getting buy-in from the allopathic community and she offered her services as a DC Since then Dr Konarski-Hart and the Arkansas Chiropractic Physicians Association (ACPA) have been working with the childrenrsquos hospital on various statewide projects dealing with all aspects of injury prevention One such program focuses on concussions

ldquoThrough this partnership we learned that Arkansas has not finalized its concussion protocols yet and we were able to get someone from our ACPA legislative team involved in that process to ensure chiropracticrsquos inclusion as an involved professionrdquo says Dr Konarski-Hart

Because of DCsrsquo knowledge and training itrsquos important for them to get involved with the concussion issue says Dr Bruns ldquoKnowing what we know about concussions we are doing a tremendous service to athletes and their families by completing pre-participation physicals and screenings and watching for signs and symptoms during participation as wellrdquo he says And itrsquos not just athletes who are suffering from concussions mdash itrsquos children who fall off a bike or a swing set or an older adult who slips on the ice

Itrsquos crucial for DCs to help disseminate information about concussions Whether you see concussion symptoms in a patient in your office or work with local sports teams you have the knowledge to serve as a local expert on the topic DCs can assess injured parties work with school administrators to create concussion protocols and push for legislation on standard concussion treatment says Dr Bruns

Kids parents coaches trainers and doctors all need to be aware of concussions and the potential risks involved with sustaining one or more ldquoItrsquos a matter of understanding the potential risks before making a decision to play in a game or to have a player sit out a game for examplerdquo says Dr Konarski-Hart

WErsquoRE ALREADY THEREAs DCs we focus on the biomechanics structure and function of the human body and we have a unique approach in that we look at the whole person in terms of nutrition flexibility blood flow and muscle and nervous tissue function says Dr Bruns ldquoThe chiropractic profession recognizes the importance of healthful eating nutritional support avoiding the bad habits of smoking and drinking alcohol and has been counseling patients on healthy lifestyles since long before it was fashionablerdquo

According to Dr Konarski-Hart simply choosing to be a doctor of chiropractic means that yoursquore involved in public health on some level because your goal is to make your patient healthier and therefore make your community healthier In other words DCs are already an integral part of public health

With the new health care emphasis on wellness and prevention many healthcare providers legislators insurance companies and government policy developers are focusing on how to offer access to these services especially in medically underserved rural areas or small towns Chiropractic representatives need to be part of those discussions to point out that in many of these communities DCs are already there providing that assessment counseling and care This representation is one of the functions of the ACA and state chiropractic associations and why your membership and involvement with these organizations is so critical says Dr Konarski-Hart

aCa neWs extraCERTIFIED CHIROPRACTIC WELLNESS SPECIALIST PROGRAMIn 2011 ACA began a partnership with the National Wellness Institute (NWI) a well respected organization recognized both inside and outside the chiropractic profession to offer a wellness certification program for DCs The 40-hour program will enable students to integrate principles of wellness coaching health promotion and disease prevention to their current practices Once the program is completed DCs will become Certified Chiropractic Wellness Specialists ldquoThe program was developed and launched by Dr Evans Cheryl Hawk DC PhD CHES and Mike Perko PhDmdashdoctors who are at the forefront of health promotion illness prevention and wellnessrdquo says Dr Bruns Originally the certification consisted of four different modules and DCs had to travel to select cities to participate in the weekend seminars However ACA quickly realized that it was difficult for DCs to get to these courses and decided to turn the program into an online certification NWI has taken the lead on this conversion

ACA RESOURCES Bookmark wwwacatoday orgpublichealth on your computer for quick and easy access to patient handouts references and research for presentations a calendar of national public health observances and other resources that have all been vetted by the ACA APHAWellness and Health Promotion Committee for use in your office Published in the March 2014 ACA news

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 17)

spring 201419

ASSOCIATES WANTED

Associate Wanted Starting base annual salary range is 50-60K plus additional monthly $500-2K in productivity compensation Benefits include MalpracticeMedical insurance CE Our care model uses the latest in Chiropractic Massage Physical Therapy Acupuncture and Nutritional medicine services South Bend is home to Notre Dame and a short drive to Chicago and Lake Michigan This is a good place to raise a family with good schools and a low cost of living Sendfax a letter of interest and resume to apintodcyahoocom or fax (574) 254-1652 Posted 11514

Chicagoland Associate Doctor Needed Busy office with multiple long term associates Family practice Thirty minutes to downtown Chicago Full timepart time paid vacation $26hour starting pay with periodic raises Proficient in the Thompson leg-check technique We are looking for someone who is ready and willing to blend with a very upbeat fun and positive staff Interested applicants should email their resume to infotrimbolichironet or fax to (219) 836-2344 wwwtrimbolichironet Posted 12914

Opportunity for Doctor to grow own practice with buyout of 40 year family practice in 2-5 years Located in North Central Indiana with easy access to Indianapolis and Chicago Wonderful area to raise a family good schools low crime slower pace of life Contact pdyer4hotmailcom Posted 2614

Associate Needed We are currently searching for an associate doctor to help us at the Osmon Chiropractic Center in Bloomington IN This would be a tremendous opportunity for a new graduate or anyone considering a possible change of location You will be working in a beautiful 2500 square foot state of the art clinic with 1 other doctor and a professional staff of 8 to assist you There will be only a small amount of practice building activities on your part because we will provide you with a practice representative who will do that for you You will enjoy the security of a known income and practice without the stress of practice overhead and staff management All you need to do is learn our system of patient managementmdashthe same system we all use in the office and work together as a team to get and keep our community under chiropractic care It is an exciting place to practice Send resume and cover letter to drosmonhotmailcom and please feel free to visit our website at wwwDrOsmoncom Posted 3314

EQUIPMENT FOR SALE

For SalemdashFutura 3000GT automatic X-ray film processor two 8x10 cassettes two 7x14 cassettes two 14x17 cassettes Xray film cabinet new film xray I D Imprinter amp infra red light for sale $80000 Mikephelps55attnet or call (765) 345-0224 Posted 92413

PRACTICES FOR SALE

Free North Manchester practice Collected gt$300000 in 2012 Drs Kelsey giving practice records and X-ray to DC who buys their building 302 W MainHwy 114 Appraised for $165000 last monthmdashyou can buy it for $145000 Closing office on 103013 so you must act soon for this opportunity (260) 568-4419 or office 260-982-4646 Posted 100213

DCS WANTED

Kauffman Chiropractic PC is looking for a full-time position to be filled October 2013 Successful 25+ years established company with physical therapy massage therapy and rehabilitation Enthusiastic ambitious doctor who is willing to learn is a must Must be proficient in Diversified Thompson and Distraction techniques Nice salary is offered Email resume to chirodancomcastnet Posted 82713

Fantastic opportunity for energetic success-oriented doctor excited to grow with us professionally Comes with ownership possibilities Learn to share chiropractic in your community Train in an established practice run on outstanding systems Great training and support for you with focus on exceptiional patient communication and care including chiropractic rehab and massage Send CV or resume to clarksvillespineandrehabinsightbbcom Contact Joseph Rogers Lousville Kentucky (812) 282-7500 Posted 1714

Career Opportunity ndash URGENT ASSOCIATE WANTED ndash PEORIA IL Work in a state of the art wellness center with upbeat and professional staff ready to support you Utilize chiropractic clinical nutrition and rehabilitation to manage a wide range of conditions Doctor must be bright outgoing enthusiastic and must have excellent clinical skills This is an opportunity you dont want to miss Designed for someone looking for a career not simply another job Extensive training and great income potential Invest in your future Send a resume to lfulleralignlifecom Posted 12414

Part Time DC needed for Gary IN office for DOT Certified Medical Exams and some Chiropractic beginning March 15 2014 NO STRESS NO BILLING No Overhead ndash No Headaches Easy hours (8 am - 5 pm - 2 dayswk) Continue in your own practice and make extra cash in our office or just work part-time for us Will tutor you and pay for your DOT Certification - work 2 daysweek ($25000) Will tutor you and pay for your DOT Certification ($50hr = $25000year for 2 daysweek) Contact Lynn Biese -Carroll DC at lbiesewirrcom or call (262) 515-2168 Posted 2614

Associate Needed ndash Bloomington Indiana Expanding practice in Bloomington Indiana is looking for full-time position to be filled Enthusiastic ambitious doctor is a must Must be proficient in Diversified and Low Force techniques rehab and physical therapy Practice is a very strong stable consistent referral based practice Salary and profit share of clinic are offered We will train and mentor in technique and all areas of patient compliance and success Send resume to Dr Fox 1710 West Third St Bloomington Indiana 47404 or email to jbfprodigynet Posted 21814

vACATION DOCTORS

Mobile Moje Chiropractic Dr Moje is available for vacation relief and office coverage Licensed in IN OH MI WI MN amp PA Specializing in maternity leave injuries and vacations Call or email for CV availability rates references and further information Contact Dr Moje at stephanmojegmailcom or (218) 205-6141 Posted 81613

indiana state ChirOPraCtiC assOCiatiOn Classifieds

Page 16: ISCA Spring Report 2014

spring 201416

Were already there ndash ChirOPraCtiC and PUBliC health hand-in-handBy Caitlin Lukacs from the March 2014 issue of ACA news

Public health is a popular buzz phrase in the healthcare arena but what exactly is it and how does chiropractic fit into it ldquoPublic health describes the overall wellbeing of the populacerdquo explains Richard Bruns DC past chairman of the American Chiropractic Associationrsquos (ACA) Wellness and Health Promotion Committee and ACA chairman of the Board of Governors ldquoAll public health issues have future implications for individuals as well as the publicrdquo

Public health encompasses habits and social norms such as smoking alcohol consumption obesity and the use of seatbelts as well as environmental issues such as clean water air quality and how livestock and agricultural practices affect the environment adds Will Evans DC PhD MCHES provost of the University of Western States Public health also includes health education and health promotion

ldquoPublic health and chiropractic go hand-in-handrdquo explains Karen Konarski-Hart DC DABCO FACO vice president of ACArsquos Council of Delegates and chairman of the American Public Health Association (APHA)Wellness and Health Promotion Committee ldquoDCs donrsquot practice in a vacuum they are interested in all aspects of a patientrsquos life that affect his or her health and wellbeing as well as how that person interacts in the healthcare community at largerdquo

Whether they identify it as public health or not all chiropractic physicians address public health issues when dealing with their patients For example when a new patient comes into your office you begin with a detailed history and an initial examination that includes not only taking vital signs but discussing tobacco and alcohol use and other behaviors that affect that patientrsquos health explains Dr Evans ldquoThis allows you to create an individual health-risk assessment based on his or her environment family history lifestyle etc and address public health issues such as tobacco use at the same timerdquo he says

BROACHING THE SUBjECTIt can sometimes be difficult to initiate conversations with patients about issues such as smoking or weight loss ldquoThe best place to address such topics is in your initial report of findings to the patientrdquo suggests Dr Evans ldquoYoursquove examined the patient and determined the cause of the pain or complaint that brought him or her into your office in the first place and now yoursquove got an opportunity to say lsquoI see some lifestyle-related issues that could be contributing to your pain or that could lead to other complaints down the roadrsquordquo

Yoursquore in a position to identify potential problems for your

patients says Dr Konarski-Hart ldquoThey may be setting themselves up for diabetes or cardiovascular disease or maybe they arenrsquot getting enough exercise mdash all of these things should be discussed as part of good primary carerdquo

You never want to force patients to make changes so yoursquoll need to assess their openness to addressing lifestyle changes first Simply ask them if theyrsquod be willing to discuss a healthier weight for example If they are you can let them know that you have multiple resources and partners in place to help them move forward

Dr Evans determines his patientsrsquo willingness to make lifestyle modifications by using the Stages of Change a common model of health behavior change The Stages of Change are

Pre-contemplator stage ndash Patient has no intention of making any changes in the next six months

Contemplator stage ndash Patient is considering a change within the next six months

Preparation stage ndash Patient has decided on a change and is preparing to take some kind of action

Action stage ndash Patient has begun implementing the change

Maintenance stage ndash Patient has made a change and is now working to maintain it

Take the example of an overweight patient Because the average weight of an individual in the United States has increased over the past few years some people who are overweight or borderline overweight donrsquot even realize it says Dr Evans Broach the subject gently and suggest a few small goals such as parking farther away from the office or shopping center or wearing a pedometer and working to increase the number of steps taken in a day You could also teach that patient how to read food labels and discuss healthier meal options Itrsquos about identifying the risk communicating the risk determining where your patient falls in the Stages of Change and then prescribing appropriate modifications explains Dr Evans ldquoAnd donrsquot forget to follow up with that patient at his or her next appointment Itrsquos important that he or she doesnrsquot lose confidence in your recommendations or in you as a healthcare providerrdquo he adds

GET INvOLvEDIn addition to discussions with patients in the treatment

Were Already There ndash Chiropractic and Public health hand-in-hand(contd on page 17)

spring 201417

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 16)

room there are many ways to incorporate public health into your practice One of the easiest ways to get involved is to participate in an observance that already exists such as the APHArsquos Public Health Week held the first week of every April (wwwaphaorgprogramshealthweek) or ACArsquos National Chiropractic Health Month (NCHM) celebrated every October These organizations come up with a new theme each year and gather all of the resources you need to participate ldquoIt takes the thinking and planning aspect off of the individual doctorrdquo says Dr Konarski-Hart ldquoAll you need to do is follow the instructions laid out by the parent organizationrdquo Additionally when you throw your hat into the ring on a larger issue or observance you know that the public health community is focused on that issue at that time so you can reach out to your county or state health department or other local healthcare associations and join in their efforts which will help you to build mutually beneficial long-term relationships says Dr Konarski-Hart ldquoMany state groups are underfunded and understaffed and they welcome participation particularly from physiciansrdquo she notes

DCs can also create their own observances ldquoACA offers webinars teleseminars and patient handouts on a variety of public health issuesmdashperuse the offerings and pick a topic to focus on for a week or a monthrdquo says Dr Konarski-Hart She suggests having your clinic sponsor a wellness competition or challenge You could partner with a local exercise facility or health foods store as well as a school or senior center and make it a community event You could also organize an eat well exercise club in which members meet for a walk or bike ride and then share a healthy breakfast or lunch Your practice could sponsor a poster contest at a local school or community center ldquoHave the kids create posters focused on healthy lifestyle choices and then give out prizes of fun healthy exercise such as a day of horseback riding or ice skatingrdquo Dr Konarski-Hart says Additionally your practice could sponsor a marathon participant or a local amateur sports team to show that you support healthy activities and active lifestyles

Similarly be informed about the public health issues in your community Maybe you live in an area with a high population of smokers or perhaps there have been numerous injuries due to not wearing a seatbelt in recent years Do some background research on these topics and then get involved whether that means simply providing patient handouts in your waiting room giving a community health talk participating in health fairs or working with your local health department (and other relevant organizations) to pass pertinent legislation

Look for organizations in your area that are already offering public health resources or programs and set up

a partnership with them For example for the topic of overweightobesity you could offer your clinic as a weigh-in site for participants in Weight Watchers programs suggests Dr Evans or partner with a local gym to give discounts to chiropractic patients Dr Bruns recommends getting involved with the school lunch program to advocate for healthy options for students For smoking cessation work with the American Lung Association to put on an informational presentation at a local hospital or sponsor a 5k or a stair run to raise awareness (and funds) for lung cancer research For drug addiction set up a referral network with psychologists or addiction centers and either offer acupuncture in your office or refer out to an acupuncturist as it has been shown to help patients through the detox process You can also use your knowledge of nutrition and exercise to facilitate the journey through detox says Dr Bruns

Additionally you should make a point to support these other organizations when they host local events (even if yoursquore not an official partner) or reach out for financial support ldquoI always participate in the American Cancer Societyrsquos golf tournament and I display their materials in my office as wellrdquo says Dr Bruns He also participates in the fundraising efforts of the American Heart Association and the American Lung Association on a regular basis ldquoItrsquos good for your patients and your community to see that you care about and support other healthcare organizationsrdquo he says

Another option for public health involvement is to join the APHArsquos Chiropractic Health Care Section Yoursquoll be informed on public health happenings have access to the latest information and research see what DCs are doing nationally and in other states on particular issues and even have the chance to give input and be involved in decision-making

CONCUSSIONConcussion prevention and treatment is one public health topic that is relevant to every patient population in every region of the United States ldquoWersquore seeing more concussions lately due in part to the number of children participating in contact sports the excessive training involved in these sports and the fact that most people arenrsquot aware of the symptoms and long-term risks of concussionsrdquo says Dr Konarski-Hart Helmets donrsquot actually provide protection against concussions either ldquoThe padding will protect the skull from fracture but because your brain is loose inside your skull it is not protected from impact or traumardquo she explains And with todayrsquos cultural emphasis on pushing through the pain wersquore starting to see more and more professional athletes coming forward with serious emotional psychological and neurological issues that are linked to multiple concussions in their past

spring 201418

As an EMT herself Dr Konarski-Hart attended an EMT convention in the summer of 2013 and heard a presentation from the Childrenrsquos Hospital of Arkansas on injury prevention After speaking with the presenters she discovered that they were having trouble getting buy-in from the allopathic community and she offered her services as a DC Since then Dr Konarski-Hart and the Arkansas Chiropractic Physicians Association (ACPA) have been working with the childrenrsquos hospital on various statewide projects dealing with all aspects of injury prevention One such program focuses on concussions

ldquoThrough this partnership we learned that Arkansas has not finalized its concussion protocols yet and we were able to get someone from our ACPA legislative team involved in that process to ensure chiropracticrsquos inclusion as an involved professionrdquo says Dr Konarski-Hart

Because of DCsrsquo knowledge and training itrsquos important for them to get involved with the concussion issue says Dr Bruns ldquoKnowing what we know about concussions we are doing a tremendous service to athletes and their families by completing pre-participation physicals and screenings and watching for signs and symptoms during participation as wellrdquo he says And itrsquos not just athletes who are suffering from concussions mdash itrsquos children who fall off a bike or a swing set or an older adult who slips on the ice

Itrsquos crucial for DCs to help disseminate information about concussions Whether you see concussion symptoms in a patient in your office or work with local sports teams you have the knowledge to serve as a local expert on the topic DCs can assess injured parties work with school administrators to create concussion protocols and push for legislation on standard concussion treatment says Dr Bruns

Kids parents coaches trainers and doctors all need to be aware of concussions and the potential risks involved with sustaining one or more ldquoItrsquos a matter of understanding the potential risks before making a decision to play in a game or to have a player sit out a game for examplerdquo says Dr Konarski-Hart

WErsquoRE ALREADY THEREAs DCs we focus on the biomechanics structure and function of the human body and we have a unique approach in that we look at the whole person in terms of nutrition flexibility blood flow and muscle and nervous tissue function says Dr Bruns ldquoThe chiropractic profession recognizes the importance of healthful eating nutritional support avoiding the bad habits of smoking and drinking alcohol and has been counseling patients on healthy lifestyles since long before it was fashionablerdquo

According to Dr Konarski-Hart simply choosing to be a doctor of chiropractic means that yoursquore involved in public health on some level because your goal is to make your patient healthier and therefore make your community healthier In other words DCs are already an integral part of public health

With the new health care emphasis on wellness and prevention many healthcare providers legislators insurance companies and government policy developers are focusing on how to offer access to these services especially in medically underserved rural areas or small towns Chiropractic representatives need to be part of those discussions to point out that in many of these communities DCs are already there providing that assessment counseling and care This representation is one of the functions of the ACA and state chiropractic associations and why your membership and involvement with these organizations is so critical says Dr Konarski-Hart

aCa neWs extraCERTIFIED CHIROPRACTIC WELLNESS SPECIALIST PROGRAMIn 2011 ACA began a partnership with the National Wellness Institute (NWI) a well respected organization recognized both inside and outside the chiropractic profession to offer a wellness certification program for DCs The 40-hour program will enable students to integrate principles of wellness coaching health promotion and disease prevention to their current practices Once the program is completed DCs will become Certified Chiropractic Wellness Specialists ldquoThe program was developed and launched by Dr Evans Cheryl Hawk DC PhD CHES and Mike Perko PhDmdashdoctors who are at the forefront of health promotion illness prevention and wellnessrdquo says Dr Bruns Originally the certification consisted of four different modules and DCs had to travel to select cities to participate in the weekend seminars However ACA quickly realized that it was difficult for DCs to get to these courses and decided to turn the program into an online certification NWI has taken the lead on this conversion

ACA RESOURCES Bookmark wwwacatoday orgpublichealth on your computer for quick and easy access to patient handouts references and research for presentations a calendar of national public health observances and other resources that have all been vetted by the ACA APHAWellness and Health Promotion Committee for use in your office Published in the March 2014 ACA news

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 17)

spring 201419

ASSOCIATES WANTED

Associate Wanted Starting base annual salary range is 50-60K plus additional monthly $500-2K in productivity compensation Benefits include MalpracticeMedical insurance CE Our care model uses the latest in Chiropractic Massage Physical Therapy Acupuncture and Nutritional medicine services South Bend is home to Notre Dame and a short drive to Chicago and Lake Michigan This is a good place to raise a family with good schools and a low cost of living Sendfax a letter of interest and resume to apintodcyahoocom or fax (574) 254-1652 Posted 11514

Chicagoland Associate Doctor Needed Busy office with multiple long term associates Family practice Thirty minutes to downtown Chicago Full timepart time paid vacation $26hour starting pay with periodic raises Proficient in the Thompson leg-check technique We are looking for someone who is ready and willing to blend with a very upbeat fun and positive staff Interested applicants should email their resume to infotrimbolichironet or fax to (219) 836-2344 wwwtrimbolichironet Posted 12914

Opportunity for Doctor to grow own practice with buyout of 40 year family practice in 2-5 years Located in North Central Indiana with easy access to Indianapolis and Chicago Wonderful area to raise a family good schools low crime slower pace of life Contact pdyer4hotmailcom Posted 2614

Associate Needed We are currently searching for an associate doctor to help us at the Osmon Chiropractic Center in Bloomington IN This would be a tremendous opportunity for a new graduate or anyone considering a possible change of location You will be working in a beautiful 2500 square foot state of the art clinic with 1 other doctor and a professional staff of 8 to assist you There will be only a small amount of practice building activities on your part because we will provide you with a practice representative who will do that for you You will enjoy the security of a known income and practice without the stress of practice overhead and staff management All you need to do is learn our system of patient managementmdashthe same system we all use in the office and work together as a team to get and keep our community under chiropractic care It is an exciting place to practice Send resume and cover letter to drosmonhotmailcom and please feel free to visit our website at wwwDrOsmoncom Posted 3314

EQUIPMENT FOR SALE

For SalemdashFutura 3000GT automatic X-ray film processor two 8x10 cassettes two 7x14 cassettes two 14x17 cassettes Xray film cabinet new film xray I D Imprinter amp infra red light for sale $80000 Mikephelps55attnet or call (765) 345-0224 Posted 92413

PRACTICES FOR SALE

Free North Manchester practice Collected gt$300000 in 2012 Drs Kelsey giving practice records and X-ray to DC who buys their building 302 W MainHwy 114 Appraised for $165000 last monthmdashyou can buy it for $145000 Closing office on 103013 so you must act soon for this opportunity (260) 568-4419 or office 260-982-4646 Posted 100213

DCS WANTED

Kauffman Chiropractic PC is looking for a full-time position to be filled October 2013 Successful 25+ years established company with physical therapy massage therapy and rehabilitation Enthusiastic ambitious doctor who is willing to learn is a must Must be proficient in Diversified Thompson and Distraction techniques Nice salary is offered Email resume to chirodancomcastnet Posted 82713

Fantastic opportunity for energetic success-oriented doctor excited to grow with us professionally Comes with ownership possibilities Learn to share chiropractic in your community Train in an established practice run on outstanding systems Great training and support for you with focus on exceptiional patient communication and care including chiropractic rehab and massage Send CV or resume to clarksvillespineandrehabinsightbbcom Contact Joseph Rogers Lousville Kentucky (812) 282-7500 Posted 1714

Career Opportunity ndash URGENT ASSOCIATE WANTED ndash PEORIA IL Work in a state of the art wellness center with upbeat and professional staff ready to support you Utilize chiropractic clinical nutrition and rehabilitation to manage a wide range of conditions Doctor must be bright outgoing enthusiastic and must have excellent clinical skills This is an opportunity you dont want to miss Designed for someone looking for a career not simply another job Extensive training and great income potential Invest in your future Send a resume to lfulleralignlifecom Posted 12414

Part Time DC needed for Gary IN office for DOT Certified Medical Exams and some Chiropractic beginning March 15 2014 NO STRESS NO BILLING No Overhead ndash No Headaches Easy hours (8 am - 5 pm - 2 dayswk) Continue in your own practice and make extra cash in our office or just work part-time for us Will tutor you and pay for your DOT Certification - work 2 daysweek ($25000) Will tutor you and pay for your DOT Certification ($50hr = $25000year for 2 daysweek) Contact Lynn Biese -Carroll DC at lbiesewirrcom or call (262) 515-2168 Posted 2614

Associate Needed ndash Bloomington Indiana Expanding practice in Bloomington Indiana is looking for full-time position to be filled Enthusiastic ambitious doctor is a must Must be proficient in Diversified and Low Force techniques rehab and physical therapy Practice is a very strong stable consistent referral based practice Salary and profit share of clinic are offered We will train and mentor in technique and all areas of patient compliance and success Send resume to Dr Fox 1710 West Third St Bloomington Indiana 47404 or email to jbfprodigynet Posted 21814

vACATION DOCTORS

Mobile Moje Chiropractic Dr Moje is available for vacation relief and office coverage Licensed in IN OH MI WI MN amp PA Specializing in maternity leave injuries and vacations Call or email for CV availability rates references and further information Contact Dr Moje at stephanmojegmailcom or (218) 205-6141 Posted 81613

indiana state ChirOPraCtiC assOCiatiOn Classifieds

Page 17: ISCA Spring Report 2014

spring 201417

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 16)

room there are many ways to incorporate public health into your practice One of the easiest ways to get involved is to participate in an observance that already exists such as the APHArsquos Public Health Week held the first week of every April (wwwaphaorgprogramshealthweek) or ACArsquos National Chiropractic Health Month (NCHM) celebrated every October These organizations come up with a new theme each year and gather all of the resources you need to participate ldquoIt takes the thinking and planning aspect off of the individual doctorrdquo says Dr Konarski-Hart ldquoAll you need to do is follow the instructions laid out by the parent organizationrdquo Additionally when you throw your hat into the ring on a larger issue or observance you know that the public health community is focused on that issue at that time so you can reach out to your county or state health department or other local healthcare associations and join in their efforts which will help you to build mutually beneficial long-term relationships says Dr Konarski-Hart ldquoMany state groups are underfunded and understaffed and they welcome participation particularly from physiciansrdquo she notes

DCs can also create their own observances ldquoACA offers webinars teleseminars and patient handouts on a variety of public health issuesmdashperuse the offerings and pick a topic to focus on for a week or a monthrdquo says Dr Konarski-Hart She suggests having your clinic sponsor a wellness competition or challenge You could partner with a local exercise facility or health foods store as well as a school or senior center and make it a community event You could also organize an eat well exercise club in which members meet for a walk or bike ride and then share a healthy breakfast or lunch Your practice could sponsor a poster contest at a local school or community center ldquoHave the kids create posters focused on healthy lifestyle choices and then give out prizes of fun healthy exercise such as a day of horseback riding or ice skatingrdquo Dr Konarski-Hart says Additionally your practice could sponsor a marathon participant or a local amateur sports team to show that you support healthy activities and active lifestyles

Similarly be informed about the public health issues in your community Maybe you live in an area with a high population of smokers or perhaps there have been numerous injuries due to not wearing a seatbelt in recent years Do some background research on these topics and then get involved whether that means simply providing patient handouts in your waiting room giving a community health talk participating in health fairs or working with your local health department (and other relevant organizations) to pass pertinent legislation

Look for organizations in your area that are already offering public health resources or programs and set up

a partnership with them For example for the topic of overweightobesity you could offer your clinic as a weigh-in site for participants in Weight Watchers programs suggests Dr Evans or partner with a local gym to give discounts to chiropractic patients Dr Bruns recommends getting involved with the school lunch program to advocate for healthy options for students For smoking cessation work with the American Lung Association to put on an informational presentation at a local hospital or sponsor a 5k or a stair run to raise awareness (and funds) for lung cancer research For drug addiction set up a referral network with psychologists or addiction centers and either offer acupuncture in your office or refer out to an acupuncturist as it has been shown to help patients through the detox process You can also use your knowledge of nutrition and exercise to facilitate the journey through detox says Dr Bruns

Additionally you should make a point to support these other organizations when they host local events (even if yoursquore not an official partner) or reach out for financial support ldquoI always participate in the American Cancer Societyrsquos golf tournament and I display their materials in my office as wellrdquo says Dr Bruns He also participates in the fundraising efforts of the American Heart Association and the American Lung Association on a regular basis ldquoItrsquos good for your patients and your community to see that you care about and support other healthcare organizationsrdquo he says

Another option for public health involvement is to join the APHArsquos Chiropractic Health Care Section Yoursquoll be informed on public health happenings have access to the latest information and research see what DCs are doing nationally and in other states on particular issues and even have the chance to give input and be involved in decision-making

CONCUSSIONConcussion prevention and treatment is one public health topic that is relevant to every patient population in every region of the United States ldquoWersquore seeing more concussions lately due in part to the number of children participating in contact sports the excessive training involved in these sports and the fact that most people arenrsquot aware of the symptoms and long-term risks of concussionsrdquo says Dr Konarski-Hart Helmets donrsquot actually provide protection against concussions either ldquoThe padding will protect the skull from fracture but because your brain is loose inside your skull it is not protected from impact or traumardquo she explains And with todayrsquos cultural emphasis on pushing through the pain wersquore starting to see more and more professional athletes coming forward with serious emotional psychological and neurological issues that are linked to multiple concussions in their past

spring 201418

As an EMT herself Dr Konarski-Hart attended an EMT convention in the summer of 2013 and heard a presentation from the Childrenrsquos Hospital of Arkansas on injury prevention After speaking with the presenters she discovered that they were having trouble getting buy-in from the allopathic community and she offered her services as a DC Since then Dr Konarski-Hart and the Arkansas Chiropractic Physicians Association (ACPA) have been working with the childrenrsquos hospital on various statewide projects dealing with all aspects of injury prevention One such program focuses on concussions

ldquoThrough this partnership we learned that Arkansas has not finalized its concussion protocols yet and we were able to get someone from our ACPA legislative team involved in that process to ensure chiropracticrsquos inclusion as an involved professionrdquo says Dr Konarski-Hart

Because of DCsrsquo knowledge and training itrsquos important for them to get involved with the concussion issue says Dr Bruns ldquoKnowing what we know about concussions we are doing a tremendous service to athletes and their families by completing pre-participation physicals and screenings and watching for signs and symptoms during participation as wellrdquo he says And itrsquos not just athletes who are suffering from concussions mdash itrsquos children who fall off a bike or a swing set or an older adult who slips on the ice

Itrsquos crucial for DCs to help disseminate information about concussions Whether you see concussion symptoms in a patient in your office or work with local sports teams you have the knowledge to serve as a local expert on the topic DCs can assess injured parties work with school administrators to create concussion protocols and push for legislation on standard concussion treatment says Dr Bruns

Kids parents coaches trainers and doctors all need to be aware of concussions and the potential risks involved with sustaining one or more ldquoItrsquos a matter of understanding the potential risks before making a decision to play in a game or to have a player sit out a game for examplerdquo says Dr Konarski-Hart

WErsquoRE ALREADY THEREAs DCs we focus on the biomechanics structure and function of the human body and we have a unique approach in that we look at the whole person in terms of nutrition flexibility blood flow and muscle and nervous tissue function says Dr Bruns ldquoThe chiropractic profession recognizes the importance of healthful eating nutritional support avoiding the bad habits of smoking and drinking alcohol and has been counseling patients on healthy lifestyles since long before it was fashionablerdquo

According to Dr Konarski-Hart simply choosing to be a doctor of chiropractic means that yoursquore involved in public health on some level because your goal is to make your patient healthier and therefore make your community healthier In other words DCs are already an integral part of public health

With the new health care emphasis on wellness and prevention many healthcare providers legislators insurance companies and government policy developers are focusing on how to offer access to these services especially in medically underserved rural areas or small towns Chiropractic representatives need to be part of those discussions to point out that in many of these communities DCs are already there providing that assessment counseling and care This representation is one of the functions of the ACA and state chiropractic associations and why your membership and involvement with these organizations is so critical says Dr Konarski-Hart

aCa neWs extraCERTIFIED CHIROPRACTIC WELLNESS SPECIALIST PROGRAMIn 2011 ACA began a partnership with the National Wellness Institute (NWI) a well respected organization recognized both inside and outside the chiropractic profession to offer a wellness certification program for DCs The 40-hour program will enable students to integrate principles of wellness coaching health promotion and disease prevention to their current practices Once the program is completed DCs will become Certified Chiropractic Wellness Specialists ldquoThe program was developed and launched by Dr Evans Cheryl Hawk DC PhD CHES and Mike Perko PhDmdashdoctors who are at the forefront of health promotion illness prevention and wellnessrdquo says Dr Bruns Originally the certification consisted of four different modules and DCs had to travel to select cities to participate in the weekend seminars However ACA quickly realized that it was difficult for DCs to get to these courses and decided to turn the program into an online certification NWI has taken the lead on this conversion

ACA RESOURCES Bookmark wwwacatoday orgpublichealth on your computer for quick and easy access to patient handouts references and research for presentations a calendar of national public health observances and other resources that have all been vetted by the ACA APHAWellness and Health Promotion Committee for use in your office Published in the March 2014 ACA news

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 17)

spring 201419

ASSOCIATES WANTED

Associate Wanted Starting base annual salary range is 50-60K plus additional monthly $500-2K in productivity compensation Benefits include MalpracticeMedical insurance CE Our care model uses the latest in Chiropractic Massage Physical Therapy Acupuncture and Nutritional medicine services South Bend is home to Notre Dame and a short drive to Chicago and Lake Michigan This is a good place to raise a family with good schools and a low cost of living Sendfax a letter of interest and resume to apintodcyahoocom or fax (574) 254-1652 Posted 11514

Chicagoland Associate Doctor Needed Busy office with multiple long term associates Family practice Thirty minutes to downtown Chicago Full timepart time paid vacation $26hour starting pay with periodic raises Proficient in the Thompson leg-check technique We are looking for someone who is ready and willing to blend with a very upbeat fun and positive staff Interested applicants should email their resume to infotrimbolichironet or fax to (219) 836-2344 wwwtrimbolichironet Posted 12914

Opportunity for Doctor to grow own practice with buyout of 40 year family practice in 2-5 years Located in North Central Indiana with easy access to Indianapolis and Chicago Wonderful area to raise a family good schools low crime slower pace of life Contact pdyer4hotmailcom Posted 2614

Associate Needed We are currently searching for an associate doctor to help us at the Osmon Chiropractic Center in Bloomington IN This would be a tremendous opportunity for a new graduate or anyone considering a possible change of location You will be working in a beautiful 2500 square foot state of the art clinic with 1 other doctor and a professional staff of 8 to assist you There will be only a small amount of practice building activities on your part because we will provide you with a practice representative who will do that for you You will enjoy the security of a known income and practice without the stress of practice overhead and staff management All you need to do is learn our system of patient managementmdashthe same system we all use in the office and work together as a team to get and keep our community under chiropractic care It is an exciting place to practice Send resume and cover letter to drosmonhotmailcom and please feel free to visit our website at wwwDrOsmoncom Posted 3314

EQUIPMENT FOR SALE

For SalemdashFutura 3000GT automatic X-ray film processor two 8x10 cassettes two 7x14 cassettes two 14x17 cassettes Xray film cabinet new film xray I D Imprinter amp infra red light for sale $80000 Mikephelps55attnet or call (765) 345-0224 Posted 92413

PRACTICES FOR SALE

Free North Manchester practice Collected gt$300000 in 2012 Drs Kelsey giving practice records and X-ray to DC who buys their building 302 W MainHwy 114 Appraised for $165000 last monthmdashyou can buy it for $145000 Closing office on 103013 so you must act soon for this opportunity (260) 568-4419 or office 260-982-4646 Posted 100213

DCS WANTED

Kauffman Chiropractic PC is looking for a full-time position to be filled October 2013 Successful 25+ years established company with physical therapy massage therapy and rehabilitation Enthusiastic ambitious doctor who is willing to learn is a must Must be proficient in Diversified Thompson and Distraction techniques Nice salary is offered Email resume to chirodancomcastnet Posted 82713

Fantastic opportunity for energetic success-oriented doctor excited to grow with us professionally Comes with ownership possibilities Learn to share chiropractic in your community Train in an established practice run on outstanding systems Great training and support for you with focus on exceptiional patient communication and care including chiropractic rehab and massage Send CV or resume to clarksvillespineandrehabinsightbbcom Contact Joseph Rogers Lousville Kentucky (812) 282-7500 Posted 1714

Career Opportunity ndash URGENT ASSOCIATE WANTED ndash PEORIA IL Work in a state of the art wellness center with upbeat and professional staff ready to support you Utilize chiropractic clinical nutrition and rehabilitation to manage a wide range of conditions Doctor must be bright outgoing enthusiastic and must have excellent clinical skills This is an opportunity you dont want to miss Designed for someone looking for a career not simply another job Extensive training and great income potential Invest in your future Send a resume to lfulleralignlifecom Posted 12414

Part Time DC needed for Gary IN office for DOT Certified Medical Exams and some Chiropractic beginning March 15 2014 NO STRESS NO BILLING No Overhead ndash No Headaches Easy hours (8 am - 5 pm - 2 dayswk) Continue in your own practice and make extra cash in our office or just work part-time for us Will tutor you and pay for your DOT Certification - work 2 daysweek ($25000) Will tutor you and pay for your DOT Certification ($50hr = $25000year for 2 daysweek) Contact Lynn Biese -Carroll DC at lbiesewirrcom or call (262) 515-2168 Posted 2614

Associate Needed ndash Bloomington Indiana Expanding practice in Bloomington Indiana is looking for full-time position to be filled Enthusiastic ambitious doctor is a must Must be proficient in Diversified and Low Force techniques rehab and physical therapy Practice is a very strong stable consistent referral based practice Salary and profit share of clinic are offered We will train and mentor in technique and all areas of patient compliance and success Send resume to Dr Fox 1710 West Third St Bloomington Indiana 47404 or email to jbfprodigynet Posted 21814

vACATION DOCTORS

Mobile Moje Chiropractic Dr Moje is available for vacation relief and office coverage Licensed in IN OH MI WI MN amp PA Specializing in maternity leave injuries and vacations Call or email for CV availability rates references and further information Contact Dr Moje at stephanmojegmailcom or (218) 205-6141 Posted 81613

indiana state ChirOPraCtiC assOCiatiOn Classifieds

Page 18: ISCA Spring Report 2014

spring 201418

As an EMT herself Dr Konarski-Hart attended an EMT convention in the summer of 2013 and heard a presentation from the Childrenrsquos Hospital of Arkansas on injury prevention After speaking with the presenters she discovered that they were having trouble getting buy-in from the allopathic community and she offered her services as a DC Since then Dr Konarski-Hart and the Arkansas Chiropractic Physicians Association (ACPA) have been working with the childrenrsquos hospital on various statewide projects dealing with all aspects of injury prevention One such program focuses on concussions

ldquoThrough this partnership we learned that Arkansas has not finalized its concussion protocols yet and we were able to get someone from our ACPA legislative team involved in that process to ensure chiropracticrsquos inclusion as an involved professionrdquo says Dr Konarski-Hart

Because of DCsrsquo knowledge and training itrsquos important for them to get involved with the concussion issue says Dr Bruns ldquoKnowing what we know about concussions we are doing a tremendous service to athletes and their families by completing pre-participation physicals and screenings and watching for signs and symptoms during participation as wellrdquo he says And itrsquos not just athletes who are suffering from concussions mdash itrsquos children who fall off a bike or a swing set or an older adult who slips on the ice

Itrsquos crucial for DCs to help disseminate information about concussions Whether you see concussion symptoms in a patient in your office or work with local sports teams you have the knowledge to serve as a local expert on the topic DCs can assess injured parties work with school administrators to create concussion protocols and push for legislation on standard concussion treatment says Dr Bruns

Kids parents coaches trainers and doctors all need to be aware of concussions and the potential risks involved with sustaining one or more ldquoItrsquos a matter of understanding the potential risks before making a decision to play in a game or to have a player sit out a game for examplerdquo says Dr Konarski-Hart

WErsquoRE ALREADY THEREAs DCs we focus on the biomechanics structure and function of the human body and we have a unique approach in that we look at the whole person in terms of nutrition flexibility blood flow and muscle and nervous tissue function says Dr Bruns ldquoThe chiropractic profession recognizes the importance of healthful eating nutritional support avoiding the bad habits of smoking and drinking alcohol and has been counseling patients on healthy lifestyles since long before it was fashionablerdquo

According to Dr Konarski-Hart simply choosing to be a doctor of chiropractic means that yoursquore involved in public health on some level because your goal is to make your patient healthier and therefore make your community healthier In other words DCs are already an integral part of public health

With the new health care emphasis on wellness and prevention many healthcare providers legislators insurance companies and government policy developers are focusing on how to offer access to these services especially in medically underserved rural areas or small towns Chiropractic representatives need to be part of those discussions to point out that in many of these communities DCs are already there providing that assessment counseling and care This representation is one of the functions of the ACA and state chiropractic associations and why your membership and involvement with these organizations is so critical says Dr Konarski-Hart

aCa neWs extraCERTIFIED CHIROPRACTIC WELLNESS SPECIALIST PROGRAMIn 2011 ACA began a partnership with the National Wellness Institute (NWI) a well respected organization recognized both inside and outside the chiropractic profession to offer a wellness certification program for DCs The 40-hour program will enable students to integrate principles of wellness coaching health promotion and disease prevention to their current practices Once the program is completed DCs will become Certified Chiropractic Wellness Specialists ldquoThe program was developed and launched by Dr Evans Cheryl Hawk DC PhD CHES and Mike Perko PhDmdashdoctors who are at the forefront of health promotion illness prevention and wellnessrdquo says Dr Bruns Originally the certification consisted of four different modules and DCs had to travel to select cities to participate in the weekend seminars However ACA quickly realized that it was difficult for DCs to get to these courses and decided to turn the program into an online certification NWI has taken the lead on this conversion

ACA RESOURCES Bookmark wwwacatoday orgpublichealth on your computer for quick and easy access to patient handouts references and research for presentations a calendar of national public health observances and other resources that have all been vetted by the ACA APHAWellness and Health Promotion Committee for use in your office Published in the March 2014 ACA news

Were Already There ndash Chiropractic and Public health hand-in-hand(contd from page 17)

spring 201419

ASSOCIATES WANTED

Associate Wanted Starting base annual salary range is 50-60K plus additional monthly $500-2K in productivity compensation Benefits include MalpracticeMedical insurance CE Our care model uses the latest in Chiropractic Massage Physical Therapy Acupuncture and Nutritional medicine services South Bend is home to Notre Dame and a short drive to Chicago and Lake Michigan This is a good place to raise a family with good schools and a low cost of living Sendfax a letter of interest and resume to apintodcyahoocom or fax (574) 254-1652 Posted 11514

Chicagoland Associate Doctor Needed Busy office with multiple long term associates Family practice Thirty minutes to downtown Chicago Full timepart time paid vacation $26hour starting pay with periodic raises Proficient in the Thompson leg-check technique We are looking for someone who is ready and willing to blend with a very upbeat fun and positive staff Interested applicants should email their resume to infotrimbolichironet or fax to (219) 836-2344 wwwtrimbolichironet Posted 12914

Opportunity for Doctor to grow own practice with buyout of 40 year family practice in 2-5 years Located in North Central Indiana with easy access to Indianapolis and Chicago Wonderful area to raise a family good schools low crime slower pace of life Contact pdyer4hotmailcom Posted 2614

Associate Needed We are currently searching for an associate doctor to help us at the Osmon Chiropractic Center in Bloomington IN This would be a tremendous opportunity for a new graduate or anyone considering a possible change of location You will be working in a beautiful 2500 square foot state of the art clinic with 1 other doctor and a professional staff of 8 to assist you There will be only a small amount of practice building activities on your part because we will provide you with a practice representative who will do that for you You will enjoy the security of a known income and practice without the stress of practice overhead and staff management All you need to do is learn our system of patient managementmdashthe same system we all use in the office and work together as a team to get and keep our community under chiropractic care It is an exciting place to practice Send resume and cover letter to drosmonhotmailcom and please feel free to visit our website at wwwDrOsmoncom Posted 3314

EQUIPMENT FOR SALE

For SalemdashFutura 3000GT automatic X-ray film processor two 8x10 cassettes two 7x14 cassettes two 14x17 cassettes Xray film cabinet new film xray I D Imprinter amp infra red light for sale $80000 Mikephelps55attnet or call (765) 345-0224 Posted 92413

PRACTICES FOR SALE

Free North Manchester practice Collected gt$300000 in 2012 Drs Kelsey giving practice records and X-ray to DC who buys their building 302 W MainHwy 114 Appraised for $165000 last monthmdashyou can buy it for $145000 Closing office on 103013 so you must act soon for this opportunity (260) 568-4419 or office 260-982-4646 Posted 100213

DCS WANTED

Kauffman Chiropractic PC is looking for a full-time position to be filled October 2013 Successful 25+ years established company with physical therapy massage therapy and rehabilitation Enthusiastic ambitious doctor who is willing to learn is a must Must be proficient in Diversified Thompson and Distraction techniques Nice salary is offered Email resume to chirodancomcastnet Posted 82713

Fantastic opportunity for energetic success-oriented doctor excited to grow with us professionally Comes with ownership possibilities Learn to share chiropractic in your community Train in an established practice run on outstanding systems Great training and support for you with focus on exceptiional patient communication and care including chiropractic rehab and massage Send CV or resume to clarksvillespineandrehabinsightbbcom Contact Joseph Rogers Lousville Kentucky (812) 282-7500 Posted 1714

Career Opportunity ndash URGENT ASSOCIATE WANTED ndash PEORIA IL Work in a state of the art wellness center with upbeat and professional staff ready to support you Utilize chiropractic clinical nutrition and rehabilitation to manage a wide range of conditions Doctor must be bright outgoing enthusiastic and must have excellent clinical skills This is an opportunity you dont want to miss Designed for someone looking for a career not simply another job Extensive training and great income potential Invest in your future Send a resume to lfulleralignlifecom Posted 12414

Part Time DC needed for Gary IN office for DOT Certified Medical Exams and some Chiropractic beginning March 15 2014 NO STRESS NO BILLING No Overhead ndash No Headaches Easy hours (8 am - 5 pm - 2 dayswk) Continue in your own practice and make extra cash in our office or just work part-time for us Will tutor you and pay for your DOT Certification - work 2 daysweek ($25000) Will tutor you and pay for your DOT Certification ($50hr = $25000year for 2 daysweek) Contact Lynn Biese -Carroll DC at lbiesewirrcom or call (262) 515-2168 Posted 2614

Associate Needed ndash Bloomington Indiana Expanding practice in Bloomington Indiana is looking for full-time position to be filled Enthusiastic ambitious doctor is a must Must be proficient in Diversified and Low Force techniques rehab and physical therapy Practice is a very strong stable consistent referral based practice Salary and profit share of clinic are offered We will train and mentor in technique and all areas of patient compliance and success Send resume to Dr Fox 1710 West Third St Bloomington Indiana 47404 or email to jbfprodigynet Posted 21814

vACATION DOCTORS

Mobile Moje Chiropractic Dr Moje is available for vacation relief and office coverage Licensed in IN OH MI WI MN amp PA Specializing in maternity leave injuries and vacations Call or email for CV availability rates references and further information Contact Dr Moje at stephanmojegmailcom or (218) 205-6141 Posted 81613

indiana state ChirOPraCtiC assOCiatiOn Classifieds

Page 19: ISCA Spring Report 2014

spring 201419

ASSOCIATES WANTED

Associate Wanted Starting base annual salary range is 50-60K plus additional monthly $500-2K in productivity compensation Benefits include MalpracticeMedical insurance CE Our care model uses the latest in Chiropractic Massage Physical Therapy Acupuncture and Nutritional medicine services South Bend is home to Notre Dame and a short drive to Chicago and Lake Michigan This is a good place to raise a family with good schools and a low cost of living Sendfax a letter of interest and resume to apintodcyahoocom or fax (574) 254-1652 Posted 11514

Chicagoland Associate Doctor Needed Busy office with multiple long term associates Family practice Thirty minutes to downtown Chicago Full timepart time paid vacation $26hour starting pay with periodic raises Proficient in the Thompson leg-check technique We are looking for someone who is ready and willing to blend with a very upbeat fun and positive staff Interested applicants should email their resume to infotrimbolichironet or fax to (219) 836-2344 wwwtrimbolichironet Posted 12914

Opportunity for Doctor to grow own practice with buyout of 40 year family practice in 2-5 years Located in North Central Indiana with easy access to Indianapolis and Chicago Wonderful area to raise a family good schools low crime slower pace of life Contact pdyer4hotmailcom Posted 2614

Associate Needed We are currently searching for an associate doctor to help us at the Osmon Chiropractic Center in Bloomington IN This would be a tremendous opportunity for a new graduate or anyone considering a possible change of location You will be working in a beautiful 2500 square foot state of the art clinic with 1 other doctor and a professional staff of 8 to assist you There will be only a small amount of practice building activities on your part because we will provide you with a practice representative who will do that for you You will enjoy the security of a known income and practice without the stress of practice overhead and staff management All you need to do is learn our system of patient managementmdashthe same system we all use in the office and work together as a team to get and keep our community under chiropractic care It is an exciting place to practice Send resume and cover letter to drosmonhotmailcom and please feel free to visit our website at wwwDrOsmoncom Posted 3314

EQUIPMENT FOR SALE

For SalemdashFutura 3000GT automatic X-ray film processor two 8x10 cassettes two 7x14 cassettes two 14x17 cassettes Xray film cabinet new film xray I D Imprinter amp infra red light for sale $80000 Mikephelps55attnet or call (765) 345-0224 Posted 92413

PRACTICES FOR SALE

Free North Manchester practice Collected gt$300000 in 2012 Drs Kelsey giving practice records and X-ray to DC who buys their building 302 W MainHwy 114 Appraised for $165000 last monthmdashyou can buy it for $145000 Closing office on 103013 so you must act soon for this opportunity (260) 568-4419 or office 260-982-4646 Posted 100213

DCS WANTED

Kauffman Chiropractic PC is looking for a full-time position to be filled October 2013 Successful 25+ years established company with physical therapy massage therapy and rehabilitation Enthusiastic ambitious doctor who is willing to learn is a must Must be proficient in Diversified Thompson and Distraction techniques Nice salary is offered Email resume to chirodancomcastnet Posted 82713

Fantastic opportunity for energetic success-oriented doctor excited to grow with us professionally Comes with ownership possibilities Learn to share chiropractic in your community Train in an established practice run on outstanding systems Great training and support for you with focus on exceptiional patient communication and care including chiropractic rehab and massage Send CV or resume to clarksvillespineandrehabinsightbbcom Contact Joseph Rogers Lousville Kentucky (812) 282-7500 Posted 1714

Career Opportunity ndash URGENT ASSOCIATE WANTED ndash PEORIA IL Work in a state of the art wellness center with upbeat and professional staff ready to support you Utilize chiropractic clinical nutrition and rehabilitation to manage a wide range of conditions Doctor must be bright outgoing enthusiastic and must have excellent clinical skills This is an opportunity you dont want to miss Designed for someone looking for a career not simply another job Extensive training and great income potential Invest in your future Send a resume to lfulleralignlifecom Posted 12414

Part Time DC needed for Gary IN office for DOT Certified Medical Exams and some Chiropractic beginning March 15 2014 NO STRESS NO BILLING No Overhead ndash No Headaches Easy hours (8 am - 5 pm - 2 dayswk) Continue in your own practice and make extra cash in our office or just work part-time for us Will tutor you and pay for your DOT Certification - work 2 daysweek ($25000) Will tutor you and pay for your DOT Certification ($50hr = $25000year for 2 daysweek) Contact Lynn Biese -Carroll DC at lbiesewirrcom or call (262) 515-2168 Posted 2614

Associate Needed ndash Bloomington Indiana Expanding practice in Bloomington Indiana is looking for full-time position to be filled Enthusiastic ambitious doctor is a must Must be proficient in Diversified and Low Force techniques rehab and physical therapy Practice is a very strong stable consistent referral based practice Salary and profit share of clinic are offered We will train and mentor in technique and all areas of patient compliance and success Send resume to Dr Fox 1710 West Third St Bloomington Indiana 47404 or email to jbfprodigynet Posted 21814

vACATION DOCTORS

Mobile Moje Chiropractic Dr Moje is available for vacation relief and office coverage Licensed in IN OH MI WI MN amp PA Specializing in maternity leave injuries and vacations Call or email for CV availability rates references and further information Contact Dr Moje at stephanmojegmailcom or (218) 205-6141 Posted 81613

indiana state ChirOPraCtiC assOCiatiOn Classifieds


Journal of ISca | May 2014 of ISca | May 2014 QuarterLY rePortInG ... How to Make SMPs ... 48 44 54. 4 IS Chartered Accountant THE SINGAPORE ACCOUNTANCY CONVENTION 2014

Journal of ISca | May 2014 of ISca | May 2014 QuarterLY rePortInG ... How to Make SMPs ... 48 44 54. 4 IS Chartered Accountant THE SINGAPORE ACCOUNTANCY CONVENTION 2014

ISCA Eastern Europe Sub-Committee Report  · Web viewon Eastern Europe ISCA International Affairs Committee. Report 2008. I. Introduction. The ISCA (“International Speech Communication

ISCA Eastern Europe Sub-Committee Report  · Web viewon Eastern Europe ISCA International Affairs Committee. Report 2008. I. Introduction. The ISCA (“International Speech Communication

Come Celebrate at ISCA Fall Fest · 2019. 10. 11. · Come Celebrate at ISCA Fall Fest Saturday, November 16, 2019 – 4:00 PM Indian Spring Terrace Park Join us for food, music,

Come Celebrate at ISCA Fall Fest · 2019. 10. 11. · Come Celebrate at ISCA Fall Fest Saturday, November 16, 2019 – 4:00 PM Indian Spring Terrace Park Join us for food, music,

ISCA 2014 | Heterogeneous System Architecture (HSA): Architecture and Algorithms Tutorial

ISCA 2014 | Heterogeneous System Architecture (HSA): Architecture and Algorithms Tutorial

ISCA Budget 2014 Update and its Tax Implications: Impact ...download.isca.org.sg/event/TAX2014.pdf1 ISCA Budget 2014 Update and its Tax Implications: Impact on Corporate Firms and

ISCA Budget 2014 Update and its Tax Implications: Impact ...download.isca.org.sg/event/TAX2014.pdf1 ISCA Budget 2014 Update and its Tax Implications: Impact on Corporate Firms and

ISCA 2019 Rulebook

ISCA 2019 Rulebook

CA FINAL ISCA

CA FINAL ISCA

TSOtool - ISCA presentation

TSOtool - ISCA presentation

Isca couple

Isca couple

ISCA Chap 9

ISCA Chap 9

Sustainability Reporting Implementation Roadmap - ISCA · eco-system, we hear issues from ... ISCA Sustainability Reporting Implementation Roadmap Below are the 6 phases of the ISCA

Sustainability Reporting Implementation Roadmap - ISCA · eco-system, we hear issues from ... ISCA Sustainability Reporting Implementation Roadmap Below are the 6 phases of the ISCA

ISCA Professional Business Accountant (ISCA PBA)...ISCA is the Designated Entity to confer the Chartered Accountant of Singapore - CA (Singapore) - designation. ISCA is a member of

ISCA Professional Business Accountant (ISCA PBA)...ISCA is the Designated Entity to confer the Chartered Accountant of Singapore - CA (Singapore) - designation. ISCA is a member of

Isca needle a_0610

Isca needle a_0610

ISCA PRE-BUDGET ROUNDTABLE 2014 · 4 ISCA PRE-BUDGET ROUNDTABLE REPORT 2014 INTEGRATED REPORTING – RESPONDING TO BUSINESS AND INVESTOR NEEDS1 1 The annual SME Survey conducted by

ISCA PRE-BUDGET ROUNDTABLE 2014 · 4 ISCA PRE-BUDGET ROUNDTABLE REPORT 2014 INTEGRATED REPORTING – RESPONDING TO BUSINESS AND INVESTOR NEEDS1 1 The annual SME Survey conducted by

ISCA: International Standard Cytogenomic Array (ISCA) … CGH 2009/David... · 2009. 7. 30. · David H. Ledbetter, Ph.D. david.ledbetter@emory.edu ISCA: International Standard Cytogenomic

ISCA: International Standard Cytogenomic Array (ISCA) … CGH 2009/David... · 2009. 7. 30. · David H. Ledbetter, Ph.D. [email protected] ISCA: International Standard Cytogenomic

ISCA ACCREDITED ACCOUNTING TECHNICIAN (ISCA-AAT) … · Upon successful completion of the ISCA-AAT qualification’s Professional level, the graduates will be eligible to apply for

ISCA ACCREDITED ACCOUNTING TECHNICIAN (ISCA-AAT) … · Upon successful completion of the ISCA-AAT qualification’s Professional level, the graduates will be eligible to apply for

ISCA 2015 ShiDianNao

ISCA 2015 ShiDianNao

Financial Forensic Accounting - ISCAIntroduction 1.1. The Institute of Singapore Chartered Accountants (ISCA) recognises that financial ... ISCA Financial Forensic Accounting (ISCA

Financial Forensic Accounting - ISCAIntroduction 1.1. The Institute of Singapore Chartered Accountants (ISCA) recognises that financial ... ISCA Financial Forensic Accounting (ISCA

ISCA GENERAL ASSEMBLY

ISCA GENERAL ASSEMBLY

ˆˇ˘˛ ˚ ˆ ˇ ˙ ˛ ISCA Pre-Budget roundtABle 2014 · FOCUS ˜˚˛˝˙ˆˇ˘˛ ˚ ˆ ˇ ˙ ˛ eld for the fifth consecutive year, the ISCA Pre-Budget Roundtable 2014 on 8 January

ˆˇ˘˛ ˚ ˆ ˇ ˙ ˛ ISCA Pre-Budget roundtABle 2014 · FOCUS ˜˚˛˝˙ˆˇ˘˛ ˚ ˆ ˇ ˙ ˛ eld for the fifth consecutive year, the ISCA Pre-Budget Roundtable 2014 on 8 January