After returning from its spring recess on Monday, the Senate quickly turned its attention to the Medicare fee schedule cuts.  In mid-March, the House passed a bill to delay the fee cuts until May 1.  The Senate has been debating that bill this week. On Wednesday, an amendment to the bill was presented that would delay the cuts until May 30.  The extension to the end of May would give Congress additional time to develop a longer-term solution to the proposed cuts.   If the delay until May 30 passes the Senate, the bill would have to return to the House for consideration. The House is already taking measures to swiftly pass the bill if it returns to its chamber.  House officials have indicated they could pass the bill by the end of the week. ACA will send out a notice to all members as soon as any final action is taken.

The NBCE Board of Directors has approved the move of public health exam content from the Microbiology and Public Health examination in the basic sciences battery of exams (Part I) to the Chiropractic Practice examination of clinical sciences series of exams (Part II).  The new Microbiology exam will be administered with the September 2010 Written Examinations, while the changes to the Chiropractic Practice exam will be instated with the March 2011 administration.  This change increases the weighting of the public health content of the NBCE exams, a change made to better reflect current chiropractic educational and practice standards and is based on a recent Delphi study that elicited feedback from chiropractic colleges on their curriculum.

The new Microbiology test plan weightings are:

The Council on Chiropractic Guidelines and Practice Parameters (CCGPP) is very pleased to announce that the literature syntheses published in JMPT have now been accepted for inclusion in the National Guideline Clearinghouse (NGC) and are available at www.guideline.gov. The NGC is a comprehensive database of evidence-based clinical practice guidelines and related documents. NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services.

This important recognition represents the culmination of a three-year effort by the best and brightest of chiropractic researchers reviewing and analyzing thousands of research articles in an effort to compile the most valid available clinical evidence. The CCGPP Scientific Commission is composed of dozens of doctors of chiropractic from around the United States and Canada and chaired by Dr. Cheryl Hawk. These doctors have donated thousands of hours of their time in this effort and deserve a resounding thank you from each and every doctor of chiropractic in this country. We would also like to recognize the countless number of people who logged in to the CCGPP site and provided valuable stakeholder input. Additionally, Dr. Claire Johnson, editor of JMPT, also deserves special recognition for the extraordinary assistance she provided in guiding CCGPP through the listing process.

“The CCGPP is very excited about the literature syntheses being accepted for inclusion by the National Guideline Clearinghouse”, said Dr. Mark Dehen, CCGPP Immediate Past Chair. “To have the CCGPP’s literature syntheses and treatment recommendations listed is a significant and historic step in our long-term Dissemination, Implementation, Evaluation and Revision (DIER) process. This level of acknowledgment will make these literature syntheses broadly available to all of our stakeholders, better educating them about the chiropractic profession and encouraging collaborative opportunities. More importantly, it will provide another avenue to make this information available to our chiropractic practitioners as they seek to continue to increase the quality of care they provide their patients.

According to the agency’s website, the NGC mission is to provide physicians, nurses, and other health professionals, health care providers, health plans, integrated delivery systems, purchasers and others an accessible mechanism for obtaining objective, detailed information on clinical practice guidelines and to further their dissemination, implementation and use.
The spectrum of evidence utilized ranged from randomized controlled trials to case series and consensus opinion. The draft documents were made available for stakeholder review and comment on the internet in an effort to improve the transparency and promote profession-wide input before these documents were published in a peer reviewed journal.

The chiropractic profession owes a tremendous debt of gratitude to Dr. Cheryl Hawk, current Commission Chair; Low Back Cochairs, Drs. Dana Lawrence and William Meeker; Low Back Consensus Chair, Dr. Gary Globe; Myofascial and Fibromyalgia Cochairs, Drs. Howard Vernon and Michael Schneider; Tendinopathy Chair Dr. Mark Pfefer; Lower Extremity Cochairs Drs. James Brantingham and Gary  Globe; as well as all of their teams and research assistants.  We also thank our previous Commission Chairs, Drs. Skip Lantz, Jay Triano and Al Adams, as well as our current and former Council members. We also would like to acknowledge our tremendous debt to all of our benefactors, most especially our former Vendor Representative, the late ChiroCode founder, D. Henry Leavitt.

On Saturday, April 3, 2010, 46 NYCC Doctor of Chiropractic graduates crossed the stage to receive their diplomas. John A. Catena, DC, (NYCC 1997) an instructor in NYCC’s Chiropractic Clinical Sciences offered the faculty greeting and John DeCicco, DC, (NYCC 1982) associate professor in the Chiropractic Clinical Sciences acted as Grand Marshall.  Rick McMichael, DC, F.A.C.C., F.I.C.C.delivered a commencement address that urged service. “I pray that you will find great success in loving service to your families, patients, communities, and our profession,” he said.  McMichael went on to explain that real happiness in life comes from serving others and making their lives more happy, more hopeful, more healthy and more productive.

Dr. McMichael is the current President of the American Chiropractic Association (ACA) and member of its Executive Committee.  He was appointed to a Department of Defense Oversight Advisory Committee to oversee implementation of chiropractic care within the Department of Defense.  He served on a similar Chiropractic Advisory Committee for the Department of Veterans Affairs at the request of the Secretary Anthony Principi to help ensure access by the nation’s active duty troops and veterans to the very best healthcare available.  Appointed by Governor Voinovich to serve on the Ohio Board of Chiropractic Examiners (now the Ohio State Chiropractic Board), Dr. McMichael has served the board eight years, two as its president.  Dr. McMichael also served as president and chairman of the Board of the Ohio State Chiropractic Association.

American College of Chiropractors Inductees
The commencement exercises also hosted formal induction of new fellows into the American College of Chiropractors. Inductees included Patrick M Casey, DC, staff doctor at Fort Carson’s Evans Army Community Hospital; Louis P. DiLorenzo, Esq., NYCC General Counsel and partner at Bond, Shoeneck and King;  Stephen Eble, DC (NYCC 1981), Chair of New York State Board for Chiropractic; and Karen Erickson, DC (NYCC 1988), member of NYCC Board of Trustees.

Regardless of what you think politically about health care reform, you have to be impressed with the inclusion of non-discrimination language in the bill that recently passed. 

On Tuesday, March 23, 2010, President Obama made history when he signed national healthcare reform legislation into law. Over the past year, Palmer College of Chiropractic has closely watched the healthcare reform debate and subsequent actions taken by Congress. Palmer administrators, faculty, staff, students and alumni have been working behind the scenes with government officials, other chiropractic organizations and at the grass-roots level for more than a year to facilitate chiropractic’s inclusion in healthcare reform legislation, and with the signing of this new law, these joint efforts have resulted in several provisions that are positive for chiropractic.

Historic Pro-Chiropractic Provisions Will Become Law

(Arlington, Va.) -- The U.S. House of Representatives passed HR 3590, the Senate-passed version of national health care reform legislation, tonight. The final vote took place after a nearly 13 month battle, culminating in a contentious struggle to garner votes from undecided members of the Democratic majority in Congress.

This means that the provisions contained in HR 3590 now only await President Obama’s signature to be enacted into law. These provisions include an important provider non-discrimination provision long championed by the American Chiropractic Association (ACA). Incorporation of this provider non-discrimination provision, also known as the “Harkin Amendment,” was achieved primarily due to the efforts of Sen. Tom Harkin (D-Iowa), with help from other key players such as Sen. Chris Dodd (D-Connecticut). Although he did not support the final bill overall, Sen. Orrin Hatch (R-Utah) also lent his support for the advancement of the non-discrimination provision.

“Regardless of how you feel about this legislation and its overall impact on the nation, it has to be recognized as an historic first for the chiropractic profession. We now have a federal law applicable to ERISA plans that makes it against the law for insurance companies to discriminate against Doctors of Chiropractic and other providers relative to their participation and coverage in health plans. Such discrimination based on a provider's license is inappropriate and now must stop,” said ACA president, Dr. Rick McMichael. “While this does not fully level the playing field for doctors of chiropractic in our health care system, this is a highly significant step that has the potential for positive, long-range impact on the profession and the patients we serve. Congress has finally addressed the issue of provider discrimination based on one's license, and they have said that such discrimination must stop.”

The provider non-discrimination provision (Section 2706) to be enacted into law reads in part: “A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.”

Regarding this provision, John Falardeau, ACA’s Vice President of Government Relations said, “The Harkin non-discrimination language will be applicable to all health benefit plans both insured and self-insured. National health care reform is designed to eventually cover 30 million currently uninsured Americans. The non-discrimination language will, over time, apply to those individuals as well. However, that number of covered individuals pales in comparison to the 55 percent of workers who are currently covered by self-insured plans that will be affected by the Harkin non-discrimination language. The potential impact in this regard cannot be overstated.”

Additionally, the legislation passed by the House includes two other provisions that impact the chiropractic profession. Doctors of chiropractic are specifically included as potential members of interdisciplinary community health teams. These teams support the development of medical homes by increasing access to comprehensive, community based, coordinated care. Community health teams are integrated teams of providers that include primary care providers, specialists, other clinicians, licensed integrative health professionals and community resources to enhance patient care, wellness and lifestyle improvements. The language in the bill ensures that doctors of chiropractic can be included in these patient-centered, holistic teams. Dr. McMichael noted, “This language was a critical inclusion to give doctors of chiropractic increased opportunities to be fully engaged as part of the health care team.”

Furthermore, the legislation establishes a National Health Care Workforce Commission to examine current and projected needs in the health care workforce. The commission specifically includes doctors of chiropractic by defining them as part of the health care workforce, and includes them in the definition of health professionals. In addition, chiropractic colleges are included among the health professional training schools to be studied. The National Health Care Workforce Commission is tasked with providing comprehensive, unbiased information to Congress and the Obama Administration about how to align federal health care workforce resources with national needs. Congress will use this information when providing appropriations to discretionary programs or in restructuring other federal funding. The language in the bill guarantees that the need for doctors of chiropractic will be addressed when considering federal health care workforce programs, another very important inclusion.

Assuming final modifications to the bill are ultimately agreed to by the Senate; ACA will then publish a detailed analysis of the entire legislation, including a timeline for when certain provisions become effective. Additionally, ACA will maintain an active watch over the implementation of the legislation over the next several years and will offer its views regarding proposed regulations that will likely be developed in order to fully implement the new law. ACA will also respond to any future legislation such as “technical corrections” and other modifications that might be considered. Dr. McMichael noted, “Our partners on the Chiropractic Summit were important team members in securing these critical inclusions for the benefit of our profession and our doctors. We thank all team members for their good collaborative work on this major effort and future efforts to come.”

March 16, 2010 — The American Chiropractic Association (ACA) Board of Governors today announced the hiring of William K. O’Connell as its new executive vice president. Connell succeeds Kevin Corcoran, who left the association in May 2009.

"After an exhaustive search, I am pleased to announce the appointment of Bill O’Connell as the association's next EVP. His extensive background in association leadership makes him a natural fit at the helm of ACA,” said Dr. Mario Spoto, chairman of ACA’s Board of Governors.

Most recently, O’Connell served as executive director of government affairs at the National Safety Council. His achievements there include gaining the support of congressional staff for authorization bills and appropriation initiatives, managing issues and key relationships with executive branch staff and appointees, and forging partnerships in coalitions of like-minded organizations to advance shared legislative interests.

Additionally, O’Connell has served as a senior executive with the American Board of Anesthesiology, the American Osteopathic Association and the American Dietetic Association, which has prepared him to face the challenges and opportunities that the chiropractic profession must address in the changing health care environment.

"I am very excited to welcome Mr. O’Connell to ACA and the chiropractic community,” said ACA President Dr. Rick McMichael. “His successful track record of creating partnerships and coalitions and working with legislators on the Hill will be a real asset to the ACA.”

Late Tuesday night, the President signed into law a bill that delays until March 31, 2010 the 21% Medicare fee cuts that were scheduled to take effect in 2010.  Further Congressional action will be necessary to stop the implemenation of these cuts for the remainder of the year.  Please contact your federal legislators in Washington today to urge them to take permanent action on this issue.

The Academic Consortium of Complementary and Alternative Medicine (ACCAHC) recently elected Horace Elliott to its board of directors.  The ACCAHC was formed in 2004 as part of a broad coalition of health care professionals and organizations driving public policy to ensure that all Americans have access to safe, high quality, integrated health care.
 
Elliott has been Executive Vice President of the National Board of Chiropractic Examiners (NBCE) since 1986.  Reporting to an 11-member board of directors, Elliott is responsible for the daily operations and finances of the NBCE, as well as the goals and policies of the organization.  Prior to the NBCE, Elliott held several executive management positions at companies such as the Bendix Corporation, and Price Waterhouse/Coopers in Houston. 
 
Elliott is a graduate of Lamar University in Beaumont, Texas.  He has received numerous awards including two honorary doctorate degrees, one from Texas Chiropractic College and another from the American College of Chiropractic.  Elliott is a fellow of the International College of Chiropractic.  In 2004, he received the George Arvidson Award for Meritorious Service to Chiropractic Licensure from the Federation of Chiropractic Licensing Boards.  
 
Elliott is actively involved in his hometown community of Greeley, Colorado, where he lives with his wife, Sue.  He has been an active member of the Greeley Chamber of Commerce, serving as Chamber representative to the Greeley Planning Commission, and the Greeley Rotary Club, where he previously served on the board of directors.

New York Chiropractic College received the “green light” to deliver its Master of Science in Applied Clinical Nutrition (MSACN) program completely online from the New York State Education Department.  The College plans to convert the nutrition curriculum to an online, distance-learning, Web-based format via Desire2Learn (D2L) by September 2010. 

NYCC’s MSACN program is uniquely structured to provide a comprehensive professional education that will prepare graduates for employment in a variety of settings including private practice, integrative practice with other professionals, research, and industry consulting.
NYCC Executive Vice President of Academic Affairs Michael Mestan, D.C., describes the new online initiative as “a successful team effort that significantly enhances practitioners’ skills and benefits patients.”

Designed for practicing chiropractors, current chiropractic students and all other qualified healthcare professionals (i.e., nurses, medical physicians, dentists, etc.), matriculants can complete this Masters level program entirely online in the comfort of their homes.

The online program, emphasizing an integrative and natural healthcare approach, distinguishes itself through an outstanding faculty, innovative and diverse curricula, and an emphasis on the applied use of clinical nutrition in disease prevention and management.  This sort of advanced training enables practitioners to expand existing practices, offer more comprehensive treatment, and augment their professional success through interventions that incorporate diet, exercise, nutritional supplementation, and life style modifications.

“We’re looking to teach healthcare practitioners who want to enhance their credentials and expand their practices by incorporating nutrition to address a myriad of health conditions,” explained Anna Kelles, PhD, director of the School of Applied Clinical Nutrition at NYCC, noting that nutrition is a fundamental building block in the success of all healthcare treatments.

“The most recent research (Neck Pain Task Force Report of the Bone and Joint Decade 2000-2010, a study sanctioned by the United Nations and the World Health Organization) indicates neck manipulation is a safe and effective form of health care,” according to Matt Pagano, DC, chiropractic profession spokesperson.

Respected researcher and epidemiologist J. David Cassidy, DC, PhD, DrMedSc, testified as a key witness last week at the hearings on informed consent before the Connecticut Board of Chiropractic Examiners in Hartford, Conn. Speaking as an expert witness and consultant to the International Chiropractors Association (ICA)—and with the support of all chiropractic organizations involved in the process, including the American Chiropractic Association, Association of Chiropractic Colleges, Foundation for Chiropractic Progress, Life West, New York College of Chiropractic, Parker College of Chiropractic, Palmer College of Chiropractic, and the University of Bridgeport College of Chiropractic—Dr. Cassidy addressed key facts and issues on the basis of the existing science and research record, to which he has been a significant contributor. The objective of his testimony was to bring the discussion from an emotional issue back to science and the objective research record.

Dr. Cassidy joined an extensive list of witnesses representing the chiropractic profession, including William J. Lauretti, DC; James J. Lehman, DC, MBA; J. Clay McDonald, DC, JD, MBA; Gerard W. Clum, DC; Stephen M. Perle, DC, MS; Gina Carucci, DC, MS, DICCP, who appeared on behalf of the Connecticut Chiropractic Association (CCA); and George Curry, DC, FICA, who appeared on behalf of the Connecticut Chiropractic Council (CCC).

“The chiropractic profession unequivocally supports a patient’s right to be informed of the material benefits and risks of any type of health care treatment – not just chiropractic. Legislation or regulatory mandates governing informed consent should apply to all health care providers and all treatments in equal measure. However, a new law, regulation or mandate highlighting one specific treatment by a specific health care profession, which carries with it an extremely rare association and no causal link identified in the research, is simply not good public health policy. It would set an unnecessary precedent for all health care providers, procedures and products that would be virtually impossible to implement,” said Pagano.

The existing informed consent standards in Connecticut allow for the best opportunity for shared decision making between a patient and his or her health care provider. Further, the chiropractic organizations participating in the hearing process all believe informed consent is more than a piece of paper; it is a process. It should occur in the context of a discussion between a doctor and a patient, and it should be appropriately documented.

In a finding highly relevant to the issue before the Connecticut Board of Chiropractic Examiners, the Neck Pain Task Force study demonstrated that patients suffering from headache and neck pain are no more likely to suffer from a stroke following a visit to a chiropractor than they are after a visit to a family medical physician. This implies that there are factors involved other than the type of care provided by doctors of chiropractic.  It’s important to note that millions of patients safely benefit from chiropractic care every year—they are able to return to their normal activities and enjoy a better quality of life.

Dr. Cassidy was an investigator with the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. The work of this international task force affirms the safety and benefits of chiropractic care for people with neck pain—a condition frequently treated by doctors of chiropractic. The Task Force initiated this new population-based, case-control and case-crossover study, which appeared in the Feb. 15, 2008 edition of the journal Spine.

The study, which analyzed nine years’ worth of data from a population of 110-million person years, concluded that vertebrobasilar artery (VBA) stroke is a very rare event and that the risk of VBA stroke following a visit to a chiropractor’s office appears to be no different than the risk of VBA stroke following a visit to the office of a primary care medical physician (PCP).

The study goes on to say that any observed association between VBA stroke and chiropractic manipulation—as well as its apparent association with PCP visits—is likely due to patients with an undiagnosed vertebral artery dissection seeking care for neck pain and headache prior to their stroke.

Over the years, popular media has all too often sensationalized the association between chiropractic cervical manipulation and cerebral vascular accidents—even though the evidence would strongly indicate that this assertion is incorrect. The organizations representing the chiropractic profession believe this most recent evidence should help to dispel any myths on this issue, as well as provide more data to support the safety and effectiveness of chiropractic procedures.

As a profession, doctors of chiropractic remain committed to expanding the research and clinical understanding of VBA injuries, because even one cerebral vascular incident that could have been prevented or detected early is one too many.

The Palmer Center for Chiropractic Research (PCCR) has undertaken a collaborative clinical trial to follow up on preliminary research indicating a specific form of chiropractic treatment can be effective in lowering blood pressure in hypertensive patients. This clinical trial involves 165 patients with high blood pressure and is called Chiropractic for Hypertension in Patients, or CHiP. Palmer is collaborating with Mount Sinai Medical Center, Miami, Fla., and Trinity at Terrace Park Family Practice, Bettendorf, Iowa. Potential participants will be examined at the PCCR clinic facility and Trinity Terrace Park Family Practice Clinic to determine eligibility. If accepted into the study, participants will be randomly assigned to one of three treatment groups, each receiving care at the Palmer Research Clinic for eight weeks. Participants will have their blood pressure monitored on a regular basis during the study.

“This study has the potential for significant impact on the treatment of hypertension,” said Palmer’s Vice Chancellor for Research and Health Policy and CHiP Co-leader Christine Goertz, D.C., Ph.D. “More than 50 million Americans suffer from high blood pressure, and although many medical treatments for diagnosed hypertension are available, only about 30% of patients achieve blood pressure goals. Many patients report that they are unable to tolerate medication side effects and find it difficult to sustain lifestyle changes. Thus, a non-pharmacological treatment that lowers blood pressure could become an attractive option to many patients and their physicians.”

Greeley, Colo.— Paul D. Townsend, D.C., the NBCE Director of Practical Testing Research and Development , is the lead author on an article published in the January 2010 issue of the journal Teaching and Learning in Medicine.  NBCE Director of Testing and Executive Vice President Mark G. Christensen also contributed to the article.

On Wednesday, Dec. 16, as part of the FY 2010 Defense appropriations bill, the House of Representatives passed legislation that would delay the 21 percent Medicare fee cuts until March 2010.  The Senate has yet to vote on this bill.  We urge members to contact your senators today, to ask them to stop the 21 percent Medicare fee cuts for 2010.  The Senate is expected to take a vote on this bill in the next few days, so your immediate action is needed.  Please visit the ACA Legislative Action Center  where you can create an e-mail message quickly and easily to send to your senators to tell them to block the implementation of these drastic fee cuts. A template e-mail is included at the Action Center.

Many providers are receiving notices that they must complete a Fraud, Waste and Abuse (FWA) training program from Medicare Advantage Plans.  In 2007, CMS regulations mandated that Medicare Advantage (MA) programs require MA providers to take a FWA training program once a year, beginning in 2009.   However, in response to concerns from the provider community, CMS has recently proposed to revise this requirement.  In the Oct. 22 Federal Register Proposed Rule, CMS stated that individuals who were enrolled as Medicare providers should not be required to complete the FWA training because it was redundant to the Medicare requirements for enrollment.  This proposal has not become a final regulation, but will most likely become final next year.  At this point, MA providers are required to take the FWA training. Many individual MA plans are offering their own FWA training courses.  An example of an available training course can be accessed here.