United Health Care used a faulty method to calculate risk costs and overcharged the state nearly $4 million for insuring the New York State Health Insurance Program (NYSHIP), according to an audit released today by State Comptroller Thomas P. DiNapoli. “United Health Care overcharged the state nearly $4 million,” DiNapoli said. “These days every dime counts and $4 million is a lot of taxpayer dimes. This practice must stop.” Civil Service Commissioner Nancy G. Groenwegen said, “This Department is constantly seeking ways to reduce premium costs to the State and local NYSHIP participants, and ultimately the taxpayers. We agree with the Comptroller and have begun negotiations with United Health Care to change the way it assesses and charges for the risks it undertakes.” New York State provides health insurance coverage to active and retired state, local government and school district employees. United Health Care is responsible for administering the medical/surgical and major medical portion of the Empire Plan, the primary health plan of NYSHIP. The New York State Department of Civil Service is responsible for overseeing the program. Auditors found that United Health Care was improperly calculating the amount it charged the state for insuring the risk associated with administering the Empire Plan. It is standard industry policy for insurance companies to charge employers for the risk of insuring their employees. United Health Care calculated its risk charge using gross premium costs rather than net, or actual, premium costs. For the last 20 years United Health Care has consistently overestimated gross premium payments the state must pay to cover anticipated costs and had to return money to the state. The three other insurance providers that administer the Empire Plan use actual costs to calculate the state’s risk charge. From 2004 to 2007, United Health Care charged the state $71.6 million for the risk associating with insuring the plan, which is $3.9 million more than if it had calculated the risk charge based on actual costs. Government Accountability The Office of the State Comptroller regularly audits state agencies, public authorities and New York City agencies. Auditors ensure that programs achieve their established goals, funds are used efficiently and assets are adequately protected against fraud, waste and abuse. DiNapoli’s office completes approximately 200 state audits annually and identifies hundreds of millions in savings and fraud each year. Click below for a copy of the audit.

NBCE HOSTS SIXTH ANNUAL STUDENT LEADERS LEADERSHIP FORUM Greeley, Colo.—The National Board of Chiropractic Examiners (NBCE) hosted 14 student leaders at the sixth annual student leadership forum on January 23, 2009. NBCE President Dr. Vernon Temple introduced students to an overview of the role of and the need for leaders to emerge at all professional levels in the chiropractic profession. Dr. Temple encouraged students to fill the important role of building unity and transparency within the chiropractic profession. He continued with a synopsis of the importance of trust, using important tenets from the book, At the Speed of Trust, which was given to each student at the end of their visit. Student leaders were given a complete overview and opportunities to ask questions concerning NBCE operations. Department overviews included: • Delphi studies, practice analysis, functions of test committees • Exams as a reflection of profession: Parts I and II reflect what is being taught; Parts III and IV reflect practice • Part III pilot testing • Part IV overview, including recent change in eligibility requirement • Test sites: security, role of TAs and ATAs, exam application processing, release of scores to state boards and examinee, test accommodations • International: worldwide growth, importance of standardized testing in helping profession gain worldwide credibility and acceptance, funding of chiropractic position at the World Health Organization • NBCE finances: budget development process, importance of forecasting future student enrollment, importance of restricted reserves, and funding agreement for the FCLB Attendees included: Student American Chiropractic Association (SACA) Officers: • Betsy Robinson, National Chair • Rachelle Mulford, National Vice Chair • Lance Cohen, National Legislative Chair • Daniel H. Bronstein, National Vice Legislative Chair American Black Chiropractic Association (ABCA) Representatives: • Micheala Edwards, National Student Representative • Norquita Johnson, Western Region Student Representative • Anthony Witherspoon, Southern Region Student Representative Student International Chiropractors Association (SICA) Representatives: • Clint Erickson, Congress Chair • Eva Sepulveda, Congress Vice-Chair • Stacy Land, Congress Secretary • Joanna Prokes, Congress Legislative Liaison World Congress of Chiropractic Students (WCCS) Representatives: • Ali Postles, Chair • Allison French, Regional Representative N. America West & Mexico • Sarah Hatherly, Regional Representative N. America East & Canada Headquartered in Greeley, Colo., the NBCE is the international testing organization for the chiropractic profession. Established in 1963, the NBCE develops, administers and scores legally defensible, standardized written and practical examinations for candidates seeking chiropractic licensure throughout the United States and in many foreign countries.

MVP Health Care is First Upstate, Non-Profit Insurer to Sign Agreement with Cuomo AG Also Issues Five-Day Notice to File Suit Against CDPHP for Consumer Fraud Attorney General Andrew M. Cuomo today announced the expansion of his historic reform of the nationwide healthcare reimbursement system to Upstate New York. Cuomo has reached an agreement with the Schenectady-based insurer MVP Health Care, Inc. in his ongoing drive to eliminate the defective and conflict-of-interest ridden Ingenix database and generate fair, out-of-network reimbursement rates for patients. Cuomo also announced that he has filed a five-day notice to file suit against another Upstate health insurer, Capital District Physician’s Health Plan (CDPHP), for failure to embrace these reforms. MVP, a non-profit health insurer that covers over 700,000 patients across Upstate New York and the East Coast, did not contribute data to Ingenix, but, like other insurers across the country, relied on the database to determine reimbursement rates for patients who went out of network. Despite not being a contributor, MVP has proactively agreed to embrace Cuomo’s reform efforts and end its relationship with Ingenix, becoming an industry-wide leader in the fight to ensure fair reimbursement rates for working families nationwide. “Companies like MVP that proactively embrace reform are an essential part of our continued momentum towards change that is nationwide and industry-deep,” said Attorney General Cuomo. “I commend MVP for being a true industry leader and hope that their forward-thinking actions today encourage others to follow suit. If they do not, as my notice to CDPHP today makes clear, this Office will not hesitate to bring legal action against anyone who was involved with Ingenix.” Earlier this month, Attorney General Cuomo announced sweeping reforms to end the manipulation of reimbursement rates at the expense of patients across the country. After a months-long investigation revealed that the health insurance industry relied on a faulty database to set rates, Cuomo reached groundbreaking agreements with UnitedHealth Group Inc. (NYSE: UNH), the owner of the Ingenix database and the second-largest insurer in the country, along with Aetna (NYSE: AET), the nation’s third-largest insurer. Attorney General Cuomo’s investigation concerned allegations that as a subsidiary of a major health insurer, Ingenix had a vested interest in setting rates low, so companies could underpay patients for out-of-network services. The investigation revealed that the database intentionally skewed “usual and customary” rates downward through faulty data collection, poor pooling procedures, and the lack of audits. That means many consumers were forced to pay more than they should have. The investigation found the rate of underpayment by insurers ranged from ten to twenty-eight percent for various medical services across the state. The Attorney General found that having a health insurer determine the “usual and customary” rate – a large portion of which the insurer then reimburses – creates an incentive for the insurer to manipulate the rate downward. The establishment of a new database, independently maintained by a nonprofit organization, is designed to remove this conflict of interest. In early January, Attorney General Cuomo announced the first settlement in his investigation with UnitedHealth, under which the database of billing information operated by Ingenix will close. United also agreed to pay $50 million to a qualified nonprofit organization that will establish a new, independent database to help determine fair out-of-network reimbursement rates for consumers throughout the United States. Cuomo has since reached an agreement with Aetna who will pay $20 million to the new database. Today’s agreement with MVP is the first involving a non-profit, upstate insurer and demonstrates the industry’s growing commitment to Cuomo’s reforms. Under the terms of the agreement: • MVP will cease using the Ingenix databases to calculate out-of-network reimbursement rates; • MVP will also amend their member disclosures to provide clearer information to its members about their method of determining reimbursement rates; • If MVP continues to promise its members that they will be reimbursed based on “usual and customary rates,” MVP will use the new database; • MVP will contribute $535,000 over a five-year period to help fund the new, independent database; • A nonprofit will own and operate the new database, and will be the sole arbiter and decision-maker with respect to all data contribution protocols and all other methodologies used in connection with the database; • The nonprofit will develop a website where, for the first time, consumers around the country can find out in advance how much they may be reimbursed for common out-of-network medical services in their area; • The nonprofit will make rate information from the database available to health insurers; • The nonprofit will use the new database to conduct academic research to help improve the health care system; • The nonprofit will be selected and announced at a future date Denise Gonick, MVP Health Care executive vice president and chief legal officer, said: “Like many other health insurers, MVP used the Ingenix database. We recognize the Attorney General’s concern about conflicts of interest inherent in the Ingenix database and appreciate his providing our industry with an independent process that is transparent and helps consumers make more informed health care purchasing decisions. MVP welcomes the opportunity to be the first upstate New York based health insurer to introduce this reform to our members, and believes that consumers and providers will be well-served by the joint effort that we are announcing today.” Dr. Nancy Nielsen, President of the American Medical Association, said: "We are encouraged that health insurers are stepping forward and recognizing the importance of restoring their damaged relationships with patients and physicians by committing to the creation of a new, independent database that will restore fair reimbursements. The American Medical Association commends MVP/Preferred Care for joining United Healthcare and Aetna by agreeing to the solution proposed by New York Attorney General Cuomo and calls upon other health insurers to do the same." Dr. Michael H. Rosenberg, President of the Medical Society of the State of New York, said: “Today’s announcement – that brings us another big step closer to achieving a major goal that the Medical Society of the State of New York and the American Medical Association have been working on since 2000. This agreement with MVP is particularly noteworthy because it will help to reduce the cost of out-of-network medical care for patients in this area, which has been impacted by the economic downturn. Efficient use of the healthcare dollar is particularly important to these New Yorkers today.” Chuck Bell, Programs Director for Consumers Union, said: “Attorney General Andrew Cuomo’s investigation of the health insurance industry has blown the cover on a massive, national problem in the out-of-network reimbursement system. Thanks to this investigation, we now know that many, many consumers are being grossly underpaid by their insurers when they go out of network to visit a physician or medical provider. We commend MVP Health Care for being an early leader in supporting a new independent nonprofit institute based in New York state that will collect and maintain data on out-of-network charges, and contributing half a million dollars to fund its work.” Cuomo also announced today that he has given CDPHP five-day notice of intent to sue for refusing to abandon the use of the Ingenix database and embrace reform. CDPHP is another non-profit insurer based in the Capital Region that insures 400,000 patients throughout 29 counties in New York State. The Attorney General’s five-day notice states that the Office intends to commence litigation against CDPHP in order to stop the unlawful acts and practices that they have engaged in and continue to engage in. It will also seek to obtain injunctive relief, restitution, damages, and civil penalties. The unlawful acts and practices complained of consist of engaging in repeated and persistent fraudulent, deceptive, and illegal business practices in connection with CDPHP’s continued use of the Ingenix databases for reimbursing members’ covered out-of-network services in New York State. The agreement announced today is the result of an investigation by Deputy Chief of the Health Care Bureau James E. Dering, Senior Trial Counsel Kathryn E. Diaz, and Assistant Attorneys General Brant Campbell and Sandra Rodriguez, under the direction of Linda A. Lacewell, the head of the Attorney General’s Healthcare Industry Taskforce. Earlier this month, Cuomo also issued a report on his investigation, “Health Care Report: The Consumer Reimbursement System is Code Blue.” The report highlights the conflicts of interest and other defects in the current system and calls for the reforms announced today. To access the report, get consumer tips for out-of-network care, or to file a complaint, please visit:

The National Board of Chiropractic Examiners (NBCE) Board of Directors recently voted to help sponsor a position in chiropractic at the headquarters of the World Health Organization (WHO) in Geneva, Switzerland. The position is the first chiropractic appointment ever established at the WHO and has been offered to Dr. Molly Meri Robinson as a mid-level technical officer, a non-treating physician. The NBCE joins the National Chiropractic Mutual Insurance Company, Foot Levelers, Standard Process and the World Federal of Chiropractic in financially supporting the first year of Dr. Robinson’s appointment. Dr. Robinson, a graduate of Northwestern Chiropractic College, previously served as National Legislative Chair for the Students of the American Chiropractic Association, as well as regional representative of the World Congress of Chiropractic Students. She was the first chiropractic intern to serve at the WHO, a position that resulted in the development of a permanent chiropractic position. NBCE President Dr. Vernon Temple announced the NBCE’s support, saying, “We are extremely proud of the dedication and prudent judgment shown by Dr. Robinson during her internship. The doors she has opened will help to lead the major paradigm shift currently taking place worldwide in chiropractic health care. Dr. Robinson’s presence in Geneva will serve as a constant reminder of the excellent education of chiropractors and their ability to serve as portal of entry physicians.” He said, “This is an excellent match for the NBCE as we develop the International Board of Chiropractic Examiner’s role in including chiropractic in national health care delivery systems.” The World Health Organization is the central clearinghouse for information on health care for 193 countries around the world. Because of the WHO’s importance in defining future health care policy, the NBCE Board of Directors chose to endorse and support the appointment of Dr. Robinson. She will represent the chiropractic profession in crafting policy that will consider non-pharmaceutical treatment, especially chiropractic, among treatment modalities. Headquartered in Greeley, Colo., the NBCE is the international testing organization for the chiropractic profession. Established in 1963, the NBCE develops, administers and scores legally defensible, standardized written and practical examinations for candidates seeking chiropractic licensure throughout the United States and in many foreign countries. For more information, please contact Joanne Monath, Director of Professional Relations and Communications at [email protected] or 970-356-9100 ext 119.

Researchers at the Palmer Center for Chiropractic Research (PCCR) clinic facility, 741 Brady St., Davenport, on the campus of Palmer College of Chiropractic, are looking for more than 200 people with low back pain in the Quad-City community to participate in a unique study. It focuses on the relationship between back pain and possible abnormal function of the supportive muscles in the back. The study begins Jan. 12. Participants must have low back pain and be between 21 and 65 years of age. This collaborative study between the Palmer Center for Chiropractic Research and the University of Iowa is one of three projects that are part of a four-year, $3.7 million grant from the National Institutes of Health National Center for Complementary and Alternative Medicine. This four-year grant was awarded to Principal Investigator Joel Pickar, D.C., Ph.D., at the Palmer Center for Chiropractic Research in 2007 to continue Palmer’s Developmental Center to Study Mechanisms and Effects of Chiropractic Manipulation. The clinical study beginning on Jan. 12 will help researchers determine whether one effect of chiropractic adjustments is a positive impact on muscle function in the low back. "We know that the back muscles are very important for movement and stability of the spine," said Palmer Vice Chancellor for Research and Health Policy Christine Goertz Choate, D.C., Ph.D., who is a co-leader for this study. "When people have back pain, it may be caused by problems in the muscles that attach to the vertebra and support the spine. We’re investigating how well people with back pain can control their muscles and whether chiropractic care can have an effect on muscle function. This work will eventually help us understand more about how chiropractic treatments work and ultimately lead to improved care for low back pain" According to the project’s other co-leader, David Wilder, Ph.D., Associate Professor of Biomedical Engineering at the University of Iowa, "Anyone who has been surprised by back pain resulting from unexpectedly stepping off a curb or from trying to pick up a squirming child in the back seat of a car understands the importance of proper muscle function." Dr. Wilder has collaborated with the PCCR for fourteen years, is a faculty member at Palmer and brings to the project thirty years of experience studying the response of the spine and trunk muscles to sitting, vibration and sudden loads. Potential participants will be examined at the PCCR clinic to determine whether they qualify for the study. If so, they will be randomly assigned to one of three different treatment groups. Members of each group will receive chiropractic care using three different adjusting techniques over a six-week period. At the beginning, middle and end of care, specialized measurements of body stability and muscle control will be taken. All examinations and treatment are provided at no charge to the patient. Anyone interested in participating in the study should contact the PCCR clinic facility at (563) 884-5188.

A Randomized Controlled Trial ABSTRACT Context Neither supervised treadmill exercise nor strength training for patients with peripheral arterial disease (PAD) without intermittent claudication have been established as beneficial. Objective To determine whether supervised treadmill exercise or lower extremity resistance training improve functional performance of patients with PAD with or without claudication. Design, Setting, and Participants Randomized controlled clinical trial performed at an urban academic medical center between April 1, 2004, and August 8, 2008, involving 156 patients with PAD who were randomly assigned to supervised treadmill exercise, to lower extremity resistance training, or to a control group. Main Outcome Measures Six-minute walk performance and the short physical performance battery. Secondary outcomes were brachial artery flow-mediated dilation, treadmill walking performance, the Walking Impairment Questionnaire, and the 36-Item Short Form Health Survey physical functioning (SF-36 PF) score. Results For the 6-minute walk, those in the supervised treadmill exercise group increased their distance walked by 35.9 m (95% confidence interval [CI], 15.3-56.5 m; P < .001) compared with the control group, whereas those in the resistance training group increased their distance walked by 12.4 m (95% CI, –8.42 to 33.3 m; P = .24) compared with the control group. Neither exercise group improved its short physical performance battery scores. For brachial artery flow-mediated dilation, those in the treadmill group had a mean improvement of 1.53% (95% CI, 0.35%-2.70%; P = .02) compared with the control group. The treadmill group had greater increases in maximal treadmill walking time (3.44 minutes; 95% CI, 2.05-4.84 minutes; P < .001); walking impairment distance score (10.7; 95% CI, 1.56-19.9; P = .02); and SF-36 PF score (7.5; 95% CI, 0.00-15.0; P = .02) than the control group. The resistance training group had greater increases in maximal treadmill walking time (1.90 minutes; 95% CI, 0.49-3.31 minutes; P = .009); walking impairment scores for distance (6.92; 95% CI, 1.07-12.8; P = .02) and stair climbing (10.4; 95% CI, 0.00-20.8; P = .03); and SF-36 PF score (7.5; 95% CI, 0.0-15.0; P = .04) than the control group. Conclusions Supervised treadmill training improved 6-minute walk performance, treadmill walking performance, brachial artery flow-mediated dilation, and quality of life but did not improve the short physical performance battery scores of PAD participants with and without intermittent claudication. Lower extremity resistance training improved functional performance measured by treadmill walking, quality of life, and stair climbing ability. Click on the link below to read the full article:

The U.S. Department of Health and Human Services today released an updated and improved version of the Surgeon General’s Internet-based family health history tool. The new tool makes it easier for consumers to assemble and share family health history information. It can also help practitioners make better use of health history information so they can provide more informed and personalized care for their patients. “This valuable tool can put family histories to work to improve patient well-being and the quality of care,” HHS Secretary Mike Leavitt said. “The tool is built on health information technology standards that make it more convenient for consumers and more useful for practitioners. It is ready for use in electronic health records. And its software code will be openly available to other health organizations, so they can customize and build on its standards base.” “Family history has always been an important part of good health care, but it has been underused,” said Acting Surgeon General Steven Galson, a rear admiral in the U.S. Public Health Service. “Today, with our growing knowledge of genetics, family history is becoming even more important. The new tool will help consumers and clinicians alike. It will also serve as a platform for developing new risk assessment software that will help in screening and prevention of cancer, heart disease, diabetes, and other conditions.” Key features of the new version of the Surgeon General’s My Family Health Portrait include: ---Convenience – Consumers can access the tool easily on the Web. Completing the family health history profile typically takes 15-20 minutes. Consumers should not have to keep filling out different health history forms for different practitioners. Information is easily updated or amended. ---Consumer control and privacy – The family health history tool gives consumers access to software that builds a family health tree. But the personal information entered during the use of the tool is not kept by a government or other site. Consumers download their information to their own computer. From there, they have control over how the information is used. ---Sharing – Because the information is in electronic form, it can be easily shared with relatives or with practitioners. Relatives can add to the information, and a special re-indexing feature helps relatives easily start their own history based on data in a history they received. Practitioners can help consumers understand and use their information. ---EHR-ready, Decision support-ready – Because the new tool is based on commonly used standards, the information it generates is ready for use in electronic health records and personal health records. It can be used in developing clinical decision software, which helps the practitioner understand and make the most use of family health information. ---Personalization of care – Family history information can help alert practitioners and patients to patient-specific susceptibilities. ---Downloadable, customizable – The code for the new tool is openly available for others to adopt. Health organizations are invited to download and customize, using the tool under their own brand and adding features that serve their needs. Developers may also use the code to create new risk assessment software tools. The first adopter of the HHS-developed tool is the National Institute of Genomic Medicine of Mexico (INMEGEN). Dr. Gerardo Jimenez-Sanchez, director general of the institute, will release the Mexican Spanish-language version of the tool in Mexico City this month. The Mexican family health history tool will be available on the INMEGEN Web site, http://www.inmegen.gob.mx. The Indian Health Service, an agency of HHS that was instrumental in developing the new Surgeon General tool, will also adopt it into the IHS care system. One organization saying it will link to the new tool is the Lance Armstrong Foundation (LAF), a cancer advocacy organization. “A strong family health history tool can be an important element for guiding medical decision-making, especially in the area of cancer screening, prevention and early detection,” said LAF founder and chairman Lance Armstrong. “This tool will further the capabilities of electronic health records and takes a significant step toward improving clinical care.” The Surgeon General’s My Family Health Portrait was originally launched in 2004, but the first version was not standards-based. The new tool was developed under Secretary Leavitt’s Initiative on Personalized Health Care. It will be hosted by the National Cancer Institute, where the caBIG® initiative is pioneering health IT networks and software sharing. A ready process for organizations to download the family health history code is at https://gforge.nci.nih.gov/projects/fhh. The Surgeon General’s new My Family Health Portrait tool is located at https://familyhistory.hhs.gov. In addition, a presentation of sample risk assessment tools under development can be viewed at http://videocast.nih.gov/summary.asp?live=7297.

Industry-Wide Reform of Reimbursement System Will End Conflicts of Interest and Create Fair Rates for Consumers Nationwide NEW YORK, NY (January 13, 2009) – Attorney General Andrew M. Cuomo today announced historic reform of the nationwide health care reimbursement system that will end conflicts of interest and generate fair reimbursement rates for working families nationwide. Cuomo has reached an agreement with UnitedHealth Group Inc. (NYSE: UNH) (“United”), the nation’s second largest health insurer, after conducting an industry-wide investigation into a scheme to defraud consumers by manipulating reimbursement rates. At the center of the scheme is Ingenix, Inc. (“Ingenix”), a wholly-owned subsidiary of United, which is the nation’s largest provider of health care billing information. Under the agreement with United, the database of billing information operated by Ingenix will close. United will pay $50 million to a qualified nonprofit organization that will establish a new, independent database to help determine fair out-of-network reimbursement rates for consumers throughout the United States. “For the past ten years, American patients have suffered from unfair reimbursements for critical medical services due to a conflict-ridden system that has been owned, operated, and manipulated by the health insurance industry. This agreement marks the end of that flawed system,” said Attorney General Cuomo. “As working families throughout our nation struggle with the burden of health care costs, we will make sure that health insurers keep their promise to pay their fair share. The industry reforms that we announce today will bring crucial accuracy, transparency, and independence to a broken system. During these tough economic times, this agreement will keep hundreds of millions of dollars in the pockets of over one hundred million Americans.” In February 2008, the Attorney General announced an industry-wide investigation into allegations that health insurers unfairly saddle consumers with too much of the cost of out-of-network health care. Seventy percent of insured working Americans pay higher premiums for insurance plans that allow them to use out-of-network doctors. In exchange, insurers often promise to cover up to eighty percent of the “usual and customary” rate of the out-of-network expenses, and consumers are responsible for paying the balance of the bill. United and the largest health insurers in the country rely on the United-owned Ingenix database to determine their “usual and customary” rates. The Ingenix database uses the insurers’ billing information to calculate “usual and customary” rates for individual claims by assessing how much the same, or similar, medical services would typically cost, generally taking into account the type of service and geographical location. Under this system, insurers control reimbursement rates that are supposed to fairly reflect the market. Attorney General Cuomo’s investigation concerned allegations that the Ingenix database intentionally skewed “usual and customary” rates downward through faulty data collection, poor pooling procedures, and the lack of audits. That means many consumers were forced to pay more than they should have. The investigation found the rate of underpayment by insurers ranged from ten to twenty-eight percent for various medical services across the state. The Attorney General found that having a health insurer determine the “usual and customary” rate – a large portion of which the insurer then reimburses – creates an incentive for the insurer to manipulate the rate downward. The creation of a new database, independently maintained by a nonprofit organization, is designed to remove this conflict of interest. Under Attorney General Cuomo’s agreement with United: ---United will pay $50 million to establish a new, independent database run by a qualified nonprofit organization; ---The nonprofit will own and operate the new database, and will be the sole arbiter and decision-maker with respect to all data contribution protocols and all other methodologies used in connection with the database; ---The nonprofit will develop a website where, for the first time, consumers around the country can find out in advance how much they may be reimbursed for common out-of-network medical services in their area; ---The nonprofit will make rate information from the database available to health insurers; ---The nonprofit will use the new database to conduct academic research to help improve the health care system; ---The nonprofit will be selected and announced at a future date. In February 2008, Cuomo also announced that he had issued subpoenas to the nation’s largest health insurance companies that use the Ingenix database, including Aetna (NYSE: AET), CIGNA (NYSE: CI), and WellPoint/Empire BlueCross BlueShield (NYSE: WLP). The Attorney General’s industry-wide investigation is ongoing. Cuomo continued, “Our agreement with United removes the conflicts of interest that have been inherent in the consumer reimbursement system. This has been an industry-wide problem, and it demands an industry-wide reform. We commend United for leading the industry on this issue, and we encourage other insurers to follow suit.” Cuomo was joined by representatives from United and from leading medical and consumer organizations in making today’s announcement at the Saint Vincent Catholic Medical Center in Manhattan. “We are committed to increasing the amount of useful information available in the health care marketplace so that people can make informed decisions, and this agreement is consistent with that approach and philosophy,” said Thomas L. Strickland, Executive Vice President and Chief Legal Officer of UnitedHealth Group. “We are pleased that a not-for-profit entity will play this important role for the marketplace.” President of the American Medical Association (AMA), Nancy Nielsen, M.D., said, “Today, patients and physicians prevailed over health insurance giant UnitedHealth Group when New York Attorney General Cuomo stopped the insurer from using a rigged Ingenix database that increased insurer profits at the expense of patients and physicians. The AMA appreciates the leadership of Attorney General Cuomo in initiating his investigation into the Ingenix database, and fully supports the Attorney General’s actions to have a nonprofit entity create a new, reliable database that is fair to patients and physicians.” President of the Medical Society of the State of New York (MSSNY) Michael H. Rosenberg, M.D., said, “We thank Attorney General Cuomo for taking decisive action to finally achieve one of the major goals of a lawsuit that the Medical Society of the State of New York initiated with two other medical societies over eight years ago. Because of the thorough research and diligent negotiation of Mr. Cuomo and his expert staff, patients and their physicians will no longer be subject to inadequate out-of-network payments determined by the flawed Ingenix database.” Consumers Union Programs Director Chuck Bell said, “Consumers Union greatly appreciates the care that Attorney General Cuomo and his staff have taken in investigating these issues, and creating the careful architecture in this settlement. This is an extremely sensible, fair solution, which will be of great benefit for consumers nationwide. We appreciate the fact that United Healthcare has come to the table to resolve these issues in a comprehensive way, and we hope that other insurance companies will quickly get on board, and strongly support this excellent plan to improve transparency for out-of-network charges.” Consumers Union is the nonprofit publisher of Consumer Reports. Today, Cuomo also issued a report on his investigation, “Health Care Report: The Consumer Reimbursement System is Code Blue.” The report highlights the conflicts of interest and other defects in the current system and calls for the reforms announced today. It can be accessed at reimbursement rates. The agreement announced today is the result of an investigation by Deputy Chief of the Health Care Bureau James E. Dering, Senior Trial Counsel Kathryn E. Diaz, and Assistant Attorneys General Brant Campbell and Sandra Rodriguez, under the direction of Linda A. Lacewell, the head of the Attorney General’s Healthcare Industry Taskforce. The Attorney General expressed his appreciation to Steven E. Fineman, Esq., of Lieff Cabraser Heimann & Bernstein, LLP, for his pro bono services in this matter. For more information, including consumer tips for out-of-network care, or to file a complaint, please visit reimbursement rates.

BLOOMINGTON, Minn. – Northwestern Health Sciences University’s practice management program for chiropractic students was jump-started in 1985 by the late William Harris, DC, a long-time benefactor of Northwestern, and Jim McDonald, MBA, Northwestern’s current vice president for administrative affairs and chief administrative officer. Now, 23 years later, the program is called Business and Professional Foundations and is part of the curriculum for chiropractic students for nine trimesters. At the end of the fall 2008 trimester, McDonald turned over his remaining class (T9) to Terry Erickson, DC, associate professor and department chair of the Business and Professional Foundations Program. “I like what McDonald did with his classes – I won’t be changing much,” says Dr. Erickson. “I will be looking to him for guidance and getting his help to make a smooth transition.” “The Business and Professional Foundations Program is intended to help new graduates get off on the right foot, and convert theory into reality,” says Jerry Peterson, business owner and guest lecturer in Northwestern Health Sciences University’s Business and Professional Foundations Program. “Successful chiropractors are not only skilled in their craft, but are also lively business persons. They need to have the ability to promote and manage a business all while also providing quality service to patients.” Dave Neubauer, DC, a Northwestern graduate who lectures in the program, says, “There is nothing else like this program in the United States. Other schools are following in Northwestern’s footsteps, but Northwestern jump-started the program. They are getting students prepared for the real world. Because of McDonald, the practice management program has been a success.” The main thing McDonald will miss about teaching is the contact with the students. He says, “I really liked having the luxury of interacting with students and being around young people. I enjoyed my years of teaching.” Northwestern Health Sciences University offers a wide array of choices in natural health care education including chiropractic, Oriental medicine, acupuncture, therapeutic massage and human biology. The University has nearly 900 students on a 25-acre campus in Bloomington, Minnesota.

BLOOMINGTON, Minn. – Northwestern Health Sciences University is working with the Volunteers of America of Minneapolis, Minn., to provide more accessible natural health care to the elderly in the community. Volunteers of America has provided $150,000 to Northwestern’s Wolfe-Harris Center for Clinical Studies to produce a one-of-a-kind project, focusing on the organization’s services for the elderly. According to Roni Evans, MS, DC, dean of research at Northwestern, this is more of a demonstration project versus a research study. She says, “The primary goal is to determine the feasibility of developing a sustainable and replicable model for providing integrated chiropractic, acupuncture and massage services for Volunteers of America’s elderly residents.” According to Dr. Evans, the integrated services will be offered to elderly residents with varying degrees of impaired physical and mental function. Some of the residents are in transitional care and are expected to return to their own homes; others are in assisted living, long-term care, or memory care. “Everybody is working very hard so that we can begin offering services to Volunteers of America residents by the end of January 2009,” says Dr. Evans. There are several things to be accomplished before services are offered. According to Dr. Evans, “Among the most important is learning more about the Volunteers of America’s facilities and how we may best help them meet their needs in caring for their elderly residents. We are also spending time educating Volunteers of America personnel about the types of services our care providers can provide, and learning what we need to do to fit into the Volunteers of America system,” she says. Kristine Westrom, MD, associate professor at Northwestern, says “The Volunteers of America funded this pilot project because they believed treatment with acupuncture, Oriental medicine, chiropractic and massage could positively affect the lives of geriatric patients; especially regarding pain, sleep, medication use, balance, strength and function.” Mark Zeigler, DC, president at Northwestern, believes that having a set of standards will help to “show how effective natural health care can be in providing treatment to the aging population.” The educational programs at Northwestern will benefit from this knowledge and will strengthen the programs at the University. The expected completion date of the project is December, 2010. For some people, it might be hard to focus for such a long period of time on one project, but Dr. Evans is continually inspired by this one. She says, “I’m inspired by finding ways to meet the needs of patients. If we can establish viable integrated models of care, and then evaluate their effectiveness, I think we will come closer to having our professions meet their full potential in serving society’s needs.” Northwestern Health Sciences University offers a wide array of choices in natural health care education including chiropractic, Oriental medicine, acupuncture, therapeutic massage and human biology. The University has nearly 900 students on a 25-acre campus in Bloomington, Minnesota.

ABSTRACT Research on physical activity and health has pointed clearly to increasing the time that adults spend doing moderate-to-vigorous intensity activities: 30 minutes a day is generally recommended. Recent evidence, however, underlines the importance of also focusing on sedentary behaviours -- the high volumes of time that adults spend sitting in their remaining ‘non-exercise’ waking hours. In the context of contemporary interest in physical activity and health, we provide a brief overview of recent evidence for the distinct relationships between ‘too much sitting’ and biomarkers of metabolic health, and thus with increased risk of type 2 diabetes, cardiovascular disease and other prevalent chronic health problems. Particular concerns for this new field include the challenges of changing sedentary behaviours in the context of ubiquitous environmental and social drivers of sitting time; examining the effects of interventions for reducing or breaking-up sitting time; and, identifying the most-relevant implications for clinical and public health practice.

Abstract Background Physical inactivity is associated with several diseases, but studies evaluating the association between chronic musculoskeletal complaints (MSCs) and physical exercise have shown conflicting results. The aim of this large-scale prospective population-based study was to investigate the association between self-reported physical exercise at baseline and the prevalence of chronic musculoskeletal complaints (MSCs) 11 years later. Methods The results are based upon two consecutive public health studies conducted within the county of Nord-Trondelag, Norway (The HUNT studies). A total of 39,520 (83%) out of 47,556 adults who participated in HUNT 1 and HUNT 2 responded to questions about physical exercise at baseline in 1984-86, and to questions about musculoskeletal complaints 11 years later (1995-97). Chronic MSCs was defined as MSCs >3 months during the past year, and chronic widespread MSCs such as pain > 15 days during the last month from the axial region, above the waist, and below the waist. Associations were assessed using multiple logistic regression, estimating prevalence odds ratio (OR) with 95 % confidence intervals (CIs). All the final analyses were adjusted for age, gender, body mass index, smoking and education level. Results At follow-up 20,223 (51%) reported chronic MSCs, and among these 2,318 (5.9%) reported chronic widespread MSCs. Individuals who exercised at baseline were less likely to report chronic MSCs 11 years later (OR 0.91, 95 % CI 0.85-0.97) than inactive persons. Among individuals who exercised more than three times per week, chronic widespread MSCs were 28% less common (OR 0.72, 95% CI 0.59-0.88) compared to inactive individuals. Conclusions In this large-scale population-based study, physical exercise was associated with lower prevalence of chronic MSCs, in particular chronic widespread MSCs. Future studies should try to clarify whether chronic MSCs are a cause or a consequence of inactivity. Holth HS, et al. BMC Musculoskeletal Disorders. 2008:

Approximately 38 percent of adults in the United States aged 18 years and over and nearly 12 percent of U.S. children aged 17 years and under use some form of complementary and alternative medicine (CAM), according to a new nationwide government survey(1). This survey marks the first time questions were included on children's use of CAM, which is a group of diverse medical and health care systems, practices, and products such as herbal supplements, meditation, chiropractic, and acupuncture that are not generally considered to be part of conventional medicine. The survey, conducted as part of the 2007 National Health Interview Survey (NHIS), an annual study in which tens of thousands of Americans are interviewed about their health- and illness-related experiences, was developed by the National Center for Complementary and Alternative Medicine (NCCAM), a part of the National Institutes of Health (NIH) and the National Center for Health Statistics (NCHS), a part of the Centers for Disease Control and Prevention (CDC). The survey included questions on 36 types of CAM therapies commonly used in the United States—10 types of provider-based therapies, such as acupuncture and chiropractic, and 26 other therapies that do not require a provider, such as herbal supplements and meditation. "The 2007 NHIS provides the most current, comprehensive, and reliable source of information on Americans' use of CAM," said Josephine P. Briggs, M.D., director of NCCAM. "These statistics confirm that CAM practices are a frequently used component of Americans' health care regimens, and reinforce the need for rigorous research to study the safety and effectiveness of these therapies. The data also point out the need for patients and health care providers to openly discuss CAM use to ensure safe and coordinated care." The 2007 survey results, released in a National Health Statistics Report by NCHS, are based on data from more than 23,300 interviews with American adults and more than 9,400 interviews with adults on behalf a child in their household. The 2007 survey is the second conducted by NCCAM and NCHS—the first was done as part of the 2002 NHIS(2). CAM Use Among Adults Comparison of the data from the 2002 and 2007 surveys suggests that overall use of CAM among adults has remained relatively steady—36 percent in 2002 and 38 percent in 2007. However, there has been substantial variation in the use of some specific CAM therapies, such as deep breathing, meditation, massage therapy, and yoga, which all showed significant increases. The most commonly used CAM therapies among U.S. adults were --Nonvitamin, nonmineral, natural products (17.7 percent) Most common: fish oil/omega 3/DHA, glucosamine, echinacea, flaxseed oil or pills, and ginseng(3) --Deep breathing exercises (12.7 percent) --Meditation (9.4 percent) --Chiropractic or osteopathic manipulation (8.6 percent) --Massage (8.3 percent) --Yoga (6.1 percent) Adults used CAM most often to treat pain including back pain or problems, neck pain or problems, joint pain or stiffness/other joint condition, arthritis, and other musculoskeletal conditions. Adult use of CAM therapies for head or chest colds showed a marked decrease from 2002 to 2007 (9.5 percent in 2002 to 2.0 percent in 2007). Consistent with results from the 2002 data, in 2007 CAM use among adults was greater among: --Women (42.8 percent, compared to men 33.5 percent) --Those aged 30-69 (30-39 years: 39.6 percent, 40-49 years: 40.1 percent, 50-59 years: 44.1 percent, 60-69 years: 41.0 percent) --Those with higher levels of education (Masters, doctorate or professional: 55.4 percent) --Those who were not poor (poor: 28.9 percent, near poor: 30.9 percent, not poor: 43.3 percent) --Those living in the West (44.6 percent) --Those who have quit smoking (48.1 percent) CAM Use Among Children Overall, CAM use among children is nearly 12 percent, or about 1 in 9 children. Children are five times more likely to use CAM if a parent or other relative uses CAM. Other characteristics of adult and child CAM users are similar—factors such as socioeconomic status, geographic region, the number of health conditions, the number of doctor visits in the last 12 months, and delaying or not receiving conventional care because of cost are all associated with CAM use. Among children who used CAM in the past 12 months, CAM therapies were used most often for back or neck pain, head or chest colds, anxiety or stress, other musculoskeletal problems, and Attention Deficit/Hyperactivity Disorder (ADD/ADHD). The most commonly used CAM therapies among children were --Nonvitamin, nonmineral, natural products (3.9 percent) --Most common: echinacea, fish oil/omega 3/DHA, combination herb pill, flaxseed oil or pills, and prebiotics or probiotics --Chiropractic or osteopathic manipulation (2.8 percent) --Deep breathing exercises (2.2 percent) --Yoga (2.1 percent) "The survey results provide information on trends and a rich set of data for investigating who in America is using CAM, the practices they use, and why," said Richard L. Nahin, Ph.D., MPH, acting director of NCCAM's Division of Extramural Research and co-author of the National Health Statistics Report. "Future analyses of these data may help explain some of the observed variation in the use of individual CAM therapies and provide greater insights into CAM use patterns among Americans." Inclusion and development of the 2007 supplement was supported, in part, by seven National Institutes of Health components: NCCAM; National Heart, Lung, and Blood Institute; National Institute of Allergy and Infectious Diseases; National Institute of Mental Health; the Eunice Kennedy Shriver National Institute of Child Health and Human Development; Office of Dietary Supplements; and Office of Behavioral and Social Sciences Research. 1.--Barnes PM, Bloom B, Nahin R. CDC National Health Statistics Report #12. Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007. December 10, 2008. 2.--Barnes P, Powell-Griner E, McFann K, Nahin R. CDC Advance Data Report #343. Complementary and Alternative Medicine Use Among Adults: United States, 2002. May 27, 2004. 3.--While the reference period for overall use of nonvitamin, nonmineral, natural products was for the past 12 months, the reference period for the use of specific nonvitamin, nonmineral, natural products was reduced from 12 months in 2002, to 30 days in 2007 in order to be more congruent with other national surveys of dietary supplement use, such as the National Health and Nutrition Examination Survey.

In a joint statement issued today by the Palmer College of Chiropractic Board of Trustees and Chancellor Larry Patten, Mr. Patten has announced his resignation and retirement from his role with the College, effective December 31, 2008. This announcement comes following Mr. Patten’s five-year tenure with Palmer College, which included his role as Board Business Coordinator beginning in late 2003 until his appointment as Chief Executive Officer in February 2006 and, finally, Chancellor in February 2007. “While I will greatly miss Palmer College and everyone associated with it, the future of Palmer College is in great hands with the current administrative team and the Board of Trustees,” said Mr. Patten. “With the institution being in such a strong, stable position and well positioned to move ahead for even more success, I am comfortable and confident that now is the right time for this transition.” His departure will allow him to focus on World Leadership Institute (WLI), a company he founded in 1997. World Leadership Institute helps organizations and individuals set strategic direction as well as helps individuals develop their personal leadership skills. “I’ve spent a great deal of time and effort over the years developing the programs available through WLI and now I will be able to devote all of my time to seeing them produce positive results for organizations and individuals,” said Mr. Patten. “It was always my hope to complete my career in this effort. I am especially excited about our programs that are designed to help young people become champions.” As part of the statement, the Board noted that, under Mr. Patten’s leadership and direction, nearly all of the major issues that existed at Palmer when he became Chancellor have been favorably resolved. “It has been an absolute privilege to serve as Chancellor of Palmer College,” said Mr. Patten. “I’ve been honored to work with so many excellent people ranging from the outstanding Board of Trustees to the superb administrative team to the talented, committed faculty and staff.” “On behalf of the Board of Trustees, I want to express deep appreciation for Mr. Patten’s dedication and devotion to Palmer, to chiropractic and to the leadership that he has provided to Palmer over the past five years,” said Dr. Trevor Ireland, chairman of the Palmer Board. “We truly understand his motivation to pursue his lifelong dream and focus on WLI. We wish him great success.” With today’s announcement, the Board of Trustees is implementing a short-term plan for maintaining the current growth and stability within the organization. A long-term plan, which will include a search process for identifying a new chancellor, is being developed. More information will be shared on this as efforts progress.

(Arlington, Va.) -- The American Chiropractic Association (ACA) today announced that it has rolled out the pilot phase of its patient advocacy network enabling an initial group of nearly 400 doctors of chiropractic to introduce their patients to a specially-designed Internet portal. This preliminary phase will ensure the network’s full functionality prior to its official launch on Jan. 5, 2009. The advocacy network is one piece in an ambitious campaign to mobilize chiropractic patients and supporters in a coordinated effort to lobby Congress and the new Obama administration in support of Americans' expanded access to services provided by doctors of chiropractic. The national grassroots campaign will utilize modern electronic methods to quickly and effectively deploy chiropractic’s voice when needed on Capitol Hill. In making the announcement to ACA’s House of Delegates, association President Glenn Manceaux, DC, said the best way to ensure a positive outcome for chiropractic in national health care and Medicare reform is to mobilize the grassroots power and influence of chiropractic patients. “Strengthening the voice of chiropractic will positively impact not only our patients, but all aspects of our profession,” Dr. Manceaux said. “ACA recognizes that there are many stakeholders in the profession: practitioners and their staff members, students, faculty, product and service vendors, trade media, and especially, our patients. Using ACA’s advocacy network, we hope to engage as many of these groups as possible because each has a constituency that responds uniquely to its respective call to action. “To ensure that the profession’s goal of full-scope inclusion becomes a reality, ACA is not only providing leadership to this initiative but is also collaborating with those organizations involved in the Chiropractic Summit,” he continued. All doctors of chiropractic will receive special instructions and information about ways they and their patients can participate in the campaign via the January issue of ACA News. Further, the ACA will promote the program through ongoing conference calls with state chiropractic associations, and in January will host a series of teleseminars open to all doctors of chiropractic to share additional information and answer questions. ACA officials assure doctors that data collection efforts will be fully HIPAA compliant and that patient information will not be shared with any third parties. Association leaders laid the groundwork for this project nearly two years ago when the House of Delegates approved a new association management system, capable of housing a national database of patient contact information that can be matched with individual members of Congress. The patient mobilization campaign was developed over the last several months by the ACA Board of Governors, Legislative Commission, and Political Action Committee (PAC) Board. Details were finalized during a joint Legislative Commission-PAC meeting at ACA headquarters Nov. 14-15, 2008.

In July, Congress passed the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA). This legislation staved off a 10.6 percent across-the-board cut facing all Medicare providers and provided for a 1.1 percent positive reimbursement update for providers in 2009. Based on this update, as well as work and practice expense changes, doctors of chiropractic can expect a 2 percent overall increase in Medicare reimbursement rates, as indicated in a final rule released last week by the Centers for Medicare and Medicaid Services (CMS). Changes to the fee schedule will take effect Jan. 1, 2009. Accurate fee schedule information may be obtained from your local Medicare contractor prior to billing for dates of service in 2009. Members can view the new Chiropractic Medicare Fee Schedule by clicking on the link below.

In July, Congress passed the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA). This legislation staved off a 10.6 percent across-the-board cut facing all Medicare providers and provided for a 1.1 percent positive reimbursement update for providers in 2009. Based on this update, as well as work and practice expense changes, doctors of chiropractic can expect a 2 percent overall increase in Medicare reimbursement rates, as indicated in a final rule released last week by the Centers for Medicare and Medicaid Services (CMS). Changes to the fee schedule will take effect Jan. 1, 2009. Accurate fee schedule information may be obtained from your local Medicare contractor prior to billing for dates of service in 2009. Members can view the new Chiropractic Medicare Fee Schedule by login to Members Only section.

The Department of Health and Human Services (HHS), Office of the Inspector General (OIG), the entity responsible for identifying and reporting inefficiency in Medicare, Medicaid and other related HHS agencies, has announced in its 2009 Work Plan that it will again seek records from doctors of chiropractic as a follow-up to previous reports on chiropractic documentation. These requests for records are expected in FY2009. To view the entire OIG report click on the link below (OIG report pg-16 or PDF pg-34).

ABSTRACT Objective: The objective of this study was to gather descriptive information concerning the clinical outcomes of patients with cervical and lumbar radiculopathy treated with a nonsurgical, chiropractic treatment protocol in combination with other interventions. Methods: This is a retrospective review of 162 patients with a working diagnosis of radiculopathy who met the inclusion criteria (312 consecutive patients were screened to obtain the 162 cases). Data reviewed were collected initially, during, and at the end of active treatment. The treatment protocol included chiropractic manipulation, neuromobilization, and exercise stabilization. Pain intensity was measured using the numerical pain rating scale. Results: Of the 162 cases reviewed, 85.5% had resolution of their primary subjective radicular complaints. The treatment trial was 9 (mean) treatment sessions. The number of days between the first treatment date and the first symptom improvement was 4.2 days (median). There were 10 unresolved cases referred for epidural steroid injection, 10 unresolved cases referred for further medication management, and 3 cases referred for and underwent surgery. Conclusion: The conservative management strategy we reviewed in our sample produced favorable outcomes for most of the patients with radiculopathy. The strategy appears to be safe. Randomized clinical trials are needed to separate treatment effectiveness from the natural history of radiculopathy. Christensen KD, Buswell K. Journal of Chiropractic Medicine. September 2008; Vol. 7, No. 3, pp. 115-125.

The National Board of Chiropractic Examiners (NBCE) reports on the latest events at NBCE. The National Board of Chiropractic Examiners (NBCE) hosted a number of meetings including registrars from chiropractic colleges across the United States, and Part IV Examiners and Administrators Workshop. To view the full report click on the link below.