Over the last few years many of you have heard the cries of our fellow chiropractic practitioners in California over the revisions in their Workers Compensation system. In 2004 the California legislature adopted the American College of Occupational and Environmental Medicine (ACOEM) guidelines for use in that system. Only those interventions recommended in the ACOEM guidelines are now reimbursable under California law. The only exception available under this law is that the ACOEM guidelines may be supplemented by other nationally published guidelines. In December of 2007 Gary Globe, DC, MBA, PhD, who is serving as the California Chiropractic Association (CCA) representative on the California Workers Compensation Advisory Board, contacted the CCGPP for assistance. Dr. Globe indicated that there was a brief window of opportunity for the chiropractic profession to provide a nationally published supplemental guideline to clarify weaknesses in the ACOEM guidelines as it pertains to chiropractic care for low back and chronic pain conditions. However, for this opportunity to be realized, that supplement had to be available for the next regularly scheduled meeting of the California Workers Compensation Advisory Board on March 19, 2008. As many of you are aware, in September, 2007 the CCGPP's Rapid Response Team initially penned a letter to United Healthcare demonstrating the inappropriateness of their newly adopted policy of non-coverage for chiropractic care of pediatrics and headaches. That letter was subsequently endorsed by the ACA, ICA, FCER, COCSA, ACC, etc. In response to that letter, in October, 2007 United Healthcare suspended both policies for additional review. They have recently announced they have retracted the pediatric policy altogether and have reworked the headache policy. Due to the rapidity and success of this response, Dr. Globe was prompted to contact the CCGPP for assistance with the California Workers Compensation situation. The CCGPP at its inception was charged with the evaluation of any guidelines, parameters, protocols, best practices, and standards of practice. This also means taking a stand for the profession when a problem or potential assault is noted. Therefore, the CCGPP accepted the California challenge and has undertaken a new initiative. We are currently involved in a Delphi process to generate consensus opinion of Doctors of Chiropractic from across the country regarding the care of low back pain, especially chronic pain. After conducting its extensive literature synthesis on low back conditions initially posted on the Internet in May of 2006, the CCGPP is acutely aware that there is inadequate literature on various areas of common chiropractic practice. Many of those studies that do exist have a medical bias that needs to be tempered with a chiropractic lens, as provided by the CCGPP's team of low back experts. The purpose of the Delphi technique is to elicit information and judgments from participants to facilitate problem-solving, planning, and decision-making. It does so without physically assembling the contributors. Instead, information is exchanged via mail, FAX, or email. It is structured to capitalize on the merits of group problem-solving and minimize the liabilities of group problem-solving. Consensus derived from a rigorous Delphi process is considered to be expert evidence, and while not as highly valued as some forms of research, it is nevertheless widely used and accepted, particularly in addressing areas where high quality research is lacking. Indeed, other national guidelines have used medical expert opinion to address issues of chiropractic care when more definitive literature was not available. The purpose of the CCGPP conducting the present Delphi process was to look at the same literature base others have, through a chiropractic expert perspective. The Delphi technique requires a Coordinator to organize requests for information, information received, and to be responsible for communication with the participants. The Delphi technique requires an efficient communication channel to link the Coordinator with each of the participants. Therefore, this Delphi process is being undertaken in an effort to clarify the role of chiropractic in these areas of care, especially as they are impacted by the Workers Compensation system and their incorporation of external guidelines, e.g. ACOEM, ODG, etc. CCGPP solicited seed panelists from chiropractic's national organizations, e.g. ACA, ICA, etc., and from the state associations through COCSA. These 39 panelists are all actively involved in chiropractic practice from across the country with a diverse variety of philosophy, technique and practice situations. As background material, those panelists were provided the CCGPP's Low Back literature synthesis, along with Dr. Gert Bronfort's recent study published in the Spine Journal. After reviewing the ACOEM guidelines, the CCGPP's Seed Committee then developed 27 seed statements defining areas of concern within those guidelines. Those seed statements were then submitted to the panel for review and comment. After the first round of review, there was greater than 80% consensus on 24 of the 27 seed statements. On the 3 outstanding seed statements, the panelist's comments were reviewed by the Seed Committee and utilized to revise those statements. Those revised seed statements were then submitted to the panelists for a second round of review and comment. After the second round, the 3 remaining outstanding seed statements again achieved greater than the 80% threshold for consensus that the Seed Committee had required at the outset of the project. The Seed Committee is currently in the process of incorporating the acquired commentary into a final consensus report. The CCGPP is hopeful of having the final version available by the beginning of June for use in the California Workers Compensation process. That consensus report will also be posted on the CCGPP's website when it is available. The CCGPP Scientific Commission Chair, Dr. Cheryl Hawk, also has a verbal commitment from the Journal of Manipulative and Physiological Therapeutics to publish the available literature syntheses chapters, inclusive of this consensus report, in the November/December 2008 issue. CCGPP has studiously avoided entering into the "guidelines" development process for a number of years, especially following the furor raised over the "Mercy" guidelines. They were widely condemned, particularly by those who never took the time to read them or learn how to properly apply them to obtain the care their patients needed. However, "Mercy" was a long time ago, given the pace of change in health care over the last decade and a half, and the literature needed to be updated. Third party payors, government agencies, other guideline organizations, patients, and yes, even DC's now want to know what kind of care is supported by evidence. Our profession's refusal to address this issue has led to the inevitable result that MD's, insurers and bureaucrats are now deciding what reasonable chiropractic care should be, based on their interpretation of the currently available scientific literature. We must remember that we exist as a profession to provide a service our patients need and want and not to advocate for what is best for our own benefit. Need proof? Our market share has not increased (and some would argue it has declined) despite the greatest increase in the use of CAM in recent history. We continue to have little cultural authority, meaning in part that the public still does not clearly understand our role and areas of expertise in the health care market. Physical therapists are publishing widely accepted papers on indications for manipulation of the low back, and have made it clear that they intend to take over chiropractic's traditional place in the health care market. The good news is that there is a great deal of evidence for what we do, as revealed by the CCGPP Low Back Literature Synthesis, as well as the subsequent CCGPP condition related chapters. The crisis in California (where nearly one-quarter of US doctors of chiropractic practice) has provided an opportunity to address what many of us consider to be mis-interpretation of the scientific literature, and to instead re-interpret the scientific literature viewed through a chiropractic lens. This Delphi process was in part developed by the CCGPP in response to what we heard at COCSA in Baltimore in 2006, where one of the primary concerns voiced by our critics during our round table discussion was that not every aspect of chiropractic practice had yet been subjected to randomized controlled trials. Now some of those same critics have already begun to naively criticize this effort as "unscientific." Nothing could be further from the truth. CCGPP conducted a multi-year, scientific evaluation of the current literature based on internationally accepted standards and resulting in the aforementioned Low Back Literature Synthesis. We also included additional, newly released research, published in interim since the completion of the Low Back Literature Synthesis. This formed the framework for the subsequent Delphi consensus process, which is widely viewed as an appropriate, defensible and scientific methodology for addressing areas where scientific literature is lacking. The issue of "dosage" is a perfect example of the need for a scientific consensus process. Patients, insurers, DC's and others want to know what reasonable parameters of chiropractic care are for a given condition. Is it short trials of treatment to see if it helps, or 75 visits and year-long contracts? Most published literature on this subject is based on treatment restrictions which do not realistically reflect actual practice, but reflect necessary limitations imposed by clinical study protocols. Accordingly, the most appropriate and valid methodology for addressing the gaps between scientific studies and clinical practice is a rigorous consensus process. We chose to use the Delphi process because of its economy in terms of both costs and timeliness. We chose to ask every state association and national organization in the country to provide participants who were conversant with using published literature, represented a wide variety of practice styles, philosophies and locals, and who were willing to work collegially to try to reach accord. Is the end result what we wanted? No, if the goal was the ability of the individual chiropractor to practice unfettered by any constraints (and we are unaware of any other health care profession with such a privilege). But if the goal was to draft a guideline which reflects the mainstream of chiropractic practice, provides advice and benchmarks for extending trials of treatment, and most importantly safeguards our patients' rights to demonstrably effective, conservative chiropractic care, then we believe this is a good start. We anticipate that this type of consensus process will eventually have national impact, as New York, Ohio and other states are also incorporating the ACOEM or other guidelines into their Workers Compensation systems. As an example, the CCGPP was contacted in early March by the ACA to participate in their recently established Guideline Review Task Force. This task force has been established in response to a request by the ACA Delegate in Tennessee, Dr Michael Massey. BCBS of Tennessee has requested a critique of the Milliman Care Guideline, 12th Edition, as it applies to chiropractic care. Once that review has been completed, the task force members are hoping to again put together an intraprofessional coalition to sign onto the review, such as was done with the successful effort to convince United Healthcare to change its Pediatric and Headache Guideline. It is the hope of the involved parties that this review will be used to enter into a collaborative effort with Milliman and Robertson to improve their product, beyond its application to BCBS of Tennessee. For further information or if you are interested in assisting with this process, please visit the CCGPP website at www.ccgpp.org Ultimately, the CCGPP views this type of consensus development as one of the next phases of the progression from the literature syntheses to the "best practices" development process we have dubbed the "Chiropractic Clinical Compass". This is also another example of the CCGPP's Rapid Response Team model, where the fluidity of our organization is able to mobilize our teams of experts and effectively address an immediate issue. However, we were only able to conduct this process due to the generous donation of time by all participants, or the generosity of the institutions at which they are employed. ABOUT THE AUTHOR: Dr. Mark D. Dehen is a second generation Doctor of Chiropractic practicing in North Mankato, MN. He does ergonomic consulting and injury prevention for local industries. Dr. Dehen is a past president of the MN Chiropractic Association and recipient of the MN Chiropractor of the Year award. Currently, he serves as Chair of the CCGPP.

The OSMA-sponsored Healthcare Simplification Act (HB 125) will bring significant, positive changes to contracts between health insurers and physicians -- putting physicians on a more equal footing with the insurers. While the Healthcare Simplification Act will not address every problem you have with payers – it’s a good first step toward building a better way of doing business with insurance companies. The OSMA will not stop working on these issues until our members can enter into agreements with insurance companies that are fair, transparent, and simplify doing business. Most importantly, the agreements must be in the best interests of the doctor-patient relationship. The Healthcare Simplification Act (HB 125) Helps Physicians in Three Major Areas: • Transparency in Contracting • Fairness in Contracting • Standardized Credentialing Transparency • The Healthcare Simplification Act will ensure that physicians get a copy of the full fee schedule from HMOs, Third Party Administrators (TPAs) and other insurers, so that the physicians will know what they will be paid for their services. • The Healthcare Simplification Act requires HMOs, TPAs, and other insurers to provide physicians with a summary disclosure form of the contract that outlines, in plain language, important terms including: compensation terms, categories of coverage, duration of the contract, the entity responsible for processing claims, and the method of dispute resolution. The Act also requires specific notice be given to the physicians of any addenda to the contract. • The Healthcare Simplification Act restricts the selling or renting of a physician’s contract to another company unless the rental is disclosed and all of the terms of the original contract are honored. • The Healthcare Simplification Act prohibits “Most Favored Payer” clauses in contracts that force doctors to provide healthcare services at a lower price than originally called for in the contract. • The Healthcare Simplification Act requires insurance companies to notify doctors 90 days in advance of changes to a contract that either: decrease payment, increase administrative expenses or add a new product. • The Healthcare Simplification Act restricts the use of “all products” clauses that force physicians to participate in all of an insurer’s products. • The Healthcare Simplification Act prohibits an insurer from forcing a physician to accept their future product offerings. Standardization • The Healthcare Simplification Act designates the Council for Affordable Quality Healthcare (CAQH) credentialing form as the sole credentialing form to be used by insurers in Ohio. No additional information can be solicited by individual insurers from physicians seeking to be credentialed. • The Healthcare Simplification Act requires that all physicians be credentialed within 90 days. • The Healthcare Simplification Act establishes a $500 per day penalty or requires retroactive reimbursement if an insurer fails to meet the 90-day credentialing deadline.

In a report to accompany legislation reauthorizing the National Health Service Corps (NHSC), the Senate Committee on Health, Education, Labor and Pensions made it abundantly clear that doctors of chiropractic are eligible to qualify for inclusion in the NHSC Loan Repayment program. The report language, which will accompany bill S.901, is supported by both the American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC). “For more than 35 years, doctors of chiropractic were excluded from the National Health Service Corps because we were not mentioned explicitly as eligible providers,” said ACA President Glenn Manceaux, DC. “Many areas of the country are experiencing shortages of qualified health professionals, and doctors of chiropractic are uniquely positioned to provide high-quality, cost-effective care to the nation’s underserved communities. I applaud the Senate committee for taking this action and I look forward to chiropractic inclusion in the program.” “This is a great victory, particularly for chiropractic students who are ready, willing and able to serve in the NHSC,” said ACC President Carl Cleveland III, DC. “Chiropractic graduates enter the profession well-qualified, prepared and most eager to serve, but many are positioned to enter practice with considerable student loan indebtedness. Thanks to the Committee’s action, doctors of chiropractic—especially the next generation of doctors graduating from our colleges—will soon have an opportunity to participate in this important loan forgiveness program.” Originally enacted in 1970, NHSC allows selected health care professionals engaged in the delivery of primary care services to be reimbursed for student loans in return for establishing and maintaining their practices in geographic areas designated as “medically underserved” by the federal government. Unfortunately, the NHSC Loan Repayment program has not included doctors of chiropractic as eligible providers. In 2002, at the request of ACA and ACC, Congress enacted language that authorized a two-year demonstration program intended to explore the feasibility of opening the program to doctors of chiropractic. The demonstration program began in 2003 and was later extended through 2007. The demonstration results are now being evaluated by the federal Health Resources and Services Administration. Report language accompanying S. 901 becomes effective once the bill has been passed by the full Senate. S. 901 has not yet been scheduled for further consideration. Watch ACA publications and the association’s Web site for more information as it becomes available. To access the full committee report Click on the link below. The information regarding inclusion of doctors of chiropractic can be found on page 19.

GREELEY, Colo.—Salvatore D. LaRusso, D.C., of Wellington, Fla., was elected on March 8 by the board of the National Board of Chiropractic Examiners (NBCE) to fill a vacancy in the roll of Director-At-Large. The vacancy was created by the untimely death of Dr. Earl L. Wiley who passed away in November 2007. Dr. LaRusso will complete the unexpired term of Dr. Wiley which will end in May 2009. At that time, Dr. LaRusso will be eligible for re-election. Dr. LaRusso is a graduate of New York Chiropractic and obtained his undergraduate degree in business administration from Seton Hall University. He has been active in many international, national, state and local organizations. In 1998, Dr. LaRusso was a gubernatorial appointee to the Florida Board of Chiropractic Medicine, serving as board chair in 2005, 2006 and 2007. From 2005 to present, he serves as chairman of the Florida Board’s Certified Chiropractic Physicians Assistant Committee. Dr. LaRusso is a long-standing member of both the Florida Chiropractic Association and the Florida Chiropractic Society (FCS) serving as president of the FCS from 1992-1993 and chairman from 1993-1997. The FCS named Dr. LaRusso Chiropractor of the Year in 1994, awarded him the Gavel Award in 1993 and honored him the Distinguished Service to the FCS in 1992. 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.

Last week, CMS released a new Advanced Beneficiary Notice (ABN) form for use by Medicare providers. Of the key changes, the form includes a new title, “Advanced Beneficiary Notice of Noncoverage” and this most recent version may also be used for noncovered services, in place of a Notice of Exclusion from Medicare Benefits (NEMB). Medicare providers may begin using the new form at any time during this six month transition period, but CMS will only accept this updated version after September 1. To view and/or print the new ABN form, click below. For CMS instructions on completing the form, click below. For further information, please visit the CMS Web site.

About 200 students from Northwestern Health Sciences University lobbied on Feb. 21 at the state capitol in St. Paul for chiropractic health care issues. They joined Northwestern faculty members and chiropractors from the area. Organized by the Minnesota Chiropractic Association, the day was planned in order to encourage legislators to revise Minnesota statutory language relating to the chiropractic scope of practice so it is more concise. In addition, lobbyists asked that their representatives and senators to support legislation to ban runners in Minnesota, which would make it illegal for chiropractors to hire or pay anyone who directly contacted a consumer after experiencing an automobile accident. Scott Mooring, DC, joined students in an effort to get the message across. “It’s important for our profession to stand up and fight,” Dr. Mooring said, who has participated in previous years. “The legislation is spread out into a number of different statutes which makes it difficult to interpret or apply. It’s a major impediment.” Northwestern students were equally passionate about seeing change in legislation. “I think it’s really important to have the people who represent us know how effective chiropractic care is,” said Ashley Cornetet, a T2 chiropractic student. “People are often misinformed, and it will help the community and help patients to learn more. This is more to make a statement about what we’re doing than to debate.” Tracking lawmakers down wasn’t as easy as expected, said Jami Rassmussen, a T2 chiropractic student, who added he was surprised how uninformed some were about chiropractic care. “We didn’t have a scheduled appointment, but as we were filling out the paperwork to make one, our representative overheard us and came out of his office,” Rassmussen said. “The other two students and I went into his office without a chiropractor with us and got to tell him about the bill. He didn’t know much about chiropractic care, but listened to us.” Rasmussen said it was a bit daunting to go in without lobbying experience, but exciting. “It was overwhelming at first, but exhilarating,” Rasmussen said. “It was sort of trial by fire, but I liked being thrown in like that.” Northwestern Health Sciences University offers a wide array of choices in natural health care education including chiropractic, Oriental medicine, acupuncture, therapeutic massage, human biology, and integrative health and wellness. The University has more than 900 full-time students on a 25-acre campus in Bloomington, Minn.

The American Chiropractic Association (ACA) has announced it will launch a historic and bold advocacy effort later this year by creating a national database of chiropractic patients. Designed to strengthen the profession’s political voice, the planned database was unveiled during the association’s National Chiropractic Legislative Conference (NCLC) Feb 27-28 in Washington, D.C.

The American Medical Association (AMA) has announced that it will issue a correction to all purchasers of its Guides to the Evaluation of Permanent Impairment, Sixth Edition, after ACA’s legal team questioned the legality of restrictive language related to evaluations by doctors of chiropractic and accused the AMA of violating the permanent Wilk injunction. In a Feb. 20 letter to ACA, AMA’s legal counsel writes that the text in question "is incorrect and warrants immediate correction."

New York Chiropractic College was recognized by the Commission on Independent Colleges and Universities (CICU) for its leadership role in New York’s independent academic sector. CICU’s winter 2008 publication highlighting private education’s favorable impact on New York residents’ health care, referenced NYCC’s Acupuncture and Oriental Medicine program and acupuncture’s reputation as a safe, cost effective, and efficacious alternative to western medicine. NYCC’s chiropractic program, long recognized for its academic excellence, was lauded for its study involving vertebral anatomy, rehabilitation and relief of neuromusculoskeletal disorders. CICU concluded with: “New York’s independent campuses draw talent, research dollars, and patients looking for promising new treatments while also reaching deep into the state’s most intractable health problems, probing for solutions – and delivering”.

Database Company Ingenix – Used by Dozens of Insurers – at Center of Scheme Cuomo Notifies Ingenix and its Parent, UnitedHealth Group, of Intent to File Suit; Subpoenas 16 Other Companies NEW YORK, NY (February 13, 2008) – Attorney General Andrew M. Cuomo today announced that he is conducting an industry-wide investigation into a scheme by health insurers to defraud consumers by manipulating reimbursement rates. At the center of the scheme is Ingenix, Inc., the nation’s largest provider of healthcare billing information, which serves as a conduit for rigged data to the largest insurers in the country. Cuomo also announced that he has issued 16 subpoenas to the nation’s largest health insurance companies including Aetna (NYSE: AET), CIGNA (NYSE: CI), and Empire BlueCross BlueShield (NYSE: WLP), and that he intends to file suit against Ingenix, Inc, its parent UnitedHealth Group (NYSE: UNH), and three additional subsidiaries. The six-month investigation found that Ingenix operates a defective and manipulated database that most major health insurance companies use to set reimbursement rates for out-of-network medical expenses. Further, the investigation found that two subsidiaries of United (the “United insurers”) dramatically under-reimbursed their members for out-of-network medical expenses by using data provided by Ingenix. Under the United insurers’ health plans, members pay a higher premium for the right to use out-of-network doctors. In exchange, the insurers promise to cover up to 80% of either the doctor’s full bill or of the “reasonable and customary” rate depending upon which is cheaper. The Attorney General’s investigation found that by distorting the “reasonable and customary” rate, the United insurers were able to keep their reimbursements artificially low and force patients to absorb a higher share of the costs. “Getting insurance companies to keep their promises and cover medical costs can be hard enough as it is,” said Attorney General Andrew Cuomo. “But when insurers like United create convoluted and dishonest systems for determining the rate of reimbursement, real people get stuck with excessive bills and are less likely to seek the care they need.” Cuomo’s investigation also found a clear example of the scheme: United insurers knew most simple doctor visits cost $200, but claimed to their members the typical rate was only $77. The insurers then applied the contractual reimbursement rate of 80%, covering only $62 for a $200 bill, and leaving the patient to cover the $138 balance. The United insurers and many other health insurance companies relied on the Ingenix database to determine their “reasonable and customary” rates. The Ingenix database used the insurers’ billing information to calculate a “reasonable and customary” rate for individual claims by assessing how much a similar type of medical service would typically cost, generally taking into account the type of service, physician, and geographical location. However, the investigation showed that the “reasonable and customary” rates produced by Ingenix were remarkably lower than the actual cost of typical medical expenses. The United insurers and Ingenix are owned by the same parent corporation, United HealthGroup. When members complained their medical costs were unfairly high, the United insurers hid their connection to Ingenix by claiming the rate was the product of “independent research.” The Attorney General’s notice to United expressed concern that the company’s ownership of Ingenix created a clear conflict of interest because their relationship gave Ingenix an incentive to set rates that benefited United and its subsidiaries. Cuomo’s notice of intent to sue names the following potential defendants: UnitedHealth Group and its subsidiaries, United HealthCare Insurance Company of New York, Inc., United Healthcare of New York, Inc., United Healthcare Services, Inc. and Ingenix. The subpoenas served today request documents showing how the insurer computes reasonable and customary rates, copies of member complaints and appeals, and communications with members and between Ingenix and the insurer on the issue. Cuomo continued, “The lack of accuracy, transparency, and independence surrounding United’s process for setting a ‘reasonable and customary rate’ is astounding. United’s ownership of Ingenix coupled with the inherent problems with the data it is using clearly demonstrate a broken reimbursement system designed to rip off patients and steer them towards in-network-doctors that cost the insurer less money.” Consumers Union Programs Director Chuck Bell said, "Based on the findings in this investigation, it appears that United Health failed to fulfill the promises it made to cover a fair portion of medical expenses, and consumers were stuck with the bill. The current process for establishing ‘reasonable and customary’ rates is riddled with conflicts of interest and manipulations that consistently lead to patients paying more, and insurers paying less. We applaud Attorney General Cuomo for taking on this issue which is vitally important for consumers everywhere.” Cancer Care’s Associate Executive Director Ellen Coleman said, “Cancer patients and others faced with life-threatening illnesses need to know that a fair portion of the often overwhelming medical expenses will be covered by their insurance company. Insurers should fulfill their promises and not leave patients forced to choose between the medical care they need and the medical care they can afford. Cancer Care thanks Attorney General Cuomo for taking action on this issue and for continuing to protect the rights of patients.” “The litigation initiated by the Attorney General is critically important for two reasons,” said Ron Pollack, Executive Director of the health consumer organization Families USA. “First, it is essential that health services obtained outside of a network be compensated fairly and adequately. Eighteen million Americans under the age of 65 will spend more than a quarter of their family income on health care this year, and healthcare debt is the number one cause of individual bankruptcy. Second, there needs to be transparency in these payment arrangements. For these reasons, we support the efforts of the Attorney General.” The American Medical Association's President-elect Nancy Nielsen M.D. said, “The investigation launched today by New York Attorney General Andrew Cuomo calls into question the validity of a system that health insurers have used for years to reimburse physicians and their enrolled members. Patients have a right to expect fair and accurate payment for services promised by health insurers. The AMA greatly appreciates the Attorney General’s interest and leadership in protecting consumers, and we offer our full cooperation in any effort to hold UnitedHealth accountable to New York state laws.” The Medical Society of the State of New York President Dr. Robert Goldberg said, “The Medical Society of the State of New York applauds Attorney General Cuomo and his hard-working staff for their diligent efforts in moving forward in an investigation that we believe will have long term benefits to healthcare in New York. MSSNY also applauds the Attorney General for acting on the complaints of our patients and our physician members.” The Attorney General’s industry-wide investigation is being handled by Acting Deputy Chief of the Healthcare Bureau James Dering as well as members of the Healthcare Industry Taskforce, Assistant Attorneys General Brant Campbell and Sandra Rodriguez, under the direction of the head of the Attorney General’s Healthcare Industry Taskforce, Linda Lacewell. 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Davenport, IA – After an illustrious 20-year legacy as chairman of the Palmer College of Chiropractic Board of Trustees, Ms. Vickie Palmer announced to Board members on Jan. 15, 2008, that she would officially conclude her tenure as chairman at the Feb. 1-2, 2008, Board meeting in San Jose, Calif. Ms. Palmer continues serving on the Board as a Board officer and member of the executive committee. “I began considering this nearly seven years ago and consulted with many advisors, including my two sisters, during that time,” explained Ms. Palmer. “For many reasons, I’m confident that this is the right time to make a smooth transition. We’ve successfully completed our capital campaign and opened the Academic Health Center. I’m also very comfortable with the strength of the Board and the College administration. More importantly, the time is right for a practicing chiropractor to lead this College as it has become a true participant in the mainstream healthcare delivery system.” As part of her announcement, Ms. Palmer submitted the nomination of Vice Chairman Trevor Ireland, D.C., as her successor. At the Board meeting, Dr. Ireland received unanimous support and approval from all members and officially assumed chairman responsibilities on Feb. 2. “I appreciate that the Board of Trustees agreed with my nomination of Dr. Ireland as chairman,” Ms. Palmer added. “He is an incredible individual and I’m certain he will do an excellent job. Dr. Ireland possesses all of the characteristics necessary to lead us on this journey.” “I’ve trained my entire life to assume this position,” Dr. Ireland said of his election to Board chairman. “It has been a privilege to have served with Vickie for all these years. As we enter this new era of chiropractic, I shall do my utmost to benefit Palmer College, pursue its mission, and protect and perpetuate its philosophy, science and art, and continue to honor the historic connection between Vickie Palmer and the College.” Dr. Ireland, a 1970 magna cum laude graduate of Palmer’s Davenport Campus and a Board member since 1988, is founder of the Ireland Clinic of Chiropractic in Anchorage, Alaska, one of the largest chiropractic healthcare facilities in that state. During his distinguished 38-year career in chiropractic, he has been honored as a fellow of the International Chiropractors Association, the Palmer Academy of Chiropractic, the Palmer West Campus Academy of Chiropractic, and the International College of Chiropractors. Dr. Ireland was the youngest doctor ever to receive all four Chiropractic fellowship honors. In addition, he co-founded the Alaska Chiropractic Society and is a past president of that organization. With Dr. Ireland assuming the Board chairman position, Mr. Kent Forney was elected vice chairman. Mr. Forney, a prominent attorney in Des Moines, Iowa, has served on the Board since 1982, most recently as the Board secretary. “Having been a Board member for more than 25 years, I have had the pleasure of serving the College with Vickie Palmer,” said Mr. Forney. “I have always been impressed with her unselfish devotion to the College and the profession. Her tireless efforts as chairman will be sorely missed. Fortunately, she will remain a member of the Board, so as we move forward, her talents will not be lost to the College.” Ms. Palmer was named to the Palmer Board in 1978 and served as vice chairman from 1985 until her election to chairman in 1987. During that tenure, she has been instrumental in many significant accomplishments for the College. Those include opening of the Palmer Academic Health Center on the Davenport Campus; the growth, development and stabilization of Palmer’s West Campus; the establishment of the Florida Campus in 2002; the creation of the Palmer Center for Business Development and the Palmer Center for Chiropractic Research, and the unification of the three Palmer campuses as one College. “Having literally grown up on the Davenport Campus, my entire life has been centered around Palmer College,” said Ms. Palmer. “It has been my pleasure to serve this wonderful College in so many ways, including my time working in various areas such as Student Affairs, Academics and, for the past 20 years, as chairman of the Board. “I have reached a time in my life – and in the life of Palmer College – when I wish to serve the Board in a new role; one that allows me to be more interactive with our students and alumni. I am excited about contributing in different ways to help Palmer College of Chiropractic move forward.” “Over the years, Vickie has quietly contributed her time, resources and talents to the College as she has honorably carried on the Palmer family legacy,” said Larry Patten, chancellor of Palmer College. “She’s been an exceptional leader and I personally want to thank her for all she has done.”

Abstract of Study Study Design: Population-based, case-control and case-crossover study. Objective: To investigate associations between chiropractic visits and vertebrobasilar artery (VBA) stroke and to compare this with visits to primary care physicians (PCP) and the occurrence of VBA stroke. Summary of Background Data: VBA stroke is a rare occurrence. Neck pain and headache are common symptoms of VBA dissection and typically precede VBA stroke. Chiropractic care is popular for neck pain and headache, but has been associated with an increased risk for VBA dissection and stroke. People experiencing headache and neck pain may also choose to consult a primary care physician. Methodology: The cases studied comprise eligible incidents of VBA stroke admitted to Ontario hospitals over a nine year period from April 1993 to March 2002. Four controls were age and gender matched to each case. Visits to chiropractors and primary care physicians during the year before the stroke date were determined from Ontario Health Insurance Plan (OHIP) billing records. In the case cross-over analysis, cases acted as their own controls. Results: Over the nine year study period, there were 818 cases of VBA stroke admitted to Ontario hospitals in a population of more than 100 million person-years. Among those under 45 years of age, cases were about three times more likely to visit a primary care physician or a chiropractor prior to their stroke compared to controls. A strong association was found between primary care physician visits and VBA strokes in all age groups. There was no increased association between chiropractic visits and VBA stroke in those older than 45 years. Conclusions: VBA stroke is a very rare event in the population. The risk of VBA stroke associated with a visit to a chiropractor’s office appears to be no different from the risk of VBA stroke following a visit to an MD’s office. The incidence of VBA stroke associated with chiropractic and primary care physician visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. The study found no evidence of excess risk of VBA stroke associated with chiropractic care compared to primary physician care. J David Cassidy, DC, PhD, et al. Spine. Vol. 33, No. 4S, pp. S176-S183.

(Arlington, Va.) -- Following an unprecedented profession-wide campaign led by the ACA, UnitedHealthcare (UHC) has announced it will rescind its recent policy declaring chiropractic manipulative treatment for headaches and pediatric patients as unproven, and therefore, not a covered service. “We are pleased that UHC has decided not to implement this policy,” said ACA President Glenn Manceaux, DC. “We strongly believe that through the actions of ACA, along with the other chiropractic organizations, the profession made a compelling argument as to why this policy should have been rescinded. We feel that our members, the profession and our patients will be well served by UHC’s recent decision.” Since September 2007, ACA has maintained a line of communication with UHC to emphasize its members’ concerns over the proposed policy change. Furthermore, ACA joined forces with ACC, CCGPP, COCSA, FCER and ICA to issue a joint letter opposing the "flawed" and "unconscionable" policy and supporting a detailed CCGPP analysis and critique of UHC's stance. The ACA Council on Chiropractic Pediatrics also submitted a separate response to UHC. In October, UHC delayed implementation of its flawed policy pending additional review of research and information provided by the ACN Chiropractic Professional Advisory Committee (CPAC) and other chiropractic organizations. “The ACA is proud to have led this effort, which serves as a very important reminder that there is strength in numbers. When all corners of the profession work together with a single vision and a single voice, there is no limit to what we can accomplish. It also underscores the critical role research and evidence play in the reimbursement world and the need for insurers to consult with the chiropractic profession before implementing changes that negatively affect our patients,” said Dr. Manceaux. Click below for the full text of UHC’s policy update.

Increasingly the New York State Board for Chiropractic has been receiving questions and concerns about certain types of advertising. The information provided in this brief article may help clarify some of the responsibilities we have as practitioners when we advertise. Beyond those rules and regulations we have that are specific to our profession in New York, we must also comply with the general Rules of the Board of Regents which are applicable to all licensed professionals in the state of New York. If you do not have a copy of these regulations you can view them online at www.op.nysed.gov or call the New York State Board for Chiropractic at 1-518-474-3817 ext. 190. The specifics of advertising are discussed in Part 29 "Unprofessional Conduct". As described in Part 29 Advertising or soliciting not in the public interest shall include, but not be limited to, advertising or soliciting that: 1. "is false, fraudulent, deceptive or misleading" 2. "guarantees any service" 3. "makes any claim relating to professional services or products or the cost or price therefore which cannot be substantiated by the licensee, who shall have the burden of proof" 4. "makes claims of professional superiority which cannot be substantiated by the licensee, who shall have the burden of proof" 5. "offers bonuses or inducements in any form other than a discount or reduction in an established fee or price for a professional service or product". This list is for the most part pretty self explanatory. However, item number three may deserve a little more attention. If in the course of your advertising you state that your technique is effective a certain percentage of the time, it is up to you to be able to prove it. If some of the information in your advertising program is being provided to you from an outside source, then please verify that it is true and accurate because you, the practitioner, are ultimately held accountable for the accuracy of your advertising. If you have any questions on these rules and regulations or any other questions you may have, please contact the New York State Board for Chiropractic office at: NY State Education Department Office of the Professions State Board for Chiropractic 89 Washington Ave. Albany, NY 12234-1000 1-518-474-3817 ext.190 NYSBC Information Committee

Dear NYSCA Members, An urgent appeal from COCSA is requesting the support of all state associations. The Congress of Chiropractic State Associations embraces two ACA initiatives. The first is a data collection project where each doctor sends the ACA 5 example charts showing managed care abuse that has hindered patient care; the second initiative is an effort to encourage all DC’s to appeal every restriction of care. This “en masse” effort is intended to push back insurers’ efforts to withhold benefits that patients are entitled to. The NYSCA is wholly behind these ACA initiatives. COCSA has set goals for the state associations in procuring un-sanitized case files of inappropriate denial of care. Details of their plan are found on their homepage www.cocsa.org. You help is needed now! The ACA General Counsel states the window is now open for the real possibility of legal action against the shameless practices of Managed Care groups. The cornerstone of any legal action will be patient files that can be used as direct evidence. These files must bear the scrutiny of the court, therefore we urge you to review the instructions below and join the effort for your future as well as that of patients in your state. Data Collection initiative at www.acatoday.org/datacollection (also below) DOI Appeals initiative at www.acatoday.org/appeals (toolkit for offices) To do your part and assist ACA, we ask that you take the following steps. 1. Read and sign the HIPAA Business Associate Agreement (found here) so that patient information may be provided directly to the ACA Insurance Relations Department. Note that all patient records will be kept in a locked room in locked cabinets pursuant to HIPAA requirements. 2. Identify patients whose care or benefits have been compromised by coverage decisions made by managed care networks and speak with them to ascertain if they are interested in allowing their medical file to be shared with the ACA and regulatory authorities. A patient information sheet is provided here for your convenience. No information regarding patients or their doctors will be shared with managed care companies. Specifically, we need copies of the following items from your patients’ files: a) Completed patient intake forms b) Completed diagnostic testing reports c) Chart notes d) All forms that show a complete chronology of the interaction with the managed care organization 3. Obtain HIPAA Authorization: Explain HIPAA rights to the patient – (a brochure can be found here just in case you are unsure if your office documentation is up to date.) Once you are sure the patient clearly understands the reason for this initiative, and they indicate they would like to participate, have them sign the HIPAA Authorization, found here which has been pre-completed for your convenience. 4. Mail the following to the ACA: copies of your five complete un-sanitized patient files with the associated HIPAA Authorization and your signed Business Associate Agreement to the following address: Documents Needed to Assist Business Associate Agreement Cover Letter to Doctors Four Steps to Help Patient Information Sheet HIPAA Authorization Questions? Contact @ ACA Daniel Lyons at [email protected] or call - 703-812-0225.

(Arlington, Va.) -- The Department of Health and Human Services Office of the Inspector General (OIG), the agency responsible for identifying and reporting inefficiency in Medicare, Medicaid and other related HHS programs, announced in its 2008 Work Plan that it would again seek records from doctors of chiropractic as a follow-up to its 2005 report on chiropractic documentation. "ACA strongly urges all doctors of chiropractic who receive an OIG record request to contact the association for assistance on how to fully comply with the request,” said ACA President Glenn Manceaux, DC. “Timely response to an OIG record request is mandatory, and ACA representatives are available to help you navigate the OIG request process.” ** Official OIG record requests will be sent on letterhead that clearly states “Office of the Inspector General.” Upon receipt of an OIG request, it is critical that doctors of chiropractic include all necessary information and complete the request by the date specified by the OIG, noted John Falardeau, ACA’s vice president of government relations. In addition to those doctors who recently received an OIG record request, ACA would also like to hear from providers who have already submitted their information to the agency. The 2005 OIG Report, which was based on a random sampling of claims data from 2001, concluded that 67 percent of the claims examined as part of the study contained documentation errors or omissions that led to what the OIG considered to be inappropriate reimbursement under Medicare. The report also extrapolated that U.S. taxpayers could save more than $280 million per year if improperly documented claims filed by chiropractors were not paid by Medicare. To contact ACA regarding an OIG record request, send an e-mail to [email protected] or [email protected] . **ACA’s assistance is designed to provide authoritative information to help doctors of chiropractic fully and accurately comply with the OIG request. This assistance is provided with the understanding that ACA is not engaged in rendering legal or other professional services. If legal advice or other expert professional assistance is required, the services of a competent professional person should be sought.

ABSTRACT Background—Vitamin D receptors have a broad tissue distribution that includes vascular smooth muscle, endothelium, and cardiomyocytes. A growing body of evidence suggests that vitamin D deficiency may adversely affect the cardiovascular system, but data from longitudinal studies are lacking. Methods and Results—We studied 1739 Framingham Offspring Study participants (mean age 59 years; 55% women; all white) without prior cardiovascular disease. Vitamin D status was assessed by measuring 25-dihydroxyvitamin D (25-OH D) levels. Prespecified thresholds were used to characterize varying degrees of 25-OH D deficiency (Conclusions—Vitamin D deficiency is associated with incident cardiovascular disease. Further clinical and experimental studies may be warranted to determine whether correction of vitamin D deficiency could contribute to the prevention of cardiovascular disease. From the Framingham Heart Study, Framingham, Mass (T.J.W., M.J.P., E.I., K.L., E.J.B., R.B.D., R.S.V.); Cardiology Division (T.J.W.) and Renal Division (M.W.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Statistics and Consulting Unit, Department of Mathematics (M.J.P., R.B.D.), Boston University, Boston, Mass; Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging (S.L.B., P.F.J.), Tufts University, Boston, Mass; and Sections of Cardiology and Preventive Medicine (E.J.B., R.S.V.), Boston Medical Center, Boston University School of Medicine, Boston, Mass. Circulation. 2008 10.1161/CIRCULATIONAHA.107.706127 FOR FULL TEXT PDF click on the link below:

(Arlington, Va.) -- The American Chiropractic Association (ACA) today announced that well-known political strategist and media personality James Carville will deliver the keynote address during the 2008 National Chiropractic Legislative Conference (NCLC) scheduled for Feb. 28-29 in Washington, D.C.