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Chiropractic Demonstration Project
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Chiropractic Demonstration Project - March 25, 2005 2:04:00 PM
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dosrinc
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Recived today from Medlearn Matters, the medicare learning network:
Expansion of coverage for chiropractic services demonstration project.
Did anyone else see this, what are your thoughts, sorry I don't know how to provide a link to the appropriate web site.
The most interesting part from a PT standpoint:
Under this demonstration, doctors of chiropractic will be allowed to PROVIDE physical therapy services and to refer patients for therapy under this demonstration. Very interesting.
Rick
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Re: Chiropractic Demonstration Project - March 25, 2005 3:36:00 PM
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PTupdate.com
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Here is the link for the information:
http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/SE0514.pdf
Is the APTA asleep at the wheel again? At times I feel like I am on a little league team competing against a AAA farm team.
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
_____________________________
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Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: Chiropractic Demonstration Project - March 25, 2005 4:47:00 PM
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jma
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This is really disturbing. This link should be forwarded to the APTA, if they don't know about it by now.
JMA
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Re: Chiropractic Demonstration Project - March 25, 2005 10:03:00 PM
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Randy Dixon
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Devil's Advocate: If we don't want them telling PT's that they shouldn't do manipulation why would PT's want to restrict them doing additional therapy? Shouldn't we be happy that they are expanding their services and providing better care for their patients.
Compete and let the best providers win.
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Re: Chiropractic Demonstration Project - March 26, 2005 2:24:00 AM
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dosrinc
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From: Bonita Springs
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Another interesting point, if I am reading it right is that this project will allow them to bill for all musculoskeletal codes that their practice act allows, not just spinal codes as was the previous restriction under medicare. Also order MRI, lab tests, bill physician evaluation and management codes. Wow, the things a strong lobby can achieve. Occured in the same Medicare Act that denied PT's a chance to have a demonstration project for direct acess.
Rick
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Re: Chiropractic Demonstration Project - March 26, 2005 2:41:00 AM
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Diane
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From: Vancouver, B.C., Canada
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[QUOTE]Occured in the same Medicare Act that denied PT's a chance to have a demonstration project for direct acess.[/QUOTE]Now, that sucks. I'd love to know what happened there.
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Re: Chiropractic Demonstration Project - March 26, 2005 3:01:00 AM
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lynx
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Actually if you fight this you will just be helping chiropractors. The subluxation straights oppose differential diagnosis and testing because it creates a situation where they have to diagnose patient complaints correctly instead of just labelling everyone subluxated and running a crack mill. So they would appreciate any efforts to kill the study.
Ideally chiros must have the ability to order tests to see patients without referral just as DPTs to. If you take away reimbursement then you are just increasing malpractice. So I think the correct thing to do is let the study go on and support DCs ability to test appropriately.
The trick will be to see how the Virginia chiropractors do since many of them come from Life University and the Sherman College of Straight Chiropractic where they were trained to overutilize (called subluxation diagnosis) and not diagnose and order tests appropriately. I expect lots of overutilization there.
Illinois should be fine since National teaches chiros to test appropriately (although they are light on giving clinical experience).
A more practical way to improve chiropractic is to go after false advertising by schools and use it to take away their nonprofit status. This kills the snake at the head. Chirotalk has a very good proposed bill on this that people should be writing to US congressional legislators about.
http://chirotalk.proboards3.com/index.cgi?board=litaleg&action=display&num=1109327849
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Re: Chiropractic Demonstration Project - March 26, 2005 3:10:00 AM
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MPT
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From: Syracuse, New York
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Randy,
Physical Therapy is a protected term. The only people who can provide "physical therapy" are physical therapists. Chiros can do PT techniques, but unless they are a physical therapist they can not use that term.
I can do a manipulation but I can not advertise that I do Chiropractic manipulation (or adjustment). Physical Therapy is not a technique or treatment modality, it is the person providing the service.
_____________________________
Where am I
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Re: Chiropractic Demonstration Project - March 26, 2005 3:19:00 AM
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Jon Newman
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From: Amherst, WI
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Shucks,
And I thought we were all just about to hold hands and practice together.
Oh, actually, I guess we are...I feel so much better now.
This should really clear things up for the consumer.
Randy, a healthy competition occurs on a level playing field. I guess if the competition was to provide direct access to medicare patients via the political process, we lost and the best man at making that type of thing happen won. But I don't think that's what you meant. It doesn't seem we will get play in your "best man wins" scenario as it comes to patient care for our medicare recipients.
But then again, perhaps so. For example, chiros can do the gait training of a TBI'ed patient and medicare can compare number of visits relative to PT's. Let the competition begin. I can just feel how good this is going to be for consumers.
jon
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Re: Chiropractic Demonstration Project - March 26, 2005 3:22:00 AM
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lynx
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Since 2/3 of chiros are into subluxation overutilization and ignoring the real causes of patient complaints, plus the fact that PTs are now able to determine who will respond to manipulation, plus the fact that they don't have a legitimate niche, it is clear that PTs are going to slaughter the chiros.
There is nothing to fear. Truth and science will prevail.
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Re: Chiropractic Demonstration Project - March 26, 2005 3:24:00 AM
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Jeep
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>>>Since 2/3 of chiros are into subluxation overutilization and ignoring the real cause of patient complaints, >>>
Please cite documentation of such.
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Re: Chiropractic Demonstration Project - March 26, 2005 3:36:00 AM
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lynx
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This comes from the Life University v. Council on Chiropractic Education case of 2002 where they discussed the number of chiropractic programs that supported subluxation based diagnosis as opposed to traditional medical diagnoses. According to the court documents 50% of the schools were pro-subluxation diagnosis and produced 2/3 of the chiropractic graduates. The reason for the greater number of graduates was because the subluxation based schools had bigger classes.
This is not the exact quotation but gives the jist of it. Notice how they correctly label schools supporting subluxation diagnosis the "conservative majority". Subluxation diagnosis is a scam because it relies on dubious conditions and diagnostic criteria. It promotes overutilization using the fact that alternative medicine is legally allowed to treat sequela like subluxations that are diagnosed using questionable criteria so that the underlying causes of patient complaints go completely unaddressed. It is a recipe for overutilization and patient dependency. With 2/3 of chiropractors using this scam I agree with them.
[QUOTE]
The District Court refused to apply the Wilfred “great deference” standard based on its finding, which was unsupported by any evidence in the record, that “an aggressive group of leaders of the eight liberal chiropractic schools . . . had undertaken a series of corporate manipulations in order to reduce the representation and dominance of the eight conservative chiropractic schools (of which Life was one) . . . which were calculated to give dominance to the liberal minority group over the conservative majority group; [and] the end result has been the disaccreditation of the largest of all the colleges. . . .” R4-28-3-4.(Life University, Inc. v. The Council on Chiropractic Education, Inc., et al., Docket No. 03-11020J, BRIEF OF APPELLANTS, p.42.)[/QUOTE]
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Re: Chiropractic Demonstration Project - March 26, 2005 3:49:00 AM
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Jeep
Posts: 353
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From: USA
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Your out of context/meaningless cite does not support your claim.
Come back with something meaningful.
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Re: Chiropractic Demonstration Project - March 26, 2005 3:50:00 AM
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lynx
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Are you a chiropractor Jeep? You seem pretty worked up over this.
I can understand why. Subluxation diagnosis is the entire niche for chiropractic. So it is essential that chiropractors try to hide the fact that subluxations are never primary conditions. So chiropractors' portrayals that they treat and correct biomechanics are false. Without subluxations chiropractors are no different than naturopaths in that they do a standard diagnosis but are then are limited to treatments without drugs or surgery- with little discrimination between scientific and quack therapies.
It is a big charge but critical for PTs to understand. Contrary to their false advertising claims, chiropractic manipulation/adjustment is simply a palliative treatment and most chiropractors have a vested interest in making patients dependent on treatment. Further, since that is all they know how to do they don't really have any other choice. After all, if they started treating the real cause of patient complaints they would be practicing medicine not chiropractic.
Anyone who wants to read about the craziness that masquerades as diagnosis in chiropractic can just go to chirobase.org and click on the techniques there.
The following are additional quotations from the appeal. So far I haven't been able to find the 2/3 quote but anyone familiar with class sizes in chiropractic institutions will consider it reasonable. After all, Life University was once the largest chiropractic program in the USA. Further, it makes perfect sense that if these programs want to control chiropractic they should put out as many students as possible. Then they can try to pass off overutilization as just another style of care instead of a scam.
At the very least, these quotations establish that at least half of the chiropractors utilize the subluxation diagnosis scam. For more information just read the state chiropractic licensing acts and see how they talk about subluxations and nerve interference. They allow chiropractors to use debunked quack instruments like neurocalorimeter heat readers, etc, despite evidence showing that they are erroneous and irrelevant.
You could also just read some of the course catalogues online and see how these straight programs create curriculums that don't integrate diagnosis. Like having obstetrics and pediatrics well after clinical practicums start. This is done because differential diagnosis is irrelevant to subluxation overutilization care.
I think you are reaching to be so nitpicky about the exact source. I do remember it was in one of the case documents, probably a response from Life University defending their subluxation diagnosis as a competing style of practice.
However, it is understandable that you could just be misinformed about chiropractic (as opposed to intentionally misinforming people). This is a very specialized subject.
[QUOTE]
For decades, the chiropractic profession has debated the proper role of a
doctor of chiropractic. Views regarding this topic range along a spectrum of
thought. The “liberal” school advocates that chiropractors are primary health care
providers who, in addition to performing spinal analysis and manipulation, should
be able to diagnose other conditions. “They contend the public is better served
when chiropractors can identify possible medical problems and if necessary refer
the patient to another health care provider.” Sherman College of Straight
Chiropractic v. Am. Chiropractic Ass’n, Inc., 654 F. Supp. 716, 718 (N.D. Ga.
1986), aff’d, 813 F.2d 349 (11th Cir. 1987). The “conservative” or “straight”
philosophy advocates that chiropractors should be limited to correcting
misalignments of the spinal vertebrae. Id.
Neither CCE nor its accreditation criteria advocates one philosophy over
another. See R3-11-Ex 29, ¶¶ 7-10; R3-11-Ex 28, ¶¶ 16-21; R3-11-Ex 71, ¶ 16;
R3-11-Ex 5, Pg vi; R3-11-Ex 2, Pg v. Rather, CCE’s Standards seek to “ensure
that chiropractic schools prepare their students to be qualified, competent providers
of quality health care, regardless of any philosophy the school may espouse.” R3-
11-Ex 29, ¶ 7. CCE accredits programs of divergent views. R3-11 -Ex 29, ¶ 10. (Ibid, pp.6-7).[/QUOTE]The following accreditation violations are intentional and typical for a subluxation based program:
[QUOTE]
In measuring LUCC against CCE criteria, the 2001 Team identified twelve
concerns that prompted “recommendations”; fourteen “suggestions”; and four
“commendations.”3 The 2001 Team found serious deficiencies in the quality of
LUCC’s education. It found insufficient evidence that an LUCC degree candidate
“demonstrates proficiency in some competencies sufficient . . . to perform the
professional obligations of a primary care clinician”; insufficient evidence that
candidates understood “clinical indications for and the relative value of diagnostic studies”; and insufficient evidence demonstrating understanding of federal and
state regulatory guidelines governing diagnostic procedures and equipment.
Exhibit Envelope-Doc 12-Pogrelis Supp. Aff.-Ex 10, Pgs 23-24. The 2001 Team
“observed substantial evidence of care plans that were not consistent with the
diagnosis and the pathophysiology and/or natural history of the disorder.” Id. at
26. LUCC students were unprepared for and experienced failure rates on national
board exams that were greater than the national average. Id. at 27. The 2001
Team noted that “basic, clinical and chiropractic science course work is not
presented in a manner conducive to the adequate training of primary care
clinicians” and “recommended” that LUCC review its curriculum, course
sequencing and academic policies. Id. at 32. The 2001 Team also found that some
of LUCC’s faculty lacked proper academic credentials and others had no valid
chiropractic license. Id. at 43-44. The 2001 Team further detailed deficiencies in
the students’ clinical training. Id. at 48-50.4 (Ibid, pp.11-12).[/QUOTE] [QUOTE]On January 2, 2003, Life filed suit against CCE, COA and Dr. Paul Walker,
CCE’s Executive Vice President. Life demanded a “correction” of CCE’s actions
including its allegedly improper (1) amendment of its Bylaws; (2) application of
procedures that purportedly conflict with CCE’s Bylaws; and (3) adoption of
accrediting Standards that supposedly favor one branch of chiropractic philosophy over another. Life also alleged CCE had violated its due process rights by
conducting a “flawed and biased process” that was “calculated to cause the
wrongful denial” of LUCC’s reaffirmation of accreditation. Life asserted that CCE
“compounded the problem” by refusing to reconsider LUCC for accreditation in a
timely manner. See R1-1-2, ¶ 1. Life’s complaint contained four counts:
(1) violation of the common law right of due process; (2) tortious interference with
contract; (3) breach of contract; and (4) violation of CCE’s Articles of
Incorporation and Bylaws. Life sought a declaration that CCE’s actions since 1999
were ultra vires and that all CCE actions that purportedly favored one chiropractic
philosophy over another were null and void. Life sought a preliminary and
permanent injunction requiring reinstatement of LUCC’s accreditation, restoration
of prior versions of CCE’s Standards and other corporate documents and renewal
of the reaffirmation process. Life further sought compensatory and punitive
damages.
Life simultaneously sought injunctive relief. The parties briefed that motion
and submitted documents and affidavits to the District Court. On February 10,
2003, the District Court heard oral argument but took no testimony. The District
Court granted Life’s motion from the bench and issued a written order on
February 12, 2003. R5-27-9; R4-28-4.
In its order, the District Court opined that Life satisfied the requirements for
a preliminary injunction on the ground that Life would be irreparably harmed by
the loss of accreditation and that the balance of equities weighed in Life’s favor.
The District Court further stated that Life was substantially likely to prevail due to
purported conflicting economic interests of LUCC’s “competitors” who were
involved in the decisionmaking and the District Court’s legal conclusion that
“[a]ctions which would violate the antitrust laws if incorporated in an accreditation
procedure, per se, indicate a lack of due process.” R4-28-34. The District Court
further stated that because of Life’s conservative philosophy, it had been the victim
of a liberal conspiracy, as manifested by purported “corporate manipulations” by
CCE’s Board. R4-28-3. Finally, the District Court stated that the danger to the
public would be not be as great as the harm of the “destruction” of LUCC, in light
of the willingness of one state to continue to permit licensure of LUCC students.
R4-28-4. [ibid, pp.22-24]
[/QUOTE]
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Re: Chiropractic Demonstration Project - March 26, 2005 6:33:00 AM
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Jeep
Posts: 353
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From: USA
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all of the above, unfortunately, does NOT support the claim of--- ">>>Since 2/3 of chiros are into subluxation overutilization and ignoring the real cause of patient complaints, >>>
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Re: Chiropractic Demonstration Project - March 26, 2005 6:34:00 AM
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lynx
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Which I already addressed above. No need to obfuscate.
Here is a listing of state laws, since you are already a chiro I'm sure it will come as no suprise.
http://www.chiropractic.org/legislation/state_statutes.htm
They will have to change some state laws to accommodate this widened scope of practice you are proposing.
I would think chiros would be familiar with their own scope of practice.
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Re: Chiropractic Demonstration Project - March 26, 2005 6:42:00 AM
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TMondale
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From: Newton-Wellelsley Hospital
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If you really want to raise H with this demonstration project send it to the same groups that opposed our bid to accomplish a demonstration project for direct access; medical doctors. That can work both ways. I plan on it.
Tim
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Re: Chiropractic Demonstration Project - March 26, 2005 7:20:00 AM
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Jeep
Posts: 353
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From: USA
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Good point Tim M.
>>>Which I already addressed above. No need to obfuscate.<<<
There is NO obfuscation. You did not validate your position with verifiable data. That makes it, until verified, OPINION.
>>>Here is a listing of state laws, since you are already a chiro I'm sure it will come as no suprise.
http://www.chiropractic.org/legislation/state_statutes.htm
They will have to change some state laws to accommodate this widened scope of practice you are proposing.
I would think chiros would be familiar with their own scope of practice.<<<
There is NO "WIDENED scope of practice" NO state laws need to be changed. It is merely coverage/getting paid for what has been/is being provided.
From your posts, there seems to be much you do not understand, or are not aware of.
If there is any aspect of this you do not understand-- Please ask. Do not assert on issues of scope of which you do not know.
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Re: Chiropractic Demonstration Project - March 26, 2005 7:37:00 AM
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Jon Newman
Posts: 1707
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From: Amherst, WI
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In WI, the chiropratice practice act defines chiropractic as:
"Definition of "chiropractic" by Chiropractic Board of Examiners as science based on premise that disease or abnormal function is caused by interference with normal nerve transmission and expression, due primarily to pressure, strain, irritation, or tension on spinal nerves as they emit from spinal column, as result of bony segments, especially of the spine, deviating from their normal juxtaposition, and that practice of "chiropractic" consists of analysis of any interference with normal nerve transmission and expression and correction thereof by specific adjustment with the hands of abnormal deviations of bony articulations, especially of the spine, for removal of cause of disease, without use of drugs or surgery, is a valid rule. State v. Grayson (1958) 92 N.W.2d 272, 5 Wis.2d 203."
Further, the practice of chiropractic is:
"To examine into the fact, condition, or cause of departure from complete health and proper condition of the human"
Here's something I don't understand, so I'll ask.
What exactly is "complete health" and "the proper condition of the human"?
jon
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Chiropractic Demonstration Project - March 26, 2005 7:46:00 AM
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Dr.Wagner
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Physical Therapy is a "protected term" as it should be, unfortunately no technique is solely physical therapy.
What if the billing codes were changed to Physical Treatment and utilized by all?
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