September/October 2012

State and National Governments are regulating the rules by which health care is rendered and paid.

Upcoming elections will effect both our national and state governments.

The Texas Legislature will meet in 2013 to create and change the rules again.

“Organized medicine” has stated that it intends to work to have the government FURTHER LIMIT Chiropractic.

How do you feel about it? Lend your voice and help your professional association to help you! The Movie

What the Critics Say ...

TEXAS THEATER, DALLAS, TXSeptember 28 - October 4, 2012 www.doctoredthemovie.com

TEXAS PREMIER

Sept 28

through

Oct 4, 2012

3

The movie Doctored opened nationwide on September 21, 2012. The premier in Texas is the weekend of September 28. Reviews of the movie are beginning to trickle out. What are the non-chiropractic critics saying?

Of this film the NY Times writes: “‘Doctored’ issues indictments of a market-based health system predisposed toward prescription drugs and surgery when less invasive, less expensive methods might be, heaven forbid, more effective. Seeing a series of “frozen shoulder” patients, unable to raise their arms, suddenly regain pain-free range of movement after spinal manipu lat ion is power fu l ev idence of chiropractic’s worth.”

The Village Voice reports “Whether or not you believe in the validity of chiropractic care, the roots of the professional prejudice date back to a period when opium was available in pharmacies, black people couldn’t eat in restaurants, and children were lobotomized for hyperactivity. At the very least, assumptions that old should probably be revisited.”

“Doctored, a talking-heads-and-stock-footage documentary by Bobby Sheehan, opens with the AMA’s conspiracy to push chiropractors out of business …. patients and chiropractors tell stories of successful treatments and diseases managed which pharmaceuticals had failed.”

“Sheehan largely omits the voices of skeptics, resulting in a considerable—but possibly overdue—slant in favor of chiropractors. Doctored frames the nearly century-long campaign against chiropractic care as a marketplace battle in which the stakes are

dollars rather than health. It’s certainly hard to discount ….”

Spirituality & Health reports: “it is clear to all Americans that the present day health care system is not serving everybody as well as it should be. One of the main reasons, according to this hard-hitting documentary by Bobby Sheehan, is that it is rigged in favor of the medical establishment, the power and money of the American Medical Association, the huge money-making machine of the pharmaceutical industry, and the public's lack of knowledge about alternative methods of treatment for cancer, autism, and other diseases.”

“To document this concerted attack, the filmmaker alludes to the federal antitrust suit Wilk vs. American Medical Association where the AMA was found guilty of an illegal conspiracy to ‘contain and eliminate’ the chiropractic profession.”

“Doctored presents a lively crosscut of cases involving individuals with multiple sclerosis, spinal pain, brain tumor, frozen shoulder, autism, and cancer who have benefited, and in some cases been cured, by alternative therapies.”

“It is painful to realize that although Americans make up only 5% of the world's population, we consume over 50% of al l the world's pharmaceutical drugs. In one segment, it is reported that some children are being given 26 vaccinations a year. The government has made it impossible for anyone who gets seriously ill or dies from a vaccination to sue the company that made the chemical stew carrying the vaccines which contains mercury.”

Texas Journal of Chiropracticwww.chirotexas.org

Doctored, The MovieThe story of adulterated Health Care in the United States

Continued. Pg 7

The Texas Chiropractic Association represents chiropractic professionals throughout the state.

TCA serves to protect chiropractic professionals, their patients, and the right for Texans to choose chiropractic as one of their health care options.

First formed in 1916, this historic association has existed for nearly 100 years representing the interests of Texans who desire safe and effective health care from chiropractic professionals.

ABOUT OUR COVERPlans have been made and preparations are under way for the upcoming 2013 Texas legislative session. The Texas Capitol in Austin will be abuzz with activity and action as various business and political entities vie for more favorable treatment.

Your participation and awareness are needed now more than ever before!

POLICIES

Annual subscription to the Texas Journal of Chiropractic is included in TCA membership dues. The digital Texas Journal of Chiropractic is regularly published six times per year by the Texas Chiropractic Association under the supervision of the TCA Communications Committee. Opinions expressed are those of the contributors and do not necessarily reflect the policy of the Texas Chiropractic Association or the Texas Journal of Chiropractic. Publication of an advertisement does not imply approval or endorsement by the Texas Chiropractic Association. The association shall have the absolute right at any time to reject any advertising for any reason. For advertising rates contact the TCA Office, or check online at www.chirotexas.org. All advertising material must be in graphics ready format and submitted as a .jpg, .jpeg, .gif, .swf, or .png file type.

Cont. Page

InsideDoctored, The Movie 3Doctored–Rough Cut Screening 7Doctored, the Movie--Why? 8News Licensees 9New TCA Members 10TBCE Will Required Proof of CE Hours 11TBCE Publishes Rules Changes 13Meet the Newest Member of the TBCE 18Seven Steps to a Sound Financial Policy 19The DOT Physical Exam and the National Registry of Certified Medical Examiners 25Texas Chiropractic’s Information Source 28TMA Seeks to Constrict Chiropractic (and others too) 28More MDs Hope to Call D.C. Home 30FiveCritical Steps to Achieve Financial Stability 30TCA Executive Director Search 32"Pain in America" Documentary Set to Begin 32Texas Law to Protect Student Athletes With Concussions 33Other News 34

Texas Chiropractic Association

Texas Journal of ChiropracticVolume XXVII, Issue 5 September/October 2012Texas Journal of ChiropracticThe Official Publication of The Texas Chiropractic Association

1122 Colorado, Suite 307Austin, TX 78701

Phone: 512 477 9292Fax: 512 477 9296E-mail: info@chirotexas.orgwww.chirotexas.org

Executive OfficersPresident: Jorge Garcia D.C. President Elect: Jack Albracht D.C. Secretary: James Welch D.C.

TCA StaffMembership Development: Amy ArcherEditor: Chris Dalrymple D.C.

Board of Directors

District 1! Paul Munoz D.C.District 2! Nancy Hinders D.C.District 3! Jason Clemmons D.C.District 4! Mark McGarrah D.C.District 5! Dr. John Quinlan D.C.District 6! Cody Chandler D.C.District 7! Lorin Wolf D.C.District 8! Shawn Isdale D.C.District 9! Mark Roberts D.C.District 10! Shane Parker D.C.District 11! Max Vige D.C.District 12! Thomas Hollingsworth D.C.

PoliciesAnnual subscription to the Texas Journal of Chiropractic is included in TCA membership dues. Contact the TCA for subscription rates for non members.

T h e p r i n t Te x a s J o u r n a l o f Chiropractic is published up to six times per year by the Texas Chiropractic Association under the supervision of the TCA Publication Committee.

Opinions expressed are those of the contributors and do not necessarily reflec t the po l i cy o f the Texas Chiropractic Association or the Texas Journal of Chiropractic.

Publication of an advertisement does not imply approval or endorsement by the Texas Chiropractic Association. The association shall have the absolute right at any time to reject any advertising for any reason. For advertising rates contact the TCA Office. All advertising material must be in graphics ready format and submitted as a .jpg, .jpeg, .gif, .swf, or .png file type.

Copyright 2012 All Rights Reserved: Texas Chiropractic Association

TCA Members obtain your CE hours online at www.ChiroCredit.com/tca and 25% will go to support the TCA.

“The only drawback to Doctored is that it tries to cover too much territory when in the last section it spins off into probes on food as medicine, the need for rich soil, the health food revolution, and the corporate rush to get involved with genetic modification of crops. All these developments can be seen as other s igns of corporate America's pursuit of profit and its lack of interest in the health and well-being of men, women, and children.”

Movieweb repor ts tha t “Illuminating historical events s u c h a s t h e W i l k v s . A m e r i c a n M e d i c a l Association case in which the AMA was found guilty of an illegal conspiracy to ‘contain and eliminate’ the chiropractic profession, Doctored sheds light on this ‘doctored’ system and opens a conversation on real solutions. The film follows Surgeons, MD’s, DC’s, DO’s, high-profile patients like Olympic Gold Medalist Picabo Street and NBA Hall of Famer John Stockton, as well as normal, every day people fighting for their lives, each having to choose to follow the typical, drug-based, standard of care or risk everything by providing or accepting belittled alternative therapies.“

Rotten Tomatoes reports that “Doctored is director Bobby Sheehan and producer Jeff Hays’ entry into the emerging genre of health focused feature documentaries and follows both patients and health care providers struggling within a broken health care system.”

“The story begins with the AMA’s attack on their non-drug providing rivals, the chiropractic profession. Interviews and historical footage expose the AMA’s clandestine campaign to eliminate chiropractic services, which culminates in a 15 year legal battle known as the Wilk case.”

“The key point made early in the film is that as it relates to health care almost all areas have been “doctored”. Endemic of the problem is the

plight of today’s MD who is forced to forgo the ‘art’ of medicine in exchange for 12-15 minute a p p o i n t m e n t s a n d f o r c e d prescriptions dispensing.”

“The film also shows spectacular successes from seeming chiropractic miracles from Olympic gold medalists, Hall of Fame NBA players and a mother that was sent home to die who regains health. “Sheehan shed’s light on this ‘doctored’

system and opens a conversation on real solutions.“

Doctored–Rough Cut ScreeningOn Friday and Saturday, September 7 and 8, 2012, “Rough Cuts” of the movie Doctored were screened in Texas. Friday night saw some 300 people in Dallas watch nearly an hour of film. In Austin on Saturday night some 30 minutes of film pertaining mostly to chiropractic was viewed by hundreds of chiropractors. The Chiropractic community has generally been supportive and thankful believing that it finally presents the perspective of those who have been on the receiving end of a vengeful medical majority.

A Rough Cut is the first stage in which a film begins to resemble its final product. Rough cuts do not necessarily flow well and will undergo many changes before the release of the film.

The art of film editing on its most fundamental level is the art, technique, and practice of assembling shots into a coherent whole. It is an art of storytelling.

The movie Doctored tells a story

Texas Journal of Chiropractic 7 www.chirotexas.org

Director Bobby Sheehan

From Pg 3

of how “health care” became “doctored” to the point that it has become unhealthy. To document the negative changes that “organized medicine” has wrought upon this country.

The screenings elicited a wide range of emotions–from “yep…I’ve lived that” to “WOW! I didn’t know that!“ Perhaps the most descriptive words about this screening were offered by Danny Gambino, D.C. Says Dr. Gambino: “Jeff Hays in his wisdom or luck, gave the movie a solid chiropractic backdrop but included the acupuncturists, naturopaths and other CAM (complimentary and alternative medicine) providers in order to tell the public that this was not just about the Chiropractic profession, but more of a rally cry for the American public to take responsibility for their health and that they DO have a choice and not to rely on our government to take care of us. And most importantly, that drugs do not heal. This means that the NDs, the Nutritionists, Acupuncturists, Homeopaths and even some of the DOs and MDs will have something exciting to share with their patients.“

Dr. Gambino continues: “And guess what–the centerpiece of the whole film is the chiropractor. That the way to get healthy is not to treat symptoms and that the medical physicians, although well-meaning individually, are pawns in the pharmaceutical industry’s agenda to drug every man, woman and child for life.”

“Although there was no mention of subluxation, there was innate, vitalistic, holistic, and the

delineation of true health care from sick care,” Dr. Gambino states.

“There was a mention of babies, celebrities, asymptomat ic e l i te a th le tes rece iv ing adjustments, Alternative cancer treatments, autism and vaccines, the AMA v Wilk case, the unveiling of Morris Fishbein, AMA’s Head for a quarter of a century, dubbed the ‘Mussolini of the AMA.’ I saw Stephen Barrett get his head handed to him while he was antagonizing Dr. Sportelli,” Dr. Gambino notes.

The most important message of this film is “this is a PERFECT springboard and opportunity to once again tell our story to the public, only this time it is coming from a third party.“

Dal las premieres are scheduled f rom September 28 through October 4. People can buy tickets directly from the theater. Go to www.doc to red themov ie . com fo r more information.

Doctored, the Movie--Why?According to an article published in Dynamic Chiropractic Jeff Hays, executive producer of “Doctored” is more proud of this film than any other film he’s done. Exciting words from the man with “On Native Soil” and “Farenhype 9/11,” among other works, to his credit.

The goal of the film, according to Hays: “get chiropractors a seat at the table” by prompting the public to take charge of their health and consider alternatives to the traditional medical model – starting with chiropractic care.”

The title of the film is D o c t o r e d , a s i n “perverted or messed with.” Says Hays: “On a personal level, what I didn’t know (and what I h o p e w e c a n communicate to viewers) is that chiropractors have a philosophy of health

8 Texas Journal of Chiropracticwww.chirotexas.org

Jeff Hays

that is uniquely needed today. We have just completely given ourselves over to the drug model, to the point that it’s not even questioned; it’s what you do.”

“I always assumed chiropractors didn’t prescribe drugs because they couldn’t. I had no idea there might be something philosophically of value as to why they shouldn’t. I was put on blood pressure medication 20 years ago and never skipped a day. It wasn’t until I started this project that someone said to me, ‘Have you ever looked at why your body has high blood pressure?’ Literally the thought had never occurred to me in 20 years. I just want to get chiropractors a seat at the table … and I think we’ve really done that.”

Hays continues, “the fundamental theme [of the movie] is that you have to be in charge of your own health – even if you don’t want to. We followed several patients, one of whom has MS. He’s 54 years old, he’s the healthiest-looking guy you’ll ever meet, and what you learn is that if you have a chronic disease, you can have a healthy body or an unhealthy body. Just because he has MS doesn’t mean he isn’t going to die of a heart attack, disease, stroke or cancer. You still have to take care of yourself, and in his case, even more so.”

Hays states “so, once you decide you have to take care of yourself, the question becomes, OK, how do I do that? One of the players on the field [chiropractic] has been cheated, and one [allopathic medicine] has propelled itself to the top of the pile by cheating. And that’s the drug-centered model of health that doesn’t make anybody healthier.”

“That’s where the story comes in – Is there a way of being healthier? Why isn’t it more popular? Why don’t we know more about it? It’s because the deck has been stacked and people have cheated. And that’s the Wilk case and everything traditional medicine has done to extinguish this branch of medicine, of health, called chiropractic.”

“The way it’s presented in the film is to consider chiropractic first, drugs second, surgery third. What happens with most people is drugs first, surgery second and if everything fails, then I might go to the chiropractor. [We need to get] chiropractic as a consideration that, as you examine the potential damage drugs and surgery do, it’s a rational thought from a conservat ive s tandpoint . Why not t ry chiropractic first? There’s so little to lose.”

“Surgery in particular seems out of control. It’s an invasive procedure with inherent risks, and yet surgery rates – back surgery, for example – are increasing exponentially. It’s just tragic.”

“I have a granddaughter who, at 16 months old, had never walked. She would take a few steps and then collapse. I looked at her and her feet were all turned sideways. I talked to my daughter and said she should take her to [my chiropractor]. She took her to see [him] and she started walking the next day. Her pelvis was

9Texas Journal of Chiropractic www.chirotexas.org

New Licensees July/August 2012

Bronson LesterJoey LoweryMirna MasriThuy Nguyen Ashley CarrMax CastilloValeria HoweRafael ValdezEric WuTellis BroussardKamaldeen IsiakaNancy LiNeal CobbDavid Gosalvez, IIIIvan Nieves Teresa RobothamBrian JestelAaron CorleyJason ChristJames SpencerJared Sporrer

Kevin Tomassini Kurt MartinTheodore Heggen, VTerra SchanzenbacherNhuyen NguyenEsteban ClementeAustin GaspardAustin ReynoldsEllen MasmanCourtney EckelkampAmy TurnerAustin SanfordJesse WoodMark AhrensJason RezansoffBrandi WasherTad SchexnailderKatie GreeleyKimberly McCutchenNicholas NiraTrevor SchoessowEdward Newsome, Jr. Erin OsterConnealy Hurter

way out of alignment. This is just one family, just one event, but do you realize if she had entered the medical model, what the next steps would have been for her? A brace, physical therapy – gosh, maybe surgery – and instead, we’re talking about a $55 appointment to a doctor of chiropractic!”

“This is where I really think this film can make an impact. It’s one thing for a bunch of chiropractors to congratulate one another and talk to each other about their successes, but after it’s all said and done, we’ve got to get this country to understand that they have options, and I think that now is the first time that everybody is mentally ready to look at alternatives – not only are patients questioning medical care, but every doctor in the country is questioning medical care and the way they’re being forced to practice medicine. Patients are crammed into 12-minute appointments, and you’ve got really good doctors that know they’re not practicing medicine anymore.”

“It’s amazing that in this health care debate, the whole debate seems to be over who pays. …

But nobody’s ever stopped to ask: Should we be paying...? And what are we buying with this money we’re paying? These are the questions the public is starting to ask.”

“The part that’s been frustrating to me as I look at chiropractic is that if you have CNN covering a health care debate, the producers walk into their office, pull out their electronic Rolodexes, and look for people to come to the studio to be interviewed or be part of the debate. And when that happens, a chiropractor will not be part of the debate. (I’ve been in studios where this has happened.) I don’t think that’s because CNN is against chiropractors; it’s because chiropractors have let themselves become irrelevant in these ongoing debates.”

It’s time for a larger number of the profession to step up, step out of the shadows and let people know they have some intelligent comments and a role to play. So, I’m hoping that we have an impact in making the public more receptive, but also in getting the profession to say, ‘OK, it is now our time to step up.’”

“There has been talk about the possibility of the film being nominated for an Academy Award. What are your thoughts? The Academy Awards qualifications are that you have to have a qualifying run in both New York and L.A., and you have to be reviewed by either The New York Times or the Los Angeles Times. So we’re doing a qualifying run, we doing everything we can to make sure we’re reviewed. We are hiring an Academy Award publicist (in addition to a publicist for the film) whose job it is to promote us in the industry. … We’re taking it seriously enough that we’re spending money on it; I just don’t want to jinx it. It’s certainly the right time in health care for this type of documentary.”

“I literally can’t think of another film in history – including Passion of the Christ– that had this many actively engaged potential promoters.”

Read the Dynamic Chiropractic Article HERE.

Read previous articles regarding this movie at:

10 Texas Journal of Chiropracticwww.chirotexas.org

TCA Welcomes our Newest Members:

Somphone AmphoneBradley Ray BakerSamuela BeanBenjamin A. CharltonJamon W. ClaytonMitchell R. Dougherty Phillip C. ElderStephen T. FordJuan GarciaDiana I. GodinezAsa U. HadsellYvonne C. HinojosaRyan M. Huffman,Ji Young KwonTaryn Nicole LoweryBryant K. MaysBrian G. McGaughran Scott A. McLellanT. K. Mochache

Jerald S. NaumAshlee L. NiebuhrTony L. OberleJames A. Palma Jr.Christel Nicole ParishPaternostro, Alesha M.Jason P. PellegrinKrista M. PerdueNataly PerezJohn H. Riggs IIITelila D. RobinsonGena RossDaniel D. SchererPhilip R. SledzBrock M. StrattonWhitney P. Tabler Barrett C. TerryWilliam M. Ursprung Ian D. VearyKristen Ann WaltersChristopher Warmath

Medical Inc. The MovieMedical, Inc. — Coming this FallMedical Inc. Movie Now Called “Doctored”–Release to be Sept. 21, 2012From the Producer…“Doctored”, a Pro-Chiropractic Documentary

TBCE WILL REQUIRE PROOF OF CE HOURSATTENTION IF YOU ARE A TBCE L I C E N S E E W H O H A S RECENTLY MOVED AND NOT YET INFORMED THE TBCE, READ THIS:

T h e T e x a s B o a r d o f Chiropractic Examiners recently ma i led a pos tcard to i t s licensees. Says the TBCE:

“As of January 1, 2013, the Board will begin enforcing Rule 73.3 in regards to continuing education. No DC will be cleared to renew their license without proof of sixteen (16), approved CE hours (including mandatory hours) from a roster submitted by the course sponsor. For any course that is taken with [sic] 30 days of the renewal, it will be the responsibility of the DC to provide proof of the hours. Any DC renewing from an inactive to an active status will also be required to submit proof of CE hours with their renewal packet. Rule 73.3 can be found on our homepage, www.tbce.state.tx.us, under the “Statutes and Rules” link.” [emphasis in the original]

“The Board will be sending important reminders via email to all DCs. To make sure you receive the correspondence, please ensure that your email address on file with the Board is correct and up to date. You may validate or update your email address in writing by submitting an email to sarah@tbce.state.tx.us, by fax to (512)

305-6705 or by mail to 333 Guadalupe, Ste. 3-825, Austin, TX.”

The agency has mailed postcards informing doctors of this change. THEY ARE ALSO USING THIS TO VERIFY MAILING ADDRESSES.

It is reported that a large number of post cards have been returned as undeliverable thus indicating that the TBCE does not have current addresses on these licensees. Complaints will be filed against these

doctors because they failed to notify the TBCE within the prescribed

time.

More importantly, these returned c a r d s m e a n s t h a t t h e s e licensees will not be getting their notices with the pending change of license renewal requirements.

If a TBCE licensee has recently moved and NOT informed the

TBCE of your new address. It WILL cost you money. Inform the TBCE NOW of

your new address.

TAKE NOTE: THE CE COURSE YOU ATTEND S H O U L D P R O V I D E P R O O F O F ATTENDANCE DIRECTLY TO TBCE. IF YOU RECEIVE YOUR CE HOURS WITHIN 30 DAYS OF YOUR RENEWAL YOU WILL NEED TO PROVIDE PROOF OF YOUR HOURS.

TBCE Publishes Rules ChangesThe Texas Board of Chiropractic Examiners has published several rules proposals in the Texas Register. Several proposed rules have been withdrawn, one rule is proposed to be repealed,

11Texas Journal of Chiropractic www.chirotexas.org

two were adopted, and one proposed rule has been published.

• Rule 71.13, Chiropractic Specialties is proposed to be repealed.

• Rule 80.7 Out of Facility Practice has been finally adopted.

This rule now reads:

(a) A licensed chiropractor who provides chiropractic services in a location other than a registered chiropractic facility (out-of-facility services) shall provide the board wi th a l is t that conta ins the fo l lowing i n f o r m a t i o n , f o r e a c h location:

(1) its name;(2) i ts address and

telephone number;(3) the name of the

owner or manager; and

(4) the planned or actual number of visits per week.

(b) At each location, the licensee must display, in the treating room, proof of licensure, such as a copy of his or her chiropractic license or the board-issued wallet size license, the name, facility number, address, and telephone number of the registered facility the licensee either owns or is employed at, and the consumer information required to be displayed under §75.8 of this title (relating to Public Interest Information). In lieu of displaying such information, the licensee may provide to each patient an information sheet that includes the information required by this subsection.

(c) A licensee must either be the registered owner of or be employed at a registered chiropractic facility in order to provide out-of-facility services. All out-of-facility services must be provided in conjunction with a registered facility.

(d) This section does not apply to a licensee who treats a patient at the patient’s home, because the patient is physically unable to travel to the chiropractic facility.

(e) A licensee shall file the list required by subsection (a) of this section, no later than the 10th day after the date that out-of-facility services were first performed, and annually, thereafter, along with the licensee’s annual license renewal. • Changes to Rule 75.17, Scope of

Practice, have been proposed by TBCE.

These proposals read:

(a)Aspects of Practice.

(1) – (2) (No change.)

(3) Needles may be used in the practice of chiropractic under standards set forth by the Board but may not be used for procedures that are incisive or surgical.

[(A)The use of a needle for a procedure is incisive if the procedure results in the removal of tissue other than for the purpose of drawing blood.]

[(B)The use of a needle for a procedure is surgical if the procedure is listed in the surgical section of the CPT Codebook.]

(4) (No change.)

(b) Definitions. The following words and terms, when used in this section, shall have the following meanings, unless the context clearly indicates otherwise:

(1) Biomechanics–the interaction of c o m p o n e n t s o f t h e h u m a n musculoskeletal system (such as the bones, muscles, ligaments, tendons, and joint capsules) with each other and with the nervous system that allows a body or part of a body to move from one place or

13Texas Journal of Chiropractic www.chirotexas.org

( 1 ) B i o m e c h a n i c s – t h e interaction of components of the human musculoskeletal system (such as the bones, muscles, ligaments, tendons, and joint capsules) with each other and with the nervous system that allows a body or part of a body to move from one place or position to another or to maintain position.

position to another or to maintain position.

(2) [ (1 ) ] Board–the Texas Board o f Chiropractic Examiners.

(3)[(2)] CPT Codebook–the American Medical Association’s annual Current Procedural Terminology Codebook (2004). The CPT Codebook has been adopted by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services as Level I of the common procedure coding system.

(4) Cosmetic treatment–a treatment that is primarily intended by the licensee to address the outward appearance of a patient.

(5)[(3)] Incision–a [A] cut or a surgical wound; also, a division of the soft parts made with a knife or hot laser.

(6)[(4)] Musculoskeletal system–the [The] system of muscles and tendons and ligaments and bones and joints and associated tissues and nerves that move the body and maintain its form.

(7)[(5)] On-site–the presence of a licensed chiropractor in the clinic, but not necessarily in the room, while a patient is undergoing an examination or treatment procedure or service.

(8) [ (6)] Pract ice of chiropract ic–the description and terms set forth under Texas Occupations Code §201.002, relating to the practice of chiropractic.

(9) Subluxation–a lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity.

( 1 0 ) [ ( 7 ) ] S u b l u x a t i o n c o m p l e x – a neuromusculoskeletal condition that involves an aberrant relat ionship between two adjacent articular structures that may have functional or pathological sequelae, causing an alteration in the b i o m e c h a n i c a l a n d / o r n e u r o -physiological reflections of these articular structures, their proximal structures, and/or other body systems that may be directly or indirectly affected by them.

(c) Examination and Evaluation.

(1) (No change.)

(2) To evaluate and examine individual patients or patient populations, licensees of this board are authorized to use:

(A) physical examinations;

(B) diagnostic imaging;

(C) laboratory examination;

(D) electro-diagnostic testing, other than an incisive procedure;

(E) sonography; and

(F ) o the r f o rms o f t es t i ng and measurement.

(3) Examination and evaluation services which require a license holder to obtain additional training or certification, in addition to the requirements of a basic chiropractic license, include:

[(A)Electro-neuro Diagnostic Testing training requirements and standards (paraspinal surface electromyography excluded) include:]

[(i)Board approved training consisting of one hundred and twenty (120) hours of initial clinical and didactic training in the technical and professional components of the procedures or completion of a

14 Texas Journal of Chiropracticwww.chirotexas.org

neurology diplomate program with sixty (60) hours of certification training in the technical and professional components of the procedures (these hours may be applied to a doctor's annual c o n t i n u i n g e d u c a t i o n requirement);]

[(ii)The professional component of these procedures may not be delegated to a technician and must be directly performed by a qualified and licensed doctor of chiropractic who must be on-site during the technical component of the procedures;]

[(iii)The technical component of these procedures may be delegated to a technician if, said technician meets the training requirements of this section and is a licensed health care provider authorized to provide those services under Texas law;]

[(iv)The technical component of surface (non-needle) procedures may be delegated to a technician that has successfully completed B o a r d a p p r o v e d t r a i n i n g consisting of sixty (60) hours of initial clinical and didactic training in the technical component of the procedures; and]

[(v)Procedures must be performed in a m a n n e r c o n s i s t e n t w i t h generally accepted parameters, including clean needle techniques, standards of the Center for Communicable Disease, and meet safe and professional standards.]

(A) [ (B) ] Per fo rmance o f rad io log ic procedures, which are authorized under the Texas Chiropractic Act, Texas Occupations Code, Chapter 201, may be delegated to an assistant who meets the

training requirements set forth under §78.1 of this title (relating to Registration of Chiropractic Radiologic Technologists).

(B) [ (C)] Technological Instrumented Vestibular-Ocular-Nystagmus Testing may be performed by a licensee with a diplomate in chiropractic neurology and that has successfully completed 150 hours of clinical and didactic training in t h e t e c h n i c a l a n d p r o f e s s i o n a l components of the procedures as part of coursework in vestibular rehabilitation including the successful completion of a written and performance examination for vestibular specialty or certification. The professional component of these procedures may not be delegated to a technic ian and must be d i rect ly performed by a qualified licensee.

(4) (No change.)

(d) (No change.)

(e) Treatment Procedures and Services.

(1) (No change.)

(2) In order to provide therapeutic care for a patient or patient population, licensees are authorized to use:

(A) osseous and soft tissue adjustment and manipulative techniques;

( B ) p h y s i c a l a n d r e h a b i l i t a t i v e procedures and modalities;

(C) acupuncture and other reflex techniques;

(D) exercise therapy;

(E) patient education;

(F) advice and counsel;

(G) diet and weight control;

(H) immobilization;

15Texas Journal of Chiropractic www.chirotexas.org

(I) splinting;

(J) bracing;

(K) therapeutic [Therapeutic] lasers (non-invasive, non-incisive), with adequate training and the use of app rop r ia te sa fe t y dev i ces and procedures for the patient, the licensee and all other persons present during the use of the laser;

(L) durable medical goods and devices;

( M ) h o m e o p a t h i c a n d b o t a n i c a l medicines, including vitamins, minerals; phytonutrients, antioxidants, enzymes, neutraceuticals, and glandular extracts;

(N) non-prescription drugs;

[(O)manipulation under anesthesia;]

(O)[(P)] referral of patients to other doctors and health care providers; and

(P)[(Q)] other treatment procedures and services consistent with the practice of chiropractic.

(3) The treatment procedures and services provided by a licensee which are outside of the scope of practice include:

(A) incisive or surgical procedures;

(B) the prescription of controlled substances, dangerous drugs, or any other drug that requires a prescription;

(C) the use of x-ray therapy or therapy that exposes the body to radioactive materials; [or]

(D) cosmetic treatments; or

(E)[(D)] other treatment procedures and services that are inconsistent with the practice of chiropractic and with the treatment procedures and services described under this subsection.

(f) (No change.)

• Rule 75.7, Required Fees and Charges

has been updated.

The new rule now reads:

(a) Current fees required by the board are as follows: Attached Graphic

(b) The board is required to increase its fees for annual renewal, an examination, and re-examinat ion by $200 pursuant to the Occupations Code §201.153(b). That increase is reflected in subsection (a) of this section under the column entitled “Professional Fee (78th Leg).” The total amount of each of these fees must be paid before the board will process an application subject to such fee.

(c) Any remittance submitted to the board in payment of a required fee for application, initial license, registration, or renewal, must be in the form of a cashier’s or certified check for guaranteed funds or money order, made out to the “Texas Board of Chiropractic Examiners.” Checks from foreign financial institutions are not acceptable.

(d) Fees for license verification or certification, license replacement, and continuing education applications may submit the required fee in the form of a personal or company check, cashier’s or certified check for guaranteed funds or money order, made out to the “Texas Board of Chiropractic Examiners.” Checks from foreign financial institutions are not acceptable. Persons who have submitted a check which has been returned, and who have not made good on that check and paid the returned check fee provided in subsection (a) of this section, within 10 days from notice from the board of the returned check, for whatever reason, shall submit all future fees in the form of a cashier’s or certified check or money order.

(e) Copies of public information, not excepted from disclosure by the Texas Open Records Act, Chapter 552, Government Code, including the information listed in paragraphs (1) – (6) of this

16 Texas Journal of Chiropracticwww.chirotexas.org

If you have ever thought about medical missions, then this your opportunity to help others, yourself and the chiropractic profession. Join Refuge International and a team of health profession-als providing health care to impoverished areas of Guatemala. Your mission will be to provide chiropractic care and to be an ambassador for chiropractic to the medical team that you will be working along side. The cost is minimal and the rewards are high.

OrganIzatIOn: Refuge International (http://www.refugein-ternational.com) Refuge International is a compassionate 501(c)3 volunteer organization dedicated to the goal of improving the lives of families and individuals through the collaborative development of sustainable programs in areas where healthcare, adequate nutrition, clean water and education are lacking or non-existent.

LOcatIOn: San Raymundo, which is located in the highlands one hour northwest of Guatemala City.

When: Refuge takes three teams to San Raymundo every year. Teams go the last weeks in )HEUXDU\�DQG�2FWREHU�DQG�WKH�¿UVW�ZHHN�LQ�$XJXVW���3K\VLFLDQV��FKLURSUDFWRUV��QXUVH�SUDFWLRQHUV��dentists, surgeons, nurses, translators, pharmacy staff, construction workers and other ancillary personnel operate a week long clinic in a free-standing hospital. The trip is from Saturday to 6DWXUGD\��DOWKRXJK�YROXQWHHUV�KDYH�DQ�RSWLRQ�WR�VWD\�DQ�DGGLWLRQDO�QLJKW�LQ�$QWLJXD�DW�D�FRVW�RI������:H�WUDYHO�WR�$QWLJXD�IRU�D�QLFH�KRWHO�VWD\�DW�WKH�HQG�RI�WKH�WULS��

cOst: �������DLUIDUH

caLL tODaY:���������������RU�HPDLO�JXDWHPDOD#DFWLYHFKLURSUDFWLF�FR�IRU�PRUH�LQIR

“Don’t put off till tomorrow what you can do today.”

ChiropractorsAbroad

³:KHQ�WKH�FOLQLF�FORVHG�DQG�,�ORRNHG�EDFN�WKURXJK�WKH�ZHHN��QRW�RQO\�KDG�WKH�ORFDO�*XDWHPDODQV�EHQH¿WHG�� EXW�,�KDG�EHQH¿WHG�DQG�WKH�FKLURSUDFWLF�SURIHVVLRQ�KDG�EHQH¿WHG���,�NQRZ�WKHUH�ZLOO�EH�1XUVH�3UDFWLWLRQHUV� referring to chiropractic because they had the opportunity to see chiropractic work up close and developed

a referral pattern for chiropractic care while in Guatemala” a'U��-HII�$OH[DQGHU

subsection may be obtained upon written request to the board, at the rates established by the Office of the Attorney General for copies of public information, 1 TAC Part 3, Chapter 70, §§70.1 – 70.10 (relating to Cost of Copies of Public Information).

(1) List of New Licensees

(2) Lists of Licensees

(3) Licensee Labels

(4) Demographic Profile

(5) Facilities List

(6) Facilities Labels

Meet the Newest Member of the TBCEMs. Anne Boatright from Smithvi l le, Texas, is the newest member of the Texas B o a r d o f C h i r o p r a c t i c

Examiners.

Texas Governor Rick Perry appointed Anne Boatright, president/CEO of Austin, Texas-based Capitol CU, to the Texas Board of Chiropractic Examiners for a term to expire Feb. 1, 2015.

The board l icenses chiropractors and chiropractic facilities, and registers chiropractic radiological technicians.

Boatright is a member of the Austin Credit Union Manager Association, the Texas Credit Union League (TCUL) Legislative Affairs Committee and the Credit Union National Association. She is a member and past board chair of the Austin Chapter of Credit Unions.

She is past chair of the TCUL board of directors and a past trustee of the Texas Credit Union Foundation.

Boatright is a graduate of the Southwest CUNA Management School.

She is also a volunteer with the 3N1 Volunteer Fire Department Ladies Auxiliary, past member of the Texas On-Site Wastewater Treatment Research Council and Private Sector Prison Industries Oversight Authority, and former honorary trustee of the Austin Children’s Hospital Foundation.

Seven Steps to a Sound Financial PolicyBy Dr. R. A. FOXWORTH, D.C., FICC, MCSP

Know Your Numbers

Many doctors do not really know the cost of doing business. We THINK we know about what it cost to run our practice. We may know what our monthly expenses are, but do you know the actual cost of providing an office visit? Don’t fool yourself into thinking it cost the same to adjust 10 patients as it does 25, just because you are already there.

According to whose numbers you read, overhead in a typical clinic runs about 50%. Don’t assume this is your number! A recent article I read suggested the following formula to determine your overhead. While it may not be 100% accurate, it will give you a ballpark number.

Unless you know your numbers, you are at a serious disadvantage when it comes to deciding to participate in your managed care contracts or other provider agreements. While it may be great to be “on the list”, if the list you are on is paying you LESS than what it cost to provide care, you are better off being OFF the list!

18 Texas Journal of Chiropracticwww.chirotexas.org

Otherwise, it’s like buying oranges for a dime and selling them for a nickel and wondering why you aren’t making any money. Getting a bigger truck is NOT the solution! Signing MORE contracts for less money than the cost of providing care is NOT the answer to improving your practice! You can’t make up for a loss by increasing volume.

Let’ s Talk Fees….or Perhaps Let’s DON’T!

You never want to “talk fees” with your colleagues. This is considered price-fixing and there is a law against it that can land you in hot water. You would be amazed how many times we hear doctors say they just asked friends around their area to see what the going rates were. This is flat out illegal…so don’t do it!

Don’t take our word for it; here’s the definition of price fixing and link from the Department of Justice:

Price Fixing: Price fixing is an agreement among competitors to raise, fix, or otherwise

maintain the price at which their goods or services are sold. It is not necessary that the competitors agree to charge exactly the same price, or that every competitor in a given industry join the conspiracy. Price fixing can take many forms, and any agreement that restricts price competition violates the law. In many cases, participants in a price-fixing conspiracy also establish some type of policing mechanism to make sure that everyone adheres to the agreement. http://www.justice.gov/atr/public/guidelines/211578.htm

So for obvious reasons, we won’t get into how much YOU should charge, but we can encourage you to at least review where you are in relation to others in your area using the resources that are available.

Know ing wha t ALL doc to rs , no t j us t chiropractors, are charging in your area is just a good business practice to make sure you maximize your income when possible. You could be charging LESS and getting PAID less than everyone around you and never know it.

19Texas Journal of Chiropractic www.chirotexas.org

! !

20www.chirotexas.org Texas Journal of Chiropractic

There are several resources to assist you in finding out the fees in your immediate area. You’ll want to use these resources to help you determine your ACTUAL fee. More about what your ACTUAL fee is in a few minutes.

So, How Many Different Types of Fees Can You Name?

Here is a sample list from the National Association of Heath Underwriters to get you started!

Actual Fee – What you actually charge for a service. (Typically your “highest fee”, also known as “my normal fee” or “what I would like to get paid”!)

UCR fee schedule – Charges of health care providers that are consistent with charges from similar providers for identical or similar services in a given locale.

Global Fees – Negotiated fees that are all-inclusive (one fee is paid for the entire range of services provided for a specific episode or episode of care.)

Negotiated Fees – Managed care plans and providers mutually agree on set fees for each service. This negotiated rate is usually based on services defined by the Current Procedural Terminology (CPT) codes, generally at a discount from what the provider would usually charge. Providers cannot charge more than this fee.

Prevailing fees – Amounts charged by health care providers that are consistent with charges from similar providers for identical or similar services in a given locale.

Allowable fees – Fees permissible by health plans, or mandated programs such as Medicare, Medicaid or Workers Compensation and PIP.

Contracted fees – Fees agreed to under a managed care or preferred provider agreement.

Mandated fees – Fees set by state and or federal programs such as Medicare, Medicaid, PIP and Workers’ Compensation

Approved Amounts –The amount Medicare determines is reasonable for a service covered under Medicare Part B. It may be less than the actual charge. For many services, including physician services, the approved amount is taken from a fee schedule that assigns a dollar value to all Medicare-covered services that are paid under that fee schedule.

I am sure there are more types of “fees” but obviously this is enough to confuse the issue for most of us. Now, here is YOUR challenge. Regardless of how many types of fees there are, YOU should have ONE fee in your clinic as your “ACTUAL FEE”. Your ACTUAL FEE is part of your FEE SYSTEM.

Your fee system reflects the range of fees you accept as part of your managed care agreements, your participation in mandated programs such as Medicare, Medicaid or PIP and Workers’ Comp, if they are regulated in your state.

While all of these fees may be different, this does NOT mean you have a dual fee system. Why? Because they are “contracted discounts” off your Actual Fee, or they are mandated fees set by either the state or federal government. Did you notice, nowhere in this list, did you see my cash fee, my PI fee, my workers comp fee, my family plan fee, my Uncle Dudley fee, or my buy 10 visits get one free fee! Why...because they shouldn’t exist!

Develop a Fee System and Stop Playing Let’s Make a Deal!

Your fee is your fee is your fee. Period! Or it should be!

Step back from the laundry list of “fees” you may now have in your office and start thinking in terms of “what is my ACTUAL fee” for each procedure in the clinic. Break the habit of your

fee being based on payer type. Insurance companies ARE sending letters to doctors asking if they offer any type of discounts to patients, and IF so, how they are reflected on the claim form. Guess what? There is NO place on a CMS 1500 claim form to SHOW a discount. Do you smell a rat?

If you have your Fee System set up properly, you should be able to answer the above question like this, “ I only have one fee for my clinic services and the only time that fee is discounted is when it is part of a contractual network agreement or a documented financial hardship.” This is a ROCK solid way to set up your fee system and IF you follow it in practice, you’ll be able to practice with much more peace of mind!

Now let’s look further at this “fee system”. Within your fee system, there are layers. (UCR Fee Schedule, Contracted Fee Schedules, Mandated Fee Schedules and Hardship Agreements)

Review the above diagram to better understand the Fee System Concept.

Build Your Fee Schedule and Your Financial Policy!

Once you’ve identified your Actual fee, then make SURE you are letting your patients, EVEN YOUR CASH PATIENTS know these are your REAL fees! Many doctors have been giving discounts to their cash patients and have NEVER let them know what their real fees were! If you’ve been in practice very long, you’ve probably had this come back to bite you when the cash patient gets involved in an auto accident and gets the Explanation of Benefits and sees your REAL fees for the first time. NOT A PRETTY SIGHT! Once you have determined your actual fees for services, stick with them until you evaluate your fees in the next year or at some given interval.

Now let’s talk about an Office Financial Policy. Having a proper Fee System allows you to set up a simple office policy that can be summarized on a single piece of paper! Keep it simple and straight-forward.

If you find yourself or any of your staff saying, “Wait until Suzy comes back and she can review our financial policy with you” … then it is

21Texas Journal of Chiropractic www.chirotexas.org

too complicated. Anyone who is at the front desk should be able to discuss the basics. If they can’t, you have to ask yourself, why not? Is your fee schedule really dependant upon who is paying the bill?

If your fee system is set up properly, and you have an ACTUAL fee established for your services, then the only time that you should charge LESS is when there is a contractual obligation or special circumstances. After you have set your policy, follow it! All patients should be aware of the financial policy. Here is a good example of a simple but solid policy:

What about pre-paid care plans and time of service discounts? Are they legal?

That depends on who you ask and where you practice. In some states, collecting in advance, or offering “unlimited care at a fixed fee” is considered the business of insurance and is prohibited, unless you want to go apply for an insurance license!

Some states require doctors to “escrow” the funds you have collected in advance and only draw down funds as services are rendered. IF you have determined they are legal where you practice, make sure you dig deeper just to be on the safe side. Don’t rely on the word of your colleagues who may say, “We’ve been doing

22 Texas Journal of Chiropracticwww.chirotexas.org

!Dr.$B.$J.$Palmer$Chiropractic$Clinic$

Notice$In$an$effort$to$maintain$compliance$with$various$state$and$federal$regulations,$managed$care$and$preferred$provider$agreements,$as$well$as$billing$and$coding$guidelines,$we$have$adopted$the$following$financial$policies:$$

1. Our&clinic&has&established&a&single&fee&schedule&that&applies&to&all&patients&for&each&service&provided.&&

2. You&may&be&entitled&to&a&network&or&contractual&discount&under&the&following&circumstances:&a. We&are&a&participating&provider&in&your&health&plan.&b. You&are&covered&by&a&State&or&Federal&program&with&a&mandated&fee&schedule.&c. You&are&a&member&of&ChiroHealthUSA,&or&any&other&Discount&Medical&Plan&Organization&we&may&

join.&Patients&who&are&uninsured,&or&underinsured&(limited&benefits&for&chiropractic&care),&may&join&ChiroHealthUSA&in&our&office&and&will&be&entitled&to&network&discounts&similar&to&our&insured&patients.&Membership&is&$39.00&a&year&and&covers&you&and&your&dependents.&Ask&our&staff&for&more&information.&

d. Patients&who&meet&state&and&or&federal&poverty&guidelines&or&other&special&circumstances&outlined&in&our&“Hardship&Policy”&may&be&offered&a&discount&for&a&period&of&time&as&determined&by&the&clinic.&Verification&will&be&required.&&&&&&

3. As&part&of&our&compliance&plan,&as&of&_______&our&office&will&be&unable&to&extend&any&type&of&discounts&other&than&those&listed&above.&

$Acknowledged$By:$________________________________________________________!Date:!_________________________________!

!If!you!would!like!a!copy!of!this!to!modify!in!Microsoft!Word,!copies!will!be!given!to!

attendees!of!the!upcoming!webinar!for!Vermont!Doctors!on!06/27/2012.!!Register!at!https://www3.gotomeeting.com/register/720069198!

!

that for years”, so it must be ok. B e c a u s e s o m e t h i n g i s commonplace, does not mean it is legal.

If you are offering these plans you should find out if you can offer the plan to insured patients. Some provider agreements prohibit collecting any part of the deductible or copayments IN ADVANCE of services rendered. So, read your agreements closely. Our consultants advise us to NEVER collect in advance on federally insured patients like Medicare.

We obviously like patients to commit to treatment plans and pre-pay plans seem to help them stick with it. A popular alternative that avoids the problems with some pre-pay plans is a good auto-debit system that incorporates legal network discounts offered by a Discount Medical Plan Organization. This type of system allows you to offer discounts to insured patients on their NON-covered services. You simply set them up on auto-debit and have the patient sign an agreement to receive care and debit their credit card or bank account weekly, bi-weekly or monthly. You should NOT offer discounts on deductibles and co-payments, but only on non-covered services (like the visits when insurance runs out). With auto-debit, the patient is simply paying on their account, after services are rendered, which avoids the problems of collecting deductibles and copayments in advance

I would also suggest you avoid offering free services as a reward for someone committing to 10 or 20 or X number of visits. These offers are still an inducement if someone else (like the government) is paying the bill .There is a $10,000.00 fine PER occurrence for this type of violation.

Now, a bit more about Time of Service or Prompt Payment Discounts.

Here are the facts as we know them:

• Time of service discounts ARE permitted in a few states.

• Not all states define the percentage allowed. • Even if your state DOES permit Time of

Service Discounts, state laws do NOT supersede federal laws and you should be mindful of federal regulations regarding charging “Fair Market Value”.

The OIG did issue an opinion to a hospital in 2009 indicating that between 5% and 15% could be considered a “reasonable” prompt payment d iscount . BUT… there were restrictions on WHEN it could be offered, and it could not be advertised (and that does not mean an ad run in a newspaper…word of mouth can constitute advertising!) There were some other caveats as well.

While a time of service discount may be permissible in some states, the problem is, far too many doctors hide behind this term when what they are really doing is trying to hide a dual fee schedule. The discounts they offer are FAR above any reasonable bookkeeping reduction. Our advice is to confirm what your state permits and if NOT defined, err on the side of caution and follow the OIG’s suggestion of 5%-15%.

Keep it Current!

Do you review your fees annually? Some carriers raise their fees at the first of the year, others in April and some in June. Ta lk to provider services and get the date on your reminder system to have someone verify the allowable, they do change and you could be leaving revenue on the table.

Train Your Staff!

Congratulations, you have developed a fee system, and you put it in writing, now what? Train your staff! There are rules and regulations

23Texas Journal of Chiropractic www.chirotexas.org

when it comes to operating your own clinic. Is your staff up on the latest information available? If not, then you are putting them and yourself at risk! There is a wealth of information and training material available through your state association and companies/consultants that specialize in the field of chiropractic.

What you measure, improves. Monitor to ensure your staff fully executes your Financial Policies. Review your financial policy during weekly team meetings and see if every new patient the prior week had financial policy formally covered. You know how important a good report of findings is for patients. Treat the financial review with just as much importance. Money or confusion about responsibility is one of the top reasons patients drop out of care. This is an easy fix with a sound financial policy. If your staff receives resistance from any patients about your new policy, problem-solve it together. Talk about it and remember to congratulate them for following policy.

Things to Avoid!

Do not undermine your front desk and insurance staff by talking fees with patients UNLESS that is YOUR normal office policy. Set and follow your policy and let them do the talking.

Inconsistent collection policies. Set and follow your policies on collections and apply them equally to all patients.

Do not tweak your coding to allow for “lower fees”. This is called down coding and many doctors do this if they are trying to lower the fee to a cash patient. Consider using a proper Discount Medical Plan Organization which will eliminate the need for this improper coding and will allow you to document, code, bill, AND discount correctly.

Do not base your fees or codes on payer type. You should have ONE fee and stick with it. The only time you should discount is when there is a contractual agreement or mandated fee schedule or the patient truly qualifies for your

hardship policy. Base CPT coding on payer type ONLY if it’s required by contract or mandate. Okay… there aren’t just 7 steps; here are a few more pointers!

Do you offer discounts?

If so, there are TWO areas of concern to consider:

Legal Implications: If you do offer discounts, BE CAREFUL! Offering discounts the WRONG WAY can cost you. There are real fines and penalties associated with improper discounts and inducements.

Financial Implications: You must know your profit margin to determine if the discounts you are offering allow you to remain profitable. We see far too often that docs are willing to offer discounts without regard to their expenses or maintain a profit margin. What they fail to realize is if offering a discount to the uninsured or underinsured may be helpful, but it should also be reasonable and not at or below your cost of rendering the services.

How can a discount impact your practice? Did you know that if you were seeing 100 patients a week, and you collected 100.00 per visit, that if you decided to cut your fees by 25% to “attract” more patients, you would literally have to see 133 visits to collect the same revenue!

So do the math and make sure you are maximizing reimbursement by at least having your Actual Fee at UCR for your community, and if you offer discounts, offer them within reason and make sure you aren’t charging less than what it cost you to deliver the care.

Action Steps!• Review and set your fees – Determine your

ACTUAL fee and stick with it!

• Implement your Financial Policy based on your Fee System

24 Texas Journal of Chiropracticwww.chirotexas.org

• Consider joining a DMPO if you are offering discounts. These plans allow you document correctly, code correctly, bill correctly and IF you are offering discounts, you can discount correctly and practice with more peace of mind.

If you want to receive a sample financial policy you can implement in your practice, send us an email to info@chirohealthusa.com with the words SAMPLE POLICY TXCA in the subject line and we will reply with the sample financial policy attached.

Dr. Foxworth is a certified Medical Compliance Specialist and President of ChiroHealthUSA. A practicing Chiropractor, he remains “in the trenches” facing challenges with billing, coding, documentation and compliance. Dr. Foxworth is a 1984 Honors Graduate, (Cum Laude), of Cleveland Chiropractic College in Kansas City, MO. He served as Staff Chiropractor for the G.V. Sonny Montgomery VA Medical Center for 4 years and is a member of the American Chiropractic Association and a 3 term past-president of the Mississippi Chiropractic Association. He was voted by his peers as Chiropractor of the Year for several years and is currently a Fellow of the International College of Chiropractic. He was appointed to the Mississippi State Board of Health by Governor Kirk Fordice and again by Governor Ronnie Musgrove and served 12 years, two of them as Chairman. Dr. Foxworth can be contacted through www.chirohealthusa.com, info@chirohealthusa.com, and 1-888-719-9990

The DOT Physical Exam and the National Registry of Certified Medical ExaminersThe ACA, TCA and TeamCME are partnered to provide physician training to perform the Department of Transportation (DOT) Physical Examination for the upcoming National Registry of Certified Medical Examiners (NRCME) training events for all doctors of chiropractic. In Dallas November 9-11, 2012.

All Commercial Vehicle Drivers will be required to use a CME from the National Registry for CDL exam. As one of only five professions

authorized to perform these examinations, DCs will have the opportunity to expand their patient base. It is estimated that (more than) 40,000 providers will be needed in the next two years to provide physicals to the 7+ million truck drivers in the United States. CLICK HERE FOR REGISTRATION INFORMATION

Learn how to perform the DOT physical exam and apply FMCSA medical standards and guidelines to correctly determine whether a driver is medically qualified to drive. Increase highway safety and provide a service to commercial drivers & motor carriers while fulfilling your role as a DOT Medical Examiner to increase highway safety. We will cover who must be examined, how often, the examination format, required forms, systems review, pharmacology, and the decision making for disqualification and how to get involved.

Attendees will:

• Learn from the leading chiropractic experts

• Receive the most comprehensive NRCME training available

• Become qualified to take the NRCME certification test and become a nationally recognized CME in your area

• Training includes:• Introduction to the National Registry,

Medical Examiner, Driver, Motor Carrier Requirements and CLIA

• Drivers Role, Forms, Certificates, History and Documentation

• Endocrine, Seizure, Mental Disorders• Drug/Alcohol Regulations• Vision, Hearing, BP, Pulse, Lab Testing,

EENT, Heart, Vascular, Respiratory, Abdomen, GU, Hernia, Orthopedic, Neurologic disciplines

• R e g u l a t o r y R e v i e w a n d E x a m Demonstration

• Steps to become certified in the National Registry

25Texas Journal of Chiropractic www.chirotexas.org

*The American Chiropractic Foundation is recognized under the PACE program of the Federation of Chiropractic Licensing Boards (FCLB)

Performing the DOT Physical Examination for the

National Registry of Certified Medical Examiners (NRCME)

General Information

Programming is brought to you by the American Chiropractic Association and TeamCME, and held in cooperation with the Texas Chiropractic Association. Within the next 20 months, all Commercial Vehicle Drivers will be required to use a Certified Medical Examiner from the National Registry for all CDL exams. Medical Examiners must attend an accredited training course in order to sit for the certification test to become a Certified Medical Examiner (CME) in the Department of Transportation, National Registry. Our competitive pricing includes all the training and support you will need to be successful! Attendees will: Learn from the leading chiropractic experts Receive the most comprehensive NRCME, Alcohol & Drug Testing training available Become qualified to take the NRCME certification test and become a nationally recognized CME in your area Training includes:

o Introduction to the National Registry, Medical Examiner, Driver, Motor Carrier Requirements and CLIA o Drivers Role, Forms, Certificates, History and Documentation o Endocrine, Seizure, Mental Disorders o Drug/Alcohol: Absorption, Metabolism, Test Result Review, DOT Regulations o Vision, Hearing, BP, Pulse, Lab Testing, EENT, Heart, Vascular, Respiratory, Abdomen, GU, Hernia,

Orthopedic, Neurologic disciplines o Regulatory Review and Exam Demonstration o Steps to become certified in the National Registry

Seminar Information

Session I: Advanced Alcohol/Drug Testing for Physicians

Friday, November 9, 2012

8:00 am – 6:00 pm

8 CE*

BONUS Session: Market and Manage Your DOT Practice

Friday, November 9, 2012

7:00 pm – 9:30 pm

No CE

Session II: National Registry of Certified Medical Examiners (NRCME) Accredited Training Course (Must attend both Saturday and Sunday sessions)

Saturday, November 10, 2012

8:00 am – 5:15 pm

8.25 CE*

Sunday, November 11, 2012

8:00 am – 1:45 pm

5.75 CE *

Location Information

Dallas, Texas Hilton Garden Inn DFW Airport South ACA DOT Training Seminar Room Rate: 2001 Valley View Lane $ 89 / night (king) Irving, TX 70561 This special rate will be available only until November 1st or until sold out. Phone: (972) 313-2800 Additional room types are available.

Additional Information 22 hours of Continuing Education Units for the State of Florida are pending. Questions? Contact ACA Education at education@acatoday.org

Texas Chiropractic’s Information SourceThere is so much information to keep track of--news from TBCE, ACA, AMA, Facebook, Twitter, Linked in, plus the clinical research, the association news, district news, federal state and health news! It seems that I have to check a dozen sources a day just to keep up with what is happening to, with, in and around our profession.

Where can you find the news that you need to know? The Texas Journal of Chiropractic online website gives you the news that you need to make working in the chiropractic health care field easier to navigate. News articles from many sources are updated and added to the Journal site every day so that you have the latest news.

Our sources range from the ACA, ICA, WCA to the AMA, Medpagetoday, and more. We have each story clearly categorized. Want to find out what is happening at the state level? Go to our “state government” category. Interested in the federal election? Go to our “federal government” category. What is the history, or the current news regarding Federal Healthcare reform? Just check out that section. And we have sections for association news, notable news, news, legislative, Chiropractic colleges, clinical, opinions, and health & wellness as well.

When you want to know the latest about what is going on of interest to your profession go to journal.chirotexas.org

Check out the Texas Journal of Chiropractic web site FIRST and you will find the news you need to stay current in chiropractic health care.

Send news and information that you wish to share to editor@chirotexas.org and we will let the chiropractic profession know.

TMA Seeks to Constrict Chiropractic (and others too)If you thought that the Texas Medical Association was going to live-and-let-live because of their recent set backs in the court system think again. The TMA now wants to eliminate the nervous system from the practice of chiropractic. NO, this is not an overblown interpretation. These are the TMA’s own words.

The TMA on July 12, 2012, wrote a letter to the TBCE. The TMA’s letter to the TBCE states:“The Texas Medical Association (TMA) is a private, voluntary, nonprofit association of Texas physicians and medical students.”

“Proposed section 75.15 would recognize a spec ia l t y o f ‘ ch i rop rac t i c neuro logy. ’ …’neurology’ connotes the practice of medicine. … neurology is beyond the lawful scope of practice of chiropractic in Texas …”

“Many definitions exist supporting the argument that neurology and neurologist are terms that the public will interpret to mean a physician practicing medicine. … All of these definitions regard a neurologist as a physician, and neurology as a medical specialty involving the nervous system. Chiropractors are not physicians. Neurology and the human nervous system are beyond the scope of chiropractic.”“The Texas Chiropractic Act defines the practic of chiropract ic [ to include] performing ‘nonsurgical, nonincisive procedures … to improve the subluxation complex … . The Chiropractic Act makes no reference to neurology. Neurology does not involve the biomechanics of the spine and musculoskeletal system. Neurology is clearly beyond the scope of chiropractic in Texas, and this proposed rule

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is a brazen effort by the board to circumvent Texas statutory law to expand chiropractors’ scope.”

On perhaps a somewhat more positive note the TMA notes that “section 101.201 of the Texas Occupations Code specifically prohibits the type of designation that the board has proposed to authorize. It states, … (9) represents in the use of a professional name a title or professional identification t h a t i s e x p r e s s l y o r commonly reserved to or used by another profession or professional.“ Surely the Texas Medical Association will now use its extensive coffers to protect the public f r o m a c u p u n c t u r i s t s , p h y s i c i a n s , p h y s i c a l therapists, veterinarians and the unlicensed from making use of the term “chiropractic” when they describe their use of manipulation.

In an attempt to relegate the chiropractic profession to ONLY “physical medicine practitioners” the TMA states “the Texas Chiropractic Act l i m i t s t h e s c o p e o f chiropractic with its term biomechanical, ...” The TMA then cites the definition of “biomechanics” from several sources and notes “none of these definitions makes any reference to the nervous system. … The Chiropractic Act does not mention nerves or the nervous system, as the nervous system is beyond the scope of chiropractic.“

Our medicinal cousins, however, seem quite confused. The TMA states “the Texas Legislature has authorized chiropractors to treat subluxation complex. In that regard, TMA does not disagree that defining the term is appropriate. TMA is aware that the board has proposed the World Health Organization’s

definition of subluxation. TMA prefers the board using the WHO definition, rather than the board creating its own definition …“

For our medicinal cousins, the WHO definition is: “A lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are

altered, although contact be tween jo in t sur faces r e m a i n s i n t a c t . I t i s essentially a functional entity, w h i c h m a y i n f l u e n c e biomechanical and neural integrity.“ “Neural” means “pertaining to a nerve or nerves,” from Greek neuron “nerve”.

So which is it to be? “The Chiropractic Act does not ment ion nerves o r the nervous system, as the nervous system is beyond the scope of chiropractic” OR “the Texas Legislature has authorized chiropractors to treat subluxation complex. … TMA prefers the board using the WHO definition” which does reference nerves.

If the TMA has it’s way it w o u l d b e “ t o r e m o v e reference to the nervous

system from the definition.“

Just the latest in a long line of TMA DISinformation in the name of “public safety.”

Meanwhile, TMA has also filed a lawsuit against the Texas State Board of Marriage and Family Therapists (TSBMFT). TMA’s suit contends the board exceeded its statutory authority when it adopted rules defining “professional therapeutic services” to include a “diagnostic assessment” and authorizing marriage and family therapists to base their services on an “assessment, evaluation, or diagnosis.” “TMA believes the board’s rule unlawfully authorizes marriage and

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“Chiropractors a r e n o t p h y s i c i a n s . Neurology and t h e h u m a n nervous system are beyond the s c o p e o f chiropractic.”

--Texas Medical Association

family therapists to diagnose mental diseases and disorders even though therapists have no medical training, and the cause of many mental diseases and disorders is medical and only a physician can treat it.”

TSBMFT contends that therapists “have been exercising the authority to diagnose in this state for at least 18 years with no known complaints.” According to the board, “Law, public policy, and common sense all dictate that MFTs should be allowed to continue doing so.”

More MDs Hope to Call D.C. HomeThe number o f medical physicians roaming the halls of Congress could grow by half -- from 20 to 30 depending on how the federal elections turn out.

A total of 28 medical physicians have their names on the ballot. That includes 17 incumbents and 11 challengers.

Of the 20 physician members of Congress, 17 are in the House and three in the Senate.

All of the physician House members, except for Rep. Ron Paul, MD, (R-Texas), who made an unsuccessful bid for the White House, are running for reelection.

Two senators -- Rand Paul, MD, (R-Ken.) and Tom Coburn, MD, (R-Okla.) -- are not up for reelection.

Of the 28 candidates, 26 are running for House seats; the only two Senate physician candidates are Wyoming Republican Sen. John Barrasso, MD, running for reelection, and Richard

Carmona, MD, a Democrat hoping to fill the seat of retiring Sen. Jon Kyl (R-Ariz.)."People who are passing laws for doctors are not doctors," said Syed Taj, MD, a Democrat and internist running in Michigan's 11th Congressional District. "We need more doctors." Less than 4% of the 535 voting members of Congress -- 435 in the House of Representatives and 100 in the Senate -- are doctors, he noted.

Of the 20 current physician members of Congress, a nonvoting delegate, Donna Christensen, MD, (D-Virgin Islands) and Rep. Jim McDermott, MD, (D-Wash.) are the only two Democrats. But of the 11 challengers this fall, seven are Democrats.

"I think that more physicians should run for office at all levels," said Ruiz, who is running for public office for the first time. "The voices of our physicians should be amplified and multiplied across the nation because you can't change the healthcare system without including the voices of our patients and providers."

Five Critical Steps to Achieve Financial Stability for Your Practice

By Ray Foxworth, DC, FICC, MCS-P

When D.D. Palmer delivered that f irst adjustment, there was no filing for insurance on that service. There were no forms to fill out, and there was no Medicare regulation. Instead, there was the heart of generosity and healing.

Chiropractic was born fresh and new into a world where compensation could take the form of a good laying hen, an offer to name the first-born for the doctor, cash, or an “I’ll take care of it next week.”

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" P e o p l e w h o a r e pass ing laws for d o c t o r s a r e n o t doctors. We need more doctors."

Today, that spirit of healing and generosity is still the life’s blood of chiropractic. But in today’s chiropractic offices, financial steadiness is the heart beat that keeps that blood flowing.

Financial stability isn’t difficult to achieve, but it does take steady, intentional acts to bring into being. Fortunately, financial success is simple and duplicatable. Here are five steps you can implement right away to take charge of your practice, and to keep that heart beat and that life blood flowing:

• Give your practice an exam and adjustments based on the results. Treat your practice like your patient! Is your practice in alignment with your own core values? With your practice goals? These may have changed over time—or they may be the goals and ideals that you started with when you first opened your office. You can tell when your practice has lost focus or gone off track—just as with a subluxation—when you do an examination and look objectively at the results. Schedule check-ups to make sure you’re still running an intentional practice in line with your own beliefs about what’s most important to you: be that authenticity, service, providing value, or “harder” values like profitability, sustainability, and building a legacy. A practice that’s out of alignment with your principles will run, but it won’t run smoothly or easily. Make the time to keep your practice on track.

• Take charge of your office. No matter how large or small your practice, it’s vital that you, if you are doctor and boss, clearly understand the administrative procedures that make your office run and why those procedures exist in the first place. But while it’s crucial to avoid abdicating responsibility, it’s equally critical to delegate and avoid immersing yourself in tasks best handled by your support staff. Find the sweet spot b e t w e e n a b d i c a t i o n a n d

micromanagement. You will free yourself and your practice to financially thrive.

• Share the love. Create community inside and outside your office.

• Create a culture of appreciation. Make sure each member of your staff knows that you value them and what they do. Interestingly, while employees can be and are motivated by bonuses and other financial rewards, they’re often even more appreciative of simple recognition. As Napoleon said, “Men will fight long and hard for a bit of colored ribbon.” P r a c t i c e s m a l l a c t s o f a c t i v e a p p r e c i a t i o n : p r a i s e a n d acknowledgment – from lunch to simply saying thank you. Let your patients know your staff is AWESOME when staff can hear it. Imagine the difference in how those staff members will then treat your patients!

And also: what are you doing to be an active part of your community? Show up. Support community events. And not just to hand out business cards and brochures. The more visible your practice is as an integrated part of your community at large, the more your potential patients will see you as a vital, committed part of their corner of the world. That kind of goodwill simply can’t be generated by advertising and marketing.

• Assess your billing and discount procedures. Offering discounts and lowering prices for patients is very much in the spirit of generosity found in the origins of chiropractic. It’s not only one of the most benevolent things you as a practitioner can offer your people; it’s also an outstanding marketing tool. But Medicare regulations are tight and tricky, and are being redefined all the time. Make sure your discounts are on the right side of the law, so that you can

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continue to help patients the way you want—and legally.

Get the support into your office that will help you do the right things the right way. Do you need to bring in a coach or a practice management company? Or explore a NEW one? Do you need the services of a Discount Medical Plan Organization, like ChiroHealthUSA, to make your patient discounts squeaky clean and legal? Do you need a medical compliance specialist to assist with proper, legal, and effective billing? Explore! Compare! Take ACTION to make your practice strong and keep the spirit of chiropractic vital and flowing!

Dr. Foxworth is a certified Medical Compliance Specialist and President of ChiroHealthUSA. A practicing Chiropractor, he remains “in the trenches” facing challenges with billing, coding, documentation and compliance. Dr. Foxworth is a 1984 Honors Graduate, (Cum Laude), of Cleveland Chiropractic College in Kansas City, MO. He served as Staff Chiropractor for the G.V. Sonny Montgomery VA Medical Center for 4 years and is a member of the American Chiropractic Association and a 3 term past-president of the Mississippi Chiropractic Association. He was voted by his peers as Chiropractor of the Year for several years and is currently a Fellow of the International College of Chiropractic. He was appointed to the Mississippi State Board of Health by Governor Kirk Fordice and again by Governor Ronnie Musgrove and served 12 years, two of them as Chairman. Dr. Foxworth can be contacted through www.chirohealthusa.com, info@chirohealthusa.com, and 1-888-719-9990

TCA Executive Director SearchFor the past year the Texas Chiropractic Association Board of Directors conducted a national search for a qualified individual to serve as the Executive Director of the Texas Chiropractic Association. After reviewing hundreds of applications and interviewing nearly a dozen potential applicants, the position was offered to one of the candidates. In August he accepted the position to serve as the TCA Executive Director. The candidate, however, found it necessary to withdraw his candidacy

prior to starting his new position due to unforeseen family obligations. The search for a qualified individual to serve as Executive Director will continue.

In order to continue moving forward with the work of our mission the TCA Board of directors has named Amy Archer, currently serving in an Administrative Multi-role staff person at the TCA, as the Acting Executive Director. She is charged with working with the executive officers and department coordinators to coordinate and grow the TCA.

The TCA will continue to move forward on its mission to protect chiropractic professionals, their patients, and the right of Texans to choose chiropractic as one of their health care options.Established in 1916, the historic Texas Chiropractic Association has existed for nearly 100 years and has represented the interest of Texans who desire safe and effective health care from chiropractic professionals.

"Pain in America" Documentary Set to Begin Principal PhotographyThe Don Barrett Productions, LLC documentary "Pain in America" is poised to begin principal photography. Between Oct. 1 and Nov. 16, our cameras will be covering over 9,000 miles of the U.S. to help answer the question: What will the various health care professions do to serve the 76 million baby boomers who will reach and surpass 65 years of age in the coming two decades? Our current infrastructure is clearly inadequate to handle those numbers.

Consider this: According to the National Association for the Advancement of Science, some 100 million Americans already suffer from chronic pain that ranges from annoying to life-threatening. What role will the chiropractic professional play in ameliorating the suffering

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and help solve the looming baby boomer problem?These are big questions and the producers of "Pain in America" are going to the best and brightest in the field of chiropractic, as well as its students (tomorrow's chiropractors), teachers, administrators and the researchers who will help determine tomorrow's modalities of treatment. Our cameras will take us to some of the most prestigious colleges and universities

teaching chiropractic, as well as to pre-eminent members of the medical profession who have concluded chiropractors must take an important role in fighting the pain epidemic. Indeed, one of our interviewees is a distinguished professor of medicine and researcher at Stanford University Medical School.

Once this plays on PBS and goes into DVD distribution through chiropractic professionals

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and to the public at large, the people of America will see that an important part of their overall health care deserves to be in the hands of the chiropractic practitioners. "Pain in America" takes a clear-eyed look into the future, since that is where all of us will spend the rest of our lives.

Texas Law to Protect Student Athletes With Concussions Takes Effect

Last year, the Legislature passed House Bill 2038, also known as Natasha’s Law, which required, among other things, training for coaches and athletic trainers on how to react when players sustain concussions. Coaches around the state had until Sept. 1 to complete two hours of training on how to identify concussion symptoms and to institute new rules about when an athlete could return to play.

Under the previous rules, a coach could put students back into a practice or a game if they were symptom-free for 15 minutes. Now, a physician has to give clearance before athletes in any sport can return to the field. Concussion symptoms include dizziness, blurred vision and headaches. Although Natasha’s Law applies only to public schools, some private schools and club leagues have also adopted it.

“We’ve hurt a kid’s brain and put him back in the game the same day, but when they have a knee injury, they’re out for three weeks,” said Dr. Jim Sterling, a sports medicine and concussion specialist who helped draft the initial version of the law. “We’ve been doing it a certain way for 30 years, but that doesn’t mean that’s the right way.”

According to the Centers for Disease Control and Prevention, up to 3.8 million sports-related concussions occur in the United States each year. People ages 15 to 19 sustain more concussions than those in most other age groups, and concussions are more damaging to adolescent brains than to adult brains.

State Senator Bob Deuell, Republican of Greenville, who sponsored the bill in the Senate, said coaches and athletic trainers can undergo the training free. They can complete it online or with guidance from one of their district’s athletic trainers.

Senator Deuell, who is also a physician, said coaches, parents and student athletes could misunderstand the symptoms and impact of concussions.

“Natasha’s Law is just the beginning, and it has stimulated the need for more research,” said the president of the athletic trainers association.

Burn Risk Seen with Topical Pain RelieversThe FDA warns of the risks of rare but serious chemical burns with certain over-the-counter topical pain relievers, including Bengay, Capzasin, Flexall, Icy Hot, and Mentholatum.

The agency has noted a number of adverse event reports that range from burning sensations to hospitalizations for first- to third-degree burns within 24 hours of the first application.

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“We’ve hurt a kid’s brain and put him back in the game the same day, but when they have a knee injury, they’re out for three weeks. We’ve been doing it a certain way for 30 years, but that doesn’t mean that’s the right way.”

Topical muscle and joint pain relievers are usually formulated as creams, lotions, ointments, and patches and contain menthol, methyl salicylate, or capsaicin as single or combination active ingredients.

The reports of second- and third-degree burns were mostly related to products with menthol or menthol and methyl salicylate as active ingredients, the agency said in a statement. In those products, menthol concentrations e x c e e d e d 3 % a n d m e t h y l s a l i c y l a t e concentrations exceeded 10%.

To reduce risk of the adverse events, the agency said, patients should avoid tightly bandaging or applying localized heat -- such as with heating pads or lamps -- after using the pain reliever.

Also, the agency noted, the products should not be applied to open wounds, broken skin, mucous membranes, or the eyes.

The agency added that, despite the serious adverse event reports, the products' labels would not be forced to carry a warning for the skin reactions at this time.

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Chiropractic professionals helping for nearly 100 years.

The Association of Chiropractic professionals

in Texas

Texas Chiropractic Association1122 Colorado, Suite 307

Austin, TX 78701Phone: 512 477 9292

Fax: 512 477 9296E-mail: info@chirotexas.org

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