October 2013 - Minnesota Chiropractic Association

---

September/October 2013

Minnesota

Chiropractic Association

MCA

Journal Knowledge is Power

Research: Protecting the Profession Minnesota Chiropractic Association

YOUR PARTNER IN PAIN MANAGEMENT CDI Pain Care can help evaluate your patients if they have reached a plateau with care, and work with you on a comprehensive solution to help manage their pain. This could include consultations in diagnostic imaging, therapeutic injections, medication management or behavioral health services. Our goal is to provide you with a resource, if needed, to help conservatively manage your patient’s care.

CDI PAIN CARE SERVICE INCLUDES: ■

■

■

A comprehensive evaluation of each patient, including a History and Physical (H&P). An individual treatment recommendation and coordinated care for services as appropriate. Progress reports shared with you to ensure you remain a part of your patient’s care.

■

■

CDI Pain Care is now a HealthPartners Designated Medical Spine Center. Meets Minnesota payers requirements for conservative pain management. CONTACT 952.738.4488 TO SCHEDULE AN APPOINTMENT OR REQUEST REFERRAL PADS. VISIT US ONLINE AT CDIPAINCARE.COM.

1

SERVING THE CHIROPRACTIC COMMUNITY SINCE 1981. THAT’S CDI.

MCA Journal September/October 2013

MCA

Table of Contents

Minnesota Chiropractic Association Board of Directors 2013-2014 President Dr. Christian Kollar First Vice-President Dr. Scott Mooring Second Vice-President Dr. Doug Broman

4, 11 & 13

Treasurer Dr. Lisa Hellerud Secretary & Parliamentarian Dr. Richard C. Hueffmeier Immediate Past-President Dr. Jennifer Naas Northeast District Director Dr. Gerald Priley

15

Northwest District Director Dr. Vincent W. Pankonin Central District Director Dr. Barbara Dolezal Metro East District Director Dr. Brian Malzer Metro East District Director Dr. Kathy Casey Metro West District Director

21

Dr. Carrie Getzmier Metro West District Director

A Message from the President. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 A Message from the Executive Director/CEO. . . . . . . . . . . . . . . . . 4 2013 Calendar of Events - Public Education. . . . . . . . . . . . . . . . . . . . 5 Welcome New and Returning Members . . . . . . . . . . . . . . . . . . . . . . . . 7 Chiropractic Federal Credit Union: The Story of Us . . . . . . . . . . . 8 Minnesota Chiropractors Encourage Backpack Safety . . . . . . . 1 0 Foundation for Chiropractic Progress Articulates Value for Chiropractic Care . . . . . . . . . . . . . . . . . . . . . . . . 10 Knowledge is Power-Continued . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Legislative Session Recap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..... . . 12 Knowledge is Power-Continued . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 MCA Key Doctors: An Essential Piece of the Legislative Puzzle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..... . . . . . 13 ICD-10: Bog Changes are Coming Will You be Prepared? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Online Presence is No Longer Relevant . . . . . . . . . . . . . ........ . . . 14 The Top 6 Reasons Your Chiropractic Claims are Denied . . . 15 All Employers Must Distribute Notice of Health Insurance Marketplace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Susan G. Komen 3-Day for the Cure Thank You Volunteers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Revalidation of Medicare Provider Enrollment Information. . 19 The Health Benefits of Mushroom Consumption........ . . . . . . 21 The American Chiropractic Association’s Public Policy on Social Media ............................................................24 Wulff on Law: How to Write Narrative Reports ............25-26 MCA Members Talk ................................................27 Why Should I Become a Member of the MCA Today?.........27 MCA Membership Application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Classified Ads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Associate Business Member Directory . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Advertising Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Dr. Nicholas Mellum Southeast District Director Dr. Andrew Klein Southwest District Director Dr. Monica Schugel Executive Director/CEO Debra Hurston

Mission Statement: The Mission of the Minnesota Chiropractic Association is to support and unify the Art, Philosophy, and Science of the Chiropractic profession. Copyright 2013 Minnesota Chiropractic Association. All rights reserved.

Articles MCA Journal regularly publishes a variety of by-lined columns authored by individuals whom we consider to be knowledgeable in their respective fields and who have a valuable message to share with the Minnesota chiropractic community. Opinions in these columns, however, are those of the authors and do not necessarily represent the opinions of the Board of Directors, members, or staff of the Minnesota Chiropractic Association.

MCA Journal September/October 2013

2

AFromMessage the President Dr. Christian Kollar

CHIRO-MART- Value vs. Commodity

A

patient of mine shared with me that they had seen an advertisement for chiropractic care that offered adjustments for as low as $20.00. While the patient had no interest in exploring it, they did wonder how it was possible to offer care at that low rate. This patient clearly saw the value vs. price dilemma, however, not everyone will. Doctors who elect to use price as a differentiating marketing tactic are extremely shortsighted. The initial challenge is that we run the real risk of creating a price war amongst ourselves. The price war then would likely result in chiropractors further driving rates downward and further eroding the profession’s ability to maintain a quality standard of living. If you are asking less from each patient, would it not follow that you are going to have to see more patients in order to meet your current financial obligations? I call it the “Chiro-Mart” effect. Now if you are squeezing more patients into an hour, what is the corresponding impact on the ability to provide patients with valuable care? And let us not forget “attention” while forming initial or enhancing existing patient/doctor relationship. When the lowest price is the only or leading benefit presented to patients, the message being sent translates into something along the lines of saying that chiropractic care can be had for pennies on the dollar. John Moore, a former marketing manager for Starbucks and director of national marketing with Whole Foods explained, “Wal-Mart has no story to tell beyond low prices. I contend that WalMart is a commodity experience because they have not adequately differentiated themselves as offering consumers value other than the value of low prices.” When Wal-Mart comes into a community, they

annihilate the competition with low prices and leave the carnage of the small mom and pop shops that could not or would not compete based on price. The customers are then left with chiropractic care run like an assembly line. Chiropractic is known historically for its strong patient/ doctor relationships. We in effect will erode our brand. Now, just for kicks and giggles, let’s toss the insurance companies into this mix. The chiropractic profession has been asking, begging and even pleading for years for professional recognition and pay parity. While results have admittedly been beyond slow and extremely painful, more and more research is now available that clearly substantiates the “value” of chiropractic care and highlights the unique relationship chiropractors have with their patients. However, if you are an insurance company and your priority is to reduce cost, what would cause you to invest more resources in paying someone for example $50 when they are advertising that they will gladly accept $20.00? Just in case anyone is having trouble with this question, the answer is NOTHING. The logical thing for payers to do is adjust their rates so that they are in-line with the markets trends. Some marketers believe that a low price strategy does not necessarily mean that a company or even a profession is slouching towards commoditization. While Southwest Airlines and Trader Joe’s are two examples of companies offering great rates, they also offer great customer experiences. The vast major of companies who hang the hat on low prices as the differentiator without the corresponding experience are bound to fail in the long run and chiropractic is no exception. Chiropractors who know the value of their brands, who know they are delivering value and that their brand has a loyal following, will not succumb to the Wal-Mart commodity-confirming machine.◆

“Doctors who elect to use price as a differentiating marketing tactic are extremely short-sighted.”

3

MCA Journal September/October 2013

A Message From the Exec. Dir./CEO Debra Hurston

I

KNOWLEDGE IS POWER

n the July/August issue of the MCA Journal, Dr. Christian Kollar provided you with highlights of some of the recent research available which substantiates the value of chiropractic care. When I came across the information below from Tim Gaughan, Public Relations Director for the Michigan Association of Chiropractors, I thought it was a great compilation of information that we all should have at our finger tips. In fact, I feel so strongly about this, that I’m dedicating my column to it and the MCA Editorial Review Committee has authorized using it as the feature article for this issue. If you would like to share it with your patients, you can download it from the “Resources” section of our website under the “Members” tab.

Research Proves It: For Effectiveness and Efficiency, Chiropractic Can’t Be Beat! ealth care costs for the treatment of musculoskeletal conditions are substantial. There were more than 132 million physician visits for musculoskeletal symptoms in 2006. According to a 2008 report from the American Academy of Orthopaedic Surgeons, musculoskeletal disorders cost the United States approximately $850 billion per year. Another study found that the total cost of treating back pain alone in the U.S. has risen 65 percent in the past decade and now rivals the economic burden of treating cancer. Pharmaceuticals and surgery often drive these costs, meaning that the noninvasive and drug-free approach of chiropractic can greatly reduce expenditures while also representing a vast improvement in public health. The efficacy and cost-effectiveness of chiropractic care in relationship to the medical model has become a critical issue. The growth of managed care networks and other systems restricting access to chiropractic has heightened the need for additional evidence that can be used by policymakers to better allocate health care dollars. The studies below add to the growing body of scientific evidence suggesting that chiropractic is a safe, effective, and efficient treatment for low back and neck pain, especially when compared to traditional medical care. What’s New? The Latest Research “As more data continues to surface touting the benefits of chiropractic care – lower costs, less risks and higher satisfaction rates – I expect that patients and practitioners will move toward considering chiropractic first, medicine second and surgery last,” - Gerald Clum, DC ​​​​​ Spokesman, Foundation for Chiropractic Progress The Early Predictors of Lumbar Spine Surgery Study (2013) This study provided documentation of chiropractic care as a first option for back pain relief and surgical avoidance.

H

Using Disability Risk Identification Study Cohort (D-RISC) data, the study authors examined the early predictors of lumbar spine surgery within three years among Washington state workers with new worker’s compensation temporary total disability claims for back injuries, and found: • Reduced odds of surgery for those under age 35, women, Hispanics and those whose first provider was a chiropractor. • In fact, 42.7 percent of workers who first saw a surgeon had surgery, in contrast to only 1.5 percent of those who saw a chiropractor. • This held true even when controlling for injury severity and other measures. Conclusion: There was a very strong association between surgery and first provider seen for the injury, even after adjustment for other important variables. Keeney, et al, “Early Predictors of Lumbar Spine Surgery after Occupational Back Injury: Results from a Prospective Study of Workers in Washington State,” Spine. 38(11): 953964. May 15, 2013 The Spine Study (2013) This randomized controlled trial assessed changes in pain levels and physical functioning in response to standard medical care (SMC) versus SMC plus chiropractic manipulative therapy for the treatment of low back pain among 18 to 35-year-old active-duty military personnel. The findings included: • Adjusted mean scores on the Roland-Morris Disability Questionnaire were significantly better in the SMC plus CMT group than in the SMC group at both week two and week four. • Pain scores were also significantly better in the group that received CMT. • Adjusted mean back pain functional scale scores were significantly improved in the SMC plus CMT group than in the SMC group, as well. Conclusion: “The results of this trial suggest that CMT in conjunction with SMC offers a significant advantage

Continued on pg 11

MCA Journal September/October 2013

4

2013

Calendar of Events

Public education Part of the MCA strategic priorities include educating the public about the benefits of chiropractic care and overall health and wellness. The MCA will be promoting these different topics during the following months and will share with you information that you can give to your patients. If you have any suggestions on possible topics for the public please feel free to contact the MCA Communications Committee.

August

January

Backpack Safety Month

Wellness and Prevention for the New Year

September Birth of Chiropractic/Chiropractic Awareness Month

October World Spine Day - October 17

March Kids Health

April Stress Awareness Month

November TMJ Awareness & Diabetes Month

December

May

Women’s Health & Pregnancy

Winter Safety Tips

Chiropractic Day at the Capital

Chiropractic Celebration

Thursday, March 6, 2014 See page 29 for more information.

May 2-4, 2014

Featured Event

MCA Hole-In-One Golf Outing September 12, 2013 StoneRidge Golf Course — Stillwater, MN 5

MCA Journal September/October 2013

(763) 746-8686 Toll Free 1 (866) 966-3445 Email: [email protected]

Milt Edgren, President CLU, ChFC, MSFS

Our team of experts are proud to service chiropractors throughout the state of Minnesota.

Woodhill Financial, Inc. is pleased to be your endorsed MCA agency We offer key products and services designed specifically for the chiropractic community.

Amy Edgren, CLU Kelly Chillstrom, CIC Blake Cadwallader, LUTCF

Does your insurance coverage need an adjustment? Contact one of our experts for a free review of your:

• Health Insurance



• Life Insurance



• Disability Insurance



• Long Term Care Insurance



• Retirement Planning Needs

MCA Journal September/October 2013

6

Member Services

Welcome Welcome New & Returning Members

Ali Rounaghi, DC 612-702-6050 Savage, MN Metro West

Chelsey Barber, DC 952-215-6330 Eagan, MN Metro East

Zen Matsuda, DC 612-886-7763 Edina, MN Metro West

Chris Patten, DC 320-693-3612 Litchfield, MN Central

Jennifer Skelton, DC 920-698-0598 Bloomington, MN Metro West

Adam Ebbers, DC 507-360-3900 Richfield, MN Metro West

Brad Meints, DC 507-356-4014 Pine Island, MN Southeast

Megan Reed, DC 952-913-1049 Minneapolis, MN Metro West

Staples Advantage, ABM Lucas Zwieg 651-639-4709 Arden Hills, MN

Peter Harmon, DC 612-237-9532 Prior Lake, MN Metro West

Kristine Meints, DC 507-356-4014 Pine Island, MN Southeast

Gregory Roberts, DC 218-209-8949 Lakeville, MN Metro East

Christopher Wood, DC 507-895-2225 La Crescent, MN Southeast

Bryan Hedlund, DC 218-824-3737 Brainerd, MN Central

Mark Olson, DC 763-682-1849 Buffalo, MN Metro West

Troy Robson, DC 952-943-2440 Eden Prairie, MN Metro West

Michael Zauhar, DC 612-396-0872 Baxter, MN Central

DOT Drug Testing and Alcohol Screening Certification September 21-22, 2013

Speakers: Elizabeth L. Auppl Brian Tasky, DC Co-Sponsored by:

Elizabeth Auppl and Dr. Brian Tasky will team up to accurately address all topics required to prepare you for the National Registry of Certified Medical Examiners (NRCME) certification exam. On Saturday, September 21, 2013 you and your CA/staff can train to become certified to perform DOT Alcohol Screening and Drug Testing services which enables you to immediately provide new services in your practice. On Sunday, September 22, 2013 prepare yourself for the newly created Federal Motor Carrier's Safety Administration (FMCSA) NRCME. Doctors of chiropractic and other licensed health professionals interested in conducting DOT Physical Exams need to complete training and pass the certification exam at an approved testing center by May 2014.

For more information or to register call 952-885-5446

7

MCA Journal September/October 2013

L

Chiropractic Federal Credit Union: The Story of Us

ast year, I had the pleasure of meeting Dr. William Ryniewicz, 88, of Rochester, MI. Dr. Ryniewicz was one of the founding members of CFCU. I was very excited to meet him, as we didn’t know that any of our founders were still living. After some discussion, Dr. Ryniewicz graciously agreed to forward me some information on the founding, much of which was unknown to us at CFCU, and which I will share with you and the chiropractic profession in this article. Imagine one of your Michigan chiropractic forefathers in 1950. Chiropractic had only been a separate profession of the healing arts for 17 years. Imagine trying to start a practice – and get a loan from a financial institution that was probably unsure about what chiropractic even was, let alone the business needs of a new chiropractor trying to set up shop or an established chiropractor looking to expand. That was the situation many DCs found themselves in, and they decided to do something about it. Chiropractic Federal Credit Union (CFCU) began as a federally chartered credit union in 1950, when a group of chiropractors who were having trouble obtaining loans from other financial institutions to advance their practices decided to pool their resources and form a credit union that would provide them with savings programs, which in turn would then provide the means to issue loans to members.

The original fee to establish the charter was paid by a personal check drawn on the account of Dr. Carl Ege of Detroit, who at the time was the President of the Michigan State Chiropractic Society. Dr. Ege is the person who researched, conceived, and advanced the idea of a credit union for doctors of chiropractic, and he would become the organization’s first president. At CFCU’s organization meeting, held in downtown Detroit on September 24, 1950, the total amount invested added up to a whopping $35- share deposits of $5 from each of the seven original members! From this modest beginning, CFCU quickly experienced tremendous growth. By the end of that first year, CFCU had 184 members; by 1955, there were more than 500. By the end of the first year, CFCU had net assets of a little more than $20,500. By 1980, net assets had reached more than $1.1 million. In comparison, as of the final quarter of 2012, CFCU had 2,641 members and more than $24 million in total assets. Also, in its first 30 years, CFCU had granted nearly 4,000 loans totaling more than $10.6 million to its members.◆

Online About the Author: Anne Blain, CEO of Chiropractic Federal Credit Union If you have a financial question, please forward to: [email protected] or contact us at 800.422.6424sbursed.

A Yummy Any Way Deal You Slice It! We have a Yummy Deal for you at Chiropractic Federal Credit Union . . . and it’s a great deal for you any way you slice it! Building relationships for 63 years. We have low rates and loan specials for personal and business needs, and a low-rate CFCU VISA.

Refinance and save. Fast approval and personal service.

Receive a Grand Traverse Pie Company pie with each loan for $6,000 or more.

We're not asking for the whole pie - just for you to bring a slice of your business to CFCU. Visit www.chirofcu.org for current rates and apply today! 23617 Liberty • Farmington, MI 48335 248-478-4020 • 800-422-6424 • Fax: 248-478-7632 www.chirofcu.org

We’re safe, we’re sound, we support Chiropractic.

Federally Insured by NCUA

MCA Journal September/October 2013

8

9

MCA Journal September/October 2013

Minnesota Chiropractors Encourage Backpack Safety

Public Education

B

6. Lift the backpack with your legs and place it on one loomington, MN- Over 79 million students carry a shoulder strap at a time. backpack to school each day. However, most students 7. Do not leave backpacks on the floor where they can are unaware of the potential hazards such as neck and back problems that come with the improper use of backpacks. To become a tripping hazard. 8. Choose a quality backpack that has wide well-cushioned avoid long-term injuries and prepare students for the fall, shoulder straps with a lumbar support/padding. Minnesota chiropractors encourage families to consider In 2010 the American Chiropractic these safety tips to ensure a safe Association began endorsing North Face for and educational school year. Weight of Child Maximum their high quality backpacks. Safety tips on how to avoid (in pounds) Backpack Weight Talk to teachers about reducing the need to backpack injuries bring home textbooks or if at all possible, 1. Wear both shoulder straps 60 5 have an extra set for home use. evenly to properly distribute 60 - 75 10 If you would like personalized help for your backpack weight. child’s backpack and other health needs, 2. Get the correct size backpack 75 - 100 15 please visit the Minnesota Chiropractic for you and/or your child. Association website at www.mnchiro.com to 3. Do not pack too much weight 100 - 125 18 “Find a Doctor” in your community. and remember that no one should 125 150 20 * American Chiropractic Association, carry more than 25 pounds in a American Academy of Orthopedic Surgeons, backpack. Follow these guidelines 150 - 200 25* American Physical Therapy Association.◆ to ensure student safety at school: 4. The backpack should not About Minnesota Chiropractic Association: extend below the lower back. Bigger is not better. Created in 1927, the Minnesota Chiropractic Association is committed to 5. Lighten the load and put the heaviest items in the promoting awareness of the health risks and impact of spinal dysfunction as backpack first keeping them close to the body. it relates to optimal health.

Foundation for Chiropractic Progress Articulates Value of Chiropractic Care

T

he Foundation for Chiropractic Progress (F4CP), a notfor-profit organization dedicated to raising awareness about the value of chiropractic care, recently released “ Accountable Care Organizations Optimize Outcomes, Cost Savings and Patient Satisfaction with Chiropractic Care,” highlighting the role Of Doctors of Chiropractic (DC) to generate better patient outcomes, improve patient satisfaction and lower costs for advanced models, such as Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMH). “Chiropractic care represents a non-invasive, evidence-based, drug-free approach that should serve as a key deliverable in the ACO model,” states Gerard Clum, DC, spokesperson, F4CP and lead author. “With ongoing positive outcomes for successfully addressing low back and neck pain, DCs are well positioned to help ACOs contain costs. Avoidance of surgical procedures and associated hospitalizations will have a profound impact on ACO achievements.” Key Conclusions: • Chiropractic care provides treatment for the leading causes of disability and burden of disease, low back and neck pain, which rank respectively as the number one and number four cause of disability worldwide, according to the World Health Organization.

Chiropractic In The News

• Injured workers whose initial healthcare provider was a surgeon underwent surgery 42.7 percent of the time, versus 1.5 percent when the provider was a DC, reported an article in Spine. • The Journal of the American Medical Association (JAMA), which explored the economics of spinal pain, reported the cost of spinal pain from 1997 to 2005 increased by 65 percent--in eight years, the costs increased by two-thirds. This problem is not shrinking--it is expanding year after year. • In the spectrum of provider-assisted care for low back pain, chiropractic care is among the least invasive, least dangerous and least expensive approaches to be considered. • In ACO and PCMH environments, DCs provide potential for greater clinical efficiency, patient satisfaction and cost savings than is currently available. • The inclusion of chiropractic services in advanced delivery models is being facilitated by credentialing processes in development by URAC and the National Committee for Quality Assurance (NCQA). “New regulation will result in a transfer of more control and ‘accountability’ to the patients and providers, and access to chiropractic care will serve the interests of all ACO stakeholders,” says Dr. Clum. ◆ Source: http://www.f4cp.com/pr/2013/aco-positionpaper.6.25.13.pdf MCA Journal September/October 2013

10

Knowledge is Power Continued from pg 3 for decreasing pain and improving physical functioning when compared with only standard care, for men and women between 18 and 35 years of age with acute LBP.” Goertz et al, Adding Chiropractic Manipulative Therapy to Standard Medical Care for Patients with Acute Low Back Pain: Results of a Pragmatic Randomized Comparative Effectiveness Study, Spine. 38(8): 627-34. April 15, 2013. The Disability Recurrence Study (2011) This study shows that the use of health maintenance care provided by physical therapist or physician services was associated with a higher disability recurrence than in chiropractic services or even no treatment at all. The study compared occurrence of repeated disability episodes across types of health care providers who treat claimants with new episodes of workrelated low back pain. Researchers followed 894 patients over one year, using workers’ compensation claims data. Findings include: • “Provider type during the health maintenance care period was significantly associated with recurrent disability… with the only or mostly physical therapy group having the highest proportion of recurrent disability (16.9%) and the only or mostly chiropractor and the no health maintenance care groups having the lowest proportion of recurrent disability (6.5% and 5.5%, respectively).” • Statistically, this means you are twice as likely to end up disabled if you got your care from a PT, rather than from a DC. You’re also 60% more likely to be disabled if you choose an MD to manage your care, rather than a chiropractor. • “There is a growing evidence that health-care-as-usual does not necessarily improve health outcomes in nonspecific LBP.” • “No health maintenance care is generally as good as chiropractic care… chiropractors might be preventing some of their patients from receiving procedures of unproven cost utility value or dubious efficacy.” • The only or mostly chiropractor group during the disability episode and health maintenance care periods and “chiropractor loyalists” during both periods combined had fewer surgeries, used fewer opioids, and had lower costs for medical care than the other provider groups. Conclusion: In work-related nonspecific LBP, the use of health maintenance care provided by physical therapist or physician services was associated with a higher disability recurrence than with chiropractic services or no treatment.” Cifuentes et al, “Health Maintenance Care in Work-Related Low Back Pain and Its Association With Disability Recurrence,” Journal of Occupational and Environmental Medicine, Vol. 197 [epub], March 14, 2011 The Spine Care Pathway Study (2011) This study of low back pain patients treated exclusively by chiropractors at a Massachusetts hospital achieved successful clinical outcomes in few visits, at low cost, and with high satisfaction rates. The study authors found that: • These patients achieved successful clinical outcomes in an average of 5.2 visits at the low cost of $302 per case • Satisfaction rates remained above 95 percent • In addition, self-reported pain and disability scores were 11

MCA Journal September/October 2013

reduced by about 70 percent over the course of just a few weeks. Conclusion: This research confirms that the inclusion of evidence-based healthcare approaches, like chiropractic care, is the undergirding support within emerging value-based health plans and may represent a significant advancement in cost and clinical effectiveness. Paskowski, et al, “A Hospital-Based Standardized Spine Care Pathway: Report of a Multidisciplinary, Evidence-Based Process,” Journal of Manipulative and Physiological Therapeutics, 34(2): 98-106, February 2011 Older Relevant Studies The Blue Cross Blue Shield of Tennessee Study (2010): Low back pain care initiated with a DC saves 40 percent on health care costs when compared with care initiated through an MD. Allowing DC-initiated episodes of care would have led to an estimated annual cost savings of $2.3 million. Conclusion: “[I] nsurance companies that restrict access to chiropractic care for LBP may, inadvertently, be paying more for care than they would if they removed these restrictions.” The C.H.I.R.O. Study (2010): Guidelines-based care (including chiropractic spinal manipulation) is significantly more effective than usual care. After 16 weeks, patients referred to MDs saw almost no improvements in their disability scores, were likely to still be taking pain drugs, and saw no benefit with added physical therapy. Conclusion: “Compared to family physician-directed [usual care], full [clinical practice guidelines]-based treatment including [chiropractic spinal manipulative therapy] is associated with significantly greater improvement in condition-specific functioning. Center for Health Value Innovation Report (2010): The Center for Health Value Innovation’s 2010 addresses the role of chiropractic services as part of the continuum of care in value-based benefit design. Conclusion: “The addition of chiropractic coverage for the treatment of low back and neck pain at prices typically payable in US employer-sponsored health plans will likely increase value-for-dollar.” The Mercer Report (2009): The Foundation for Chiropractic Progress (F4CP) calls the study “one of the most significant reports regarding the cost effectiveness and clinical efficacy of chiropractic care.” Conclusion: Chiropractic care for the treatment of “low back and neck pain is highly cost effective, represents a good value in comparison to medical physician care and to widely accepted cost effectiveness thresholds.” “The addition of chiropractic coverage for the treatment of low back and neck pain...will likely increase value-for-dollar by improving clinical outcomes...” ACN/UnitedHealth Group Report (2007): Chiropractic services for back and neck pain are significantly more costeffective than all competing approaches. The single most important factor in holding down costs is the profession of the doctor with whom care was initiated. When care was initiated with a PCP, spinal care was characterized by radiology, pharmacy, hospitalization and surgery, rather than the more conservative care provided by DCs. Conclusion: “[B]y aligning decision-making with current clinical evidence Minnesota Continued on pg 13

Legislative Update

Legislative Session Recap The Minnesota Chiropractic Association (MCA) had a very eventful and active legislative session this past year. We were successful because of your involvement. As we continue to move the chiropractic profession forward, we will only be successful with your continued involvement and full engagement. Below are a few of the issues on which the MCA worked during the 2013 legislative session.

C

hiropractic Scope of Practice. The MCA wants to enact the chiropractic scope of practice bill to modernize the current language to mirror current enforcement practices and education; to strengthen the language by providing clarity; and, centralizing chiropractic scope language where practical. This session, HF1850/SF1665 was introduced with strong bipartisan authorship—Representative Patti Fritz (DFL-Faribault) and Representative Tara Mack (R-Apple Valley) in the House; and, Senator John Hoffman (DFLAnoka) and Senator Sean Nienow (R-Forest Lake) in the Senate. This bill was introduced on behalf of the MCA, even though complete agreement on the language amongst all stakeholders has not been achieved. Our intent is to continue further negotiations and discussions of potential language changes over the interim in preparation for action during the 2014 legislative session.

that is charged on all health care services in the state must be maintained and strengthened. The tax is scheduled to phase out as the Health Care Access Fund surpluses allow with a projected total repeal by the end of 2019. When the Senate HHS Omnibus bill was released this year, it included a repeal of the phase-out of the Health Care Provider Tax. Although the complete phase-out is not a given, passage of this repeal language would have quashed efforts to eliminate the tax in the future. After hearing from many providers, including MCA members, the Senate removed this section from its bill before it moved out of committee. ◆

Online

About the Author: Kevin Goodno is the MCA lead lobbyist and is a shareholder and Chair of Fredriskson’s Government Relations practice. His focus is to provide a comprehensive range of services to clients, including legislative drafting and tracking, policy development, government lobbying at all levels, and strategy creation regarding governmental relations.

No Fault Automobile Insurance The MCA will fight for the patient’s ability to choose the provider of his or her choice and to receive the necessary health care treatments to address the injury caused by an accident covered by no fault automobile insurance while working with other stakeholders to reduce fraud, waste, and abuse in the no fault system. This session, Representative Joe Atkins (DFL-South St. Paul) authored no fault insurance language that was carried in HF647. This initiative was brought forward by the Minnesota Association for Justice (MAJ) and certain insurance companies, and proposed changes to current No Fault Auto regulations. The MCA had concerns with the bill but was able to work with stakeholders to address those concerns. The bill with the MCA negotiated amendments passed the House, but did not pass the Senate. It is possible HF647 will be brought forward again during the 2014 legislative session. Currently, the Minnesota Senate has convened meetings to discuss possible insurance “fraud” legislation. The MCA was invited by the Senate to participant in those meetings. Although the MCA supports efforts to stop fraud and abuse in the no fault system, it will oppose any efforts to restrict the rights of patients seeking chiropractic care in Minnesota’s no fault automobile insurance system. Health Care Provider Tax The MCA believes that the current law that phases out the two percent “sick tax” MCA Journal September/October 2013

12

Knowledge is Power Continued from pg 11 chiropractors produce large improvement in disability at a low episode cost.” The AMI Study (2004, 2007 follow-up): When comparing a chiropractic network in which DCs performed all patient examinations, treatments, and procedures at their own discretion, to a more traditional medical model, a comparative analysis of clinical and cost outcomes found decreases of 43 percent in hospital admissions, 58.4 percent in hospital days, 43.2 percent in outpatient surgeries and procedures, and 51.8 percent in pharmaceutical costs. A three-year follow-up study demonstrated even greater reductions in both clinical and cost utilization. Conclusion: “The AMI experience seems to indicate that a nonpharmaceutical/ nonsurgical orientation can reduce overall health care costs significantly and yet deliver high quality care.” The Stano Study (2005): Dr. Miron Stano, a professor of economics at Oakland University in Rochester, has done a number of seminal, groundbreaking studies regarding the cost-efficiency of chiropractic care. His latest study found that chiropractic and medical care have comparable costs (not counting hospitalizations and surgical costs) for treating chronic low-back pain, with chiropractic care producing significantly better outcomes. Conclusion: “Chiropractic patients with chronic LBP showed an advantage over medical patients in pain, disability, and satisfaction outcomes without additional costs.” The Procedures Study (2005): The study analyzed use rates of advanced imaging, surgery, inpatient care, and plain-film radiographs between employer groups with and without a chiropractic benefit., with chiropractic care leading to lower costs by reducing the rates of all four in patients with lowback and neck pain. Conclusion: “Among employer groups with chiropractic coverage compared with those without such coverage, there is a significant reduction in the use of high-cost and invasive procedures for the treatment of back pain. The California Study (2004): This study concluded that if all members of the examined plan had chiropractic coverage, total health care costs would drop by 12 percent and the plan would save $47.5 million per year, the result of less utilization of hospital beds, drugs, surgery, x-rays and, most importantly,

speedier patient recovery times. Conclusion: Access to managed chiropractic care may reduce overall health rate expenditures. The Spinal Manipulation Efficacy Study (2005) Initial and extended follow-up showed that the application of spinal manipulation revealed a broad-based long-term benefit: Five of the seven main outcome measures showed significant improvements, compared with only one item in the acupuncture and medication groups. Conclusion: “In patients with chronic spinal pain syndromes, “spinal manipulation, if not contraindicated, may be the only treatment modality of the assessed regimens that provides broad and significant long-term benefit.”​ The North Carolina Study (2004): This study found dramatic differences in the average treatment costs between chiropractic patients, medical patients, and patients treated by both. For chiropractic patients, costs, lost work days, and hospital inpatient and outpatient costs were significantly lower. Conclusion: “[I]t seems likely that substantial savings to the workers’ compensation system would be possible if chiropractic services were increased in North Carolina.” The Efficacy of Chiropractic for Chronic Low-Back Pain Study (2004): Analysis of the data showed that in patients who received maintenance spinal manipulation, disability scores were significantly lower after a 10-month period than before the initial phase of treatment. Conclusion: The study “shows the positive effects of preventive chiropractic treatment in maintaining functional capacities and reducing the number and intensity of pain episodes after an acute phase of treatment.” The DNA Repair Study (2005): This landmark study suggests that wellness care provided by doctors of chiropractic may improve health behaviors, enhance patient-perceived quality of life, and reduce health care costs. The study found that chiropractic care could influence basic physiological processes that affect oxidative stress and DNA repair. The study’s results offer a scientific explanation for the positive health benefits reported by chiropractic patients. Conclusion: “The results clearly support the recommendations being made for wellness care by chiropractors. ◆

MCA Key Doctors: An Essential Piece of the Legislative Puzzle

T

he best way to protect and promote chiropractic is to develop a good working relationship with legislators. Creating a relationship is vital to the profession and to the patients that receive care. We ask you to volunteer as a MCA Key Doctor for your area. You will be our voice for chiropractic issues. There are 3 small but very important tasks associated with the program. 1. Make an appointment with your legislator NOW to introduce yourself and discuss what issues matter to them. 2. Later make an appointment with your legislator again for Chiropractic Day at the Capitol (March 6, 2014) to explain what issues matter to chiropractors. 3. Attend Chiropractic Day at the Capitol & bring a colleague. Your help at this critical time will help give your lobby team the leverage they need at the State Capitol during the 2014 Legislative session and beyond. To become a Key Doctor please contact the MCA at 952-882-9411.

13

MCA Journal September/October 2013

ICD-10: Big Changes are Coming Will You be Prepared?

C

hanges in the healthcare profession are hitting us at an alarming rate – mandatory electronic claims, electronic health records, an overhaul to the entire electronic claims system (5010), and a new medical coding system (ICD-10). Change is difficult but it is essential to the future of the healthcare profession. The key to surviving change is to arm yourself with as much knowledge as possible so you can sail through the changes instead of swimming against the tide. Providers need to educate themselves on the upcoming transition to ICD-10 to ensure they are fully prepared when 2014 rolls around. The differences between ICD-9 and ICD-10 are extensive and it will take time to learn the new coding rules. ICD-10 incorporates much greater specificity and clinical detail, which will result in improvements in the quality and usefulness of healthcare data. Almost every code in the Musculoskeletal & Connective Tissue Systems chapter has been significantly changed. In many cases, the changes include very specific sites as well as laterality. For this reason, it is imperative that Doctors of Chiropractic have a proficient understanding of the new ICD-10 codes. It’s not just a matter of learning new codes; providers also need to learn the new rules of coding. Some of the changes in the new ICD-10 code sets include: • ICD-10 codes consist of 3 to 7 characters – both alpha & numeric. • Providers can use up to 12 diagnosis codes on a claim. • Injuries are now included in the main classification in ICD-10, and have been significantly expanded. • ICD-10 groups injuries by site first, instead of by injury type.

• New combination codes for symptom/diagnoses and etiologies/manifestations. Doctors need to become familiar with ICD-10 coding as soon as possible to ensure they are proficient prior to its implementation. The increased specificity of the ICD-10 codes will make complete and accurate documentation essential. Providers may need to make improvements to their documentation to take advantage of the expanded ICD-10 code sets. Additionally, payers will be well versed in the ICD-10 changes and could deny claims if doctors use the ICD-10 codes incorrectly. Payers will be less tolerant of providers who use “unspecified” and “not elsewhere classified” codes. An in-depth understanding of proper ICD-10 coding will help avoid unnecessary disruptions in the doctor’s income during the transition. The health care profession has gone through some significant changes in the past several years, and will continue to experience changes in the upcoming years. Change is not easy, but it is inevitable. Big changes are coming whether we like it or not – and providers need to be prepared. With proper preparation, you can embrace change and meet it head on. ◆

About the Author: Cathi Hammond is the founder of Medical Business Consulting, a billing and practice management consulting company specializing in Chiropractic and physical medicine billing and collections. For more information about Medical Business Consulting, visit www. medicalbusinessconsulting.net.

Online Presence is No Longer Relevant

A

s a chiropractor, the single most important marketing thing you can do is build a relationship with your patients. Chiropractic care is personal, emotional, and life changing. Connecting on that level requires patience and consistency from every point of patient contact. In today’s digital world that means your website and your online practice. Just having an online presence is no longer relevant, no longer effective, and in some cases actually hurts your chances of building a relationship. If your website looks the same or has the same content as every other chiropractor’s website you have lost an opportunity to connect. Step inside your patient’s shoes and go take a look at your website plus 9 other chiropractic websites. Think like a patient, take notes and ask these questions about your first impression: • What is the experience? What is their philosophy? • Why are they different? Why should I choose them? • Do they have the same info and health articles as every other chiropractic website? • Do they answer, “Why am I here?” and “What do you want me to do next?” Like it or not patients go to your website to learn about you and validate your practice. Of the 10 sites you looked at, you probably

Compliance

Technology: Marketing Minute

came across generic content, canned images, and TMCI (Too Much Chiropractic Information). If your website was not the best website you looked at, keep reading. Tell Stories That Leave Patients Wanting More Everyone loves a good story. Stories reach us on an emotional level, create excitement, and build trust. It’s easy to focus on getting more patients to your website. But once they get to your home page you better tell your story and start a conversation. When patients arrive at your website it’s like they are walking in your front door. Would you want your office to look like every other office or your staff to say the same thing as the chiropractor down the street? Here is your chance to show them what makes your practice different. What is your philosophy? What values shape your practice? Why should patients choose you?◆

Online

About the Author: Kevin Ebben is the President & CEO of Move One Degree. The Chiro Connect Project is a grass roots movement that integrates technology with education to help DCs connect better with their patients. To learn more or to register for future educational webinars go to www.chiro-connect.com or email [email protected]. MCA Journal September/October 2013

14

Compliance

The Top 6 Reasons Your Chiropractic Claims Are Denied, Delayed or Paid Incorrectly

C

hiropractors make many mistakes, but statistically speaking here are the reasons from the medical billing industry that things go wrong, payments get denied, pending or cause your claims and your money to get held up at the insurance company: 1. Incorrect payment 2. Ignored modifiers 3. Incorrectly reduced codes 4. Claims in review for an excessive amount of time 5. Coverage issues (pre-existing condition, no coverage, lapse of coverage, no chiro benefits) 6. Insufficient documentation resolving the denial or pending claim Before You Freak Out… Before you get all worked up over the latest denial or goof from the insurance company, you should first check to make sure no claim problems exist on your end. I know YOU may be perfect, but there’s a slight chance that someone ELSE who touched this claim before it hit the insurance company may have screwed it up. Seriously, doc, if the claim is denied for insufficient documentation, make sure you have actually documented the issue correctly. Resolving the Problem Secondly, most of these incorrectly denied or pended claims can be resolved over the phone. It is important to document who you spoke with and any reference # you are given, also document the day the issue should be resolved and follow-up. Phone calls will resolve about 60%-80% of your issues. The other 20%-40% will need a written appeal. Do not give up on these claims! The written appeal is extremely important for two reasons: (1) to show that you made a reasonable effort to resolve the issue. The insurance commissioner or the Office of Personnel Management (OPM) will require a copy of your letter and the payor’s response and (2) a special unit with more experience handle written appeals which may have a more favorable resolution.

15

MCA Journal September/October 2013

Also, by NOT appealing, you are playing right into the hands of the insurance company. They know you won’t usually take the time to appeal so they can confidently deny your claims — whether you deserved it or not! So, foil their plan and appeal! Appeal Through the Patient Another approach to appeal is through the patient. These appeals are handled by a completely different department at the insurance company. To handle a patient appeal, simply send the patient a letter to sign giving you permission to address the issue for them; attach their letter to the front of your appeal letter and send it off. Insurance companies may not care about you (they can always get another doctor) but they do care about the patient’s premium checks. So, this method does work if needed, but it is slow. Forever Pended Claims We have all received support needed letters that present a delay in payment issue. However, lately, payors are pending a huge amount of claims to verify pre-existing conditions for new enrollees. A written request for the first date of treatment is usually your clue that pre-existing is being verified. Understand that, in most states, pre-existing exclusions typically only apply if the patient has a lapse of coverage; however, the insurance companies never ask this question and are having issues developing an internal workflow. A copy of the effective and term date of the previous payor should resolve this issue. Check with your state insurance commissioner to find out pre-existing clauses in your state. If you have sent all requested support and verified it has been received, do not allow non-payment to exceed 60 days from the date received for any issue you have complied with. ◆ About the Author: Tom Necela, DC, CPC, CPMA, CCP-P, June 19th, 2013 http://www.strategicdc.com

Online

Increases your cash flow/revenue

Alleviates the paint and improves mobility

Generate referrals to your practice

1034-12.01-0613USA

Treats pain associated with:

Pin-points the ‘pain’ and ‘treats’ at the source

For more information visit www.wellwaveusa.com or email [email protected]

(800) 323-WOLF (9653)

MCA Journal September/October 2013

16

Insurance

All Employers Must Distribute Notice of Health Insurance Marketplace Background any of the provisions of the Patient Protection and Affordable Care Act of 2010,that goes into effect next year, were designed to expand access to affordable health coverage. These include: • Provisions for coverage to be offered through a Health Insurance Marketplace • Premium tax credits to assist individuals in purchasing coverage, and • Employer notice to employees of coverage options available through the Marketplace Beginning January 1, 2014, individuals and employees of small businesses will have access to affordable coverage through a new competitive private health insurance market: the Health Insurance Marketplace. The Marketplace offers “one-stop shopping” to find and compare private health insurance options. Open enrollment for health insurance coverage through the Marketplace begins October 1, 2013. A section of the Affordable Care Act requires a notice to employees of coverage options available through the Marketplace. The U.S. Department of Labor (DOL) has announced that employers must distribute a written notice about the existence of the Marketplace to all existing employees and all new hires by October 1, 2013. Which Employers are Subject to the Notice Requirement? All employers (even those who do not offer employees a group health plan) subject to the Fair Labor Standards Act (FLSA) must distribute notices to employees. The FLSA provides two methods for determining whether provisions of the Act apply to employees of a given employer. 1. If the annual dollar volume of sales or business done is $500,000 or more, whether from an enterprise made up of only one establishment or one with multiple establishments, all employees of the enterprise are covered by the Act on an “enterprise” basis. 2. Additionally, the Act also provides an “individual employee” basis of coverage. If the gross sales or volume of business done does not meet the requisite dollar volume of $500,000 annually, employees may still be covered if they individually engage in interstate commerce, the production of goods for interstate commerce, or in an occupation closely related and directly essential to such production. Interstate commerce includes such activities as transacting business via interstate telephone calls or the US Mail (such as handling insurance claims), ordering or receiving goods from an outof-state supplier, or handling the accounting or bookkeeping

M

17

MCA Journal September/October 2013

for such activities. It would also include the handling of credit card transactions, since that involves the interstate banking and finance systems. Who Must Receive the Notice? Each employee must receive the notice, whether part- or full-time status or whether or not the employee is currently enrolled or eligible to enroll in the employer’s group health plan (if available). Where Can I Find the Notice? The Department of Labor has issued two model notices on its website: • For employers who offer a group health plan: http://www.dol.gov/ebsa/pdf/FL-SAwithplans.pdf • For employers who do not offer a group health plan: http://www.dol.gov/ebsa/pdf/FLSAwithoutplans.pdf Must I use one of the Model Notices? No. Pursuant to the statute, the notice to inform employees of coverage options must include the following: • Information regarding the existence of a new Marketplace • Contact information and description of the services provided by the Marketplace. • Information that the employee may be eligible for a premium tax credit under section 36B of the Code if the employee purchases a qualified health plan through the Marketplace • A statement informing the employee that if the employee purchases a qualified health plan through the Marketplace, the employee may lose the employer contribution (if any) to any health benefits plan offered by the employer and that all or a portion of such contribution may be excludable from income for Federal income tax purposes. Additionally, you must ensure that the notice is written in a manner that can be understood by the average employee. When Does the Notice Need to be Distributed? Employers must provide the Notice (in written form) no later than October 1, 2013, to all employees employed prior to that date. Beginning October 1, 2013, to all newly hired employees. Through 2014, a notice will be deemed to be given “upon hire” if provided within 14 days of the employee’s start date.◆ Source: U.S. Department of Labor, www.dol.gov/ebsa/healthreform

Online

WTCOO_MINNChiropacticAssocJournal_7.5x10_Layout 1 5/22/13 1:09 PM Page 1

We Back in 1946, NCMIC was formed by a group of chiropractors with the express purpose of offering malpractice insurance to D.C.s at a time when no one else would.

Take Care of It has always been our mission to protect doctors’ practice and reputation. But don’t just take our word for it. In a recent survey, 95 percent of our

policyholders were extremely or very likely to recommend NCMIC to a friend.*

Our Own

®

More than 40,000 D.C.s know they can count on NCMIC—a company created by chiropractors and for chiropractors. Find out how you, too, can benefit from NCMIC’s “We Take Care of Our Own®” approach.

Call 1-800-769-2000, ext. 3120.

www.ncmic.com We Take Care of Our Own is a registered service mark of NCMIC Group, Inc. and NCMIC Risk Retention Group, Inc. ∗ Based on a NCMIC policyholder survey conducted by Ward Group, the leading provider of benchmarking and best practices research studies for insurance companies. For more information about Ward Group, visit www.wardinc.com. ©2013 NCMIC NFL 3520

MCA Journal September/October 2013

18

Community Involvement

Susan G. Komen 3-Day for the Cure: Volunteers Represented the Profession Well

T

he 2013 Susan G. Komen 3-Day once again drew thousands of participates from all across the state in support of breast cancer awareness. “The Minnesota Chiropractic Association and the MCA Sports Council is committed to helping the walkers take each step of the race in as healthy a manner as possible” explained, Dr. Scott Mooring, Sports Council chair. While this year’s race generated 2.6 million dollars for breast cancer research, our chiropractic volunteers were there to support the walkers and to introduce the public to the benefits of chiropractic care. The MCA would like to thank everyone who volunteered for all of their hard work and expertise shared during this annual event. Their efforts were an amazing display of giving which was greatly appreciated by the walkers, crew, staff and the From left to right: Danielle Brink, DC, Cindy VanSickler, DC, Scott rest of the health services team. We would also like the thank Mooring, DC, Hans Thurmer, DC, Michelle Norton, DC, Amber Trice, RockTape for sponsoring tape during this event. With such great support from volunteers, we cannot wait to see DC, Jodi Dorpinghaus, DC, Craig Couillard, DC, Jake Sundberg, DC, & Jake Dalbec, DC. what next year’s turn out will be. ◆ Special Thanks to the Great Team of Volunteers Ben Backus, DC Danielle Brink, DC Craig Couillard, DC Jake Dalbec, DC Jodi Dorpinghaus, DC

Insurance

A

Nick Eyvindsson, DC Randi Hartley, DC Jeremy Hurkman, DC Gwen Kelly, DC Marcia Krueger, DC

Carron Perry, DC Jake Sundberg, DC Hans Thurmer, DC Amber Trice, DC Paul Undersander, DC Cindy VanSickler, DC

Revalidation of Medicare Provider Enrollment Information Save Valuable Time: Use Internet-based PECOS

ll providers who enrolled with Medicare prior to March 25, 2011, will be required to revalidate their Medicare enrollment. Providers have 60 days from the date of the revalidation notice to submit their complete enrollment information. You will receive a green revalidation letter through the mail when it is your turn. The fastest, easiest, and most secure way to complete revalidation is by using Internet-based PECOS. For this reason, WPS Medicare encourages all providers to utilize the Internet-based Provider Enrollment, Chain and Ownership System (PECOS) for revalidating with the Medicare program. You can find more information about revalidation on the WPS Medicare website at: http://www.wpsmedicare. com/j8macpartb/departments/enrollment/revali-dationmed-enrollment.shtml. Information regarding Internet-based PECOS is available at: http://www.wps-medicare.com/j8macpartb/ departments/enrollment/internetbasedenroll.shtml. Save Valuable Time: Use Internet-based PECOS Do you need to enroll in Medicare, change your enrollment information, or add a reassignment of

19

Jenna Lenards ATC Nick Moe, DC Steven Moore, DC Scott Mooring, DC Michelle Norton, DC

MCA Journal September/October 2013

benefits? Use Internet-based PECOS and save time. Internet-based PECOS includes a tailored application process (you only supply information relevant to your application), which means less staff time and lower administrative costs to complete and submit enrollment applications to Medicare. Learn more about Internet-based PECOS on the CMS website: http://www.cms.gov/Medicare/ProviderEnrollment-and-Certification/MedicareProviderSupEnroll/InternetbasedPECOS.html.◆

2013 MCA Golf Outing

Driving It Home for Chiropractic!

Thursday, September 12, 2013

StoneRidge Golf Club 13600 N. Hudson Blvd. Stillwater, MN 55082 Schedule

THANK YOU SPONSORS Lunch Sponsored by:

10:00 a.m.

Registration

12:00 p.m.

Lunch

1:00 p.m.

Shotgun start – 4 person scramble

6:00 p.m.

Dinner, door prizes and networking

Center for Diagnostic Imaging

Carts Sponsored by: T & K X-Ray Consultants

Includes:  18 holes of golf with cart  Lunch and Dinner Buffet  Prizes, Prizes & Prizes!  Hole in One Games  1st Place- $400/ 2nd Place - $200  And much more!

*All proceeds go to the MCA Warchest/Fairshare Fund ------------------------------------------------------------------------------------------------------------------------------------------

We’re explorers. My team and I travel to the unknown. We dream big and search for answers to the most complex mysteries. At Noran Neurological Clinic, we work collaboratively with chiropractors and explore each disorder and treatment option together. of explorers Noran ClinicTrust hasoura team Sleep Center with these and other disorders: dedicated to assessing sleep

Adult & Pediatric Neurology in adults and children? disorders Diagnostic Imaging Sleep Center Infusion Center Specialists in the diagnosis and treatment of neurological and musculoskeletal injuries and disorders • Vinton Albers, DC, DACBR – Chiropractic Radiologist • • • • •

Collaborative care chiropractors trust. You’ve done everything. Now, it’s our turn. Our neurologists have worked collaboratively with the chiropractic community for 35 years.

Our neurologists have been and providing comprehensive services for more than 40 years. We work closely with our patients to assure personalized, comprehensive effective care. Visit NoranClinic.com to learn more about how we can help, or call (612) 879-1500 to Visit NoranClinic.com or call (612) 879-1500 to learn more about how we can help. schedule an appointment. Evening and weekend hours are available. Blaine | Burnsville | Edina | Maplewood | Minneapolis | Plymouth

MCA Journal September/October 2013

20

Nutrition

The Health Benefits of Mushroom Consumption

M

ushrooms contain some of the most potent natural medicines on the planet. Of the 140,000 species of mushroom-forming fungi, science is familiar with only 10 percent, according to worldrenown mycologist Paul Stamets, who has written six books on the topic. About 100 species of mushrooms are being studied for their health-promoting benefits. Of those hundred, about a half dozen really stand out for their ability to deliver a tremendous boost to your immune system. It’s important to eat only organically grown mushrooms because they absorb and concentrate whatever they grow in — good OR bad. This is what gives mushrooms their potency. Mushrooms are known to concentrate heavy metals, as well as air and water pollutants, so healthy growing conditions is a critical factor. While it may sound strange, we’re actually more closely related to fungi than we are to any other kingdom, as we

share the same pathogens, meaning bacteria and viruses. As a defense against bacterial invasion, fungi have developed strong antibiotics, which also happen to be effective for us humans. Penicillin, streptomycin, and tetracycline all come from fungal extracts. The Many Health Benefits of Mushrooms The FASEB Journal (The Journal of the Federation of American Societies for Experimental Biology) recently published nine studies on mushrooms that were also presented at Experimental Biology 2013, which detailed a wide variety of health benefits, including: • Weight management: One study found that substituting red meat with white button mushrooms can help enhance weight loss. Obese participants with a mean age of just over 48 years ate approximately one cup of mushrooms per day in place of meat. The control group ate a standard diet without mushrooms.◆ About the Author: Joseph M. Mercola Online

Vitamin E May Alleviate Symptoms of Liver Disease Brought on by Obesity

S

ometimes excess fat accumulates in the liver and can lead to inflammation and scarring, which is a serious condition called nonalcoholic steatohepatitis (NASH). When the liver becomes fatty and scarred, it can no longer function normally. In its most severe form, this can progress to cirrhosis, liver failure and even death. Although anyone can develop NASH, especially considering that fructose consumption is a primary cause, it’s most common in people who are overweight or obese, and its incidence has been rising along with rates of obesity in the last decade. So, for those that have this disease, of course the very first step would be to limit total fructose to under 15 grams per day (including fruits). With no known treatment – and often no symptoms until serious damage has occurred – this “silent” disease is one of the greatest obesity-related health risks; for the 63 million Americans currently at risk of NASH, there’s good news: increasing the intake of vitamin E may help significantly. Vitamin E May Help Alleviate NASH Symptoms Two new studies recently investigated the role of vitamin E, a powerful antioxidant we cannot live without, on NASH. The first tested the hypothesis that low levels of vitamin E may be linked to liver disease and indeed found that in mice bioengineered to have inadequate vitamin E levels there was increased oxidative stress, fat deposition and other signs of

21

MCA Journal September/October 2013

liver injury. When the mice were supplemented with vitamin E, the majority of NASH-related symptoms were relieved. Likewise, a second study looking into the role of vitamin E on NASH showed that rats with the liver disease that were supplemented with both full spectrum d-mixed tocotrienols and alpha-tocopherol had multiple improvements compared to those supplemented with only alpha-tocopherol or mixed tocotrienols. Benefits included: • Reduced triglyceride accumulation in the liver • Decreased level of lipid peroxides • Improved liver damage markers • Inhibited liver fibrosis (scarring) “This study shows us that taking both natural full spectrum tocotrienol complex and alpha-tocopherol together help to synergistically improve NASH and support healthy liver,” the researchers said. ◆ About the Author: Joseph M. Mercola is a web entrepreneur and alternative medicine guru who markets a variety of controversial dietary supplements and medical devices as part of his diet- and lifestyle-based approach to health. Mercola, an osteopathic physician, also operates the “Dr. Mercola Natural Health Center” (formerly the “Optimal Wellness Center”) in Schaumburg, Illinois.

Current MN PRACTICES FOR SALE

MCA Journal September/October 2013

22

Dr. Dan Murphy’s Nutri-West Omega-3 Connection

PRODUCTS ReSeaRCheD by aND FORMUlaTeD FOR DR. DaN MURPhy, D.C., D.a.b.C.O. FOR NUTRi-WeST

Dr. Dan Murphy, D.C.

COMPLETE CHILDREN’S CO-FACTORS™ – Children’s Co-Factors provide for the proper absorption and utilization of Omega 3 fatty acids. Also support the heart, and mitochondria, in addition to being an excellent anti-oxidant formula. Contains NO excitotoxins! Recommendation: Take with Complete Children’s DHA/EPA for best results. COMPLETE CHILDREN’S DHA/EPA™ – Support for a healthy immune system.

Also supports the cardiovascular system, normal brain and nervous system development/function and kidney support. Recommendation: Take with Complete Children’s Co-Factors for best results.

Dr. Dan Murphy, D.C., DABCO: 2009 ICA Chiropractor of the Year; Renowned National Lecturer; Voted Post-Graduate Educator of the Year (3 years); Recipient of the Clinical Science Faculty Award (8 years). Why Nutri-West?

• High quality top manufacturer of doctor formulated products • FDA blue ribbon award for facility

• Molecular distilled pharmaceutical grade fish oil from cold-water wild fish

• Independently tested to the strictest standards to screen toxins • Complies with the CRN Monograph

COMPLETE HI-POTENCY OMEGA-3 LIQUID™ 2:1 Ratio – Nutritional support for non-specific inflammatory response and a healthy immune system. Also supports the cardiovascular system, normal brain and nervous system development/ function, and kidneys. Use as part of the diet to help maintain healthy cholesterol and triglyceride levels. Mood enhancer. Recommendation: Take with Complete Omega-3 Co-Factors For best results. COMPLETE OMEGA-3 CO-FACTORS™ – Co-factors provide for the proper

absorption and utilization of Omega 3 fatty acids. Co-factors also supports the heart and mitochondria, in addition to being an excellent anti-oxidant/aging formula. Take with Complete Omega-3 Essentials for best results.

COMPLETE OMEGA-3 ESSENTIALS™ 2:1 Ratio – Nutritional support for

non-specific inflammatory and a healthy immune system. Also supports the cardiovascular system, normal brain and nervous system development/function, and kidneys. Use as part of the diet to help maintain healthy cholesterol and triglyceride levels. Mood enhancer. Take with Complete Omega-3 Co-Factors for best results.

Why Fish Oil?

Proven support for a host of conditions from cardiovascular to chronic pain/inflammation, and many more.

Why Dr. Dan Murphy, D.C.? • Noteworthy credentials

• Extensive research of the omega-3

• Fatty acids and ratios for optimal health

23

MCA Journal September/October 2013

For your nearest distributor, please call toll-free: Phone: 1-800-443-3333 • Fax: 1-307-358-9208 Email: [email protected] The above statements have not been evaluated by the FDA. The nutritional information, suggestions, and research provided are not intended to diagnose, treat, cure, or prevent disease and should not by used as a substitute for sound medical advice. Please see your health care professional in all matters pertaining to your physical health.

The American Chiropractic Association’s Public Policy on Social Media

I

n this current era of electronic communications, the illusion of personal privacy in web related interactions, and the ease with which information can be used outside of its intended electronic context, it would be wise to consider the following areas identified to be the most commonly misunderstood aspects of digital communication as part of interpersonal interactions: 1. Establish and implement professional boundaries for the digital doctor/patient relationship: Unlike face to face communications with patients, there is no way to verify, with absolute certainty, the actual identity of the person with whom you are interacting online, nor can you control with whom that interaction is shared. It is often seen that doctors of chiropractic will “friend” their patients or maintain a “close” social tie with them. Publicly posting information containing private patient information or even publicly acknowledging a doctor-patient relationship could jeopardize the patients’ right to privacy by violating HIPAA. If a doctor feels compelled to establish a close social networking tie with a patient, it would be well advised that the doctor refrain from any public communication about any private health care information about the patient. Private online discussion of that business relationship should be treated as public as NOTHING is completely secure online. 2. Privacy and confidentiality: Virtually everything that is online is discoverable despite our best efforts to keep them secure. Examples of hacks, leaks and security breaches are

Technology

frequently in the news. So, whether you are writing on your blog, commenting on a news article, posting messages or pictures on Facebook or tweeting your most recent professional developments, remember that information that can be accessed by most people can easily be taken out of context and can greatly harm your reputation. It is best to exercise the following discretion: If I would not openly share it in the lobby of my practice, would it be wise to post it online? 3. Ethics and professionalism online and offline. It is common to conduct yourself in a professional manner when at professional functions such as trade shows, holiday parties and even meet and greets, but the same discretion is now necessary at all functions as it is entirely possible that you are photographed during a less than perfect moment and that picture ends up in an online context. Such information could raise question regarding your suitability to treat patients and can even result in disciplinary measures by your licensing board 4. Separation of one’s personal and professional identity online: To whatever extent possible, separation of personal and professional identities online is always recommended. As such, whenever possible, sharing health information should be primarily from a separate business page (i.e. a practice Facebook page vs. a personal Facebook page.) However, the personal and professional identities and content are never truly separate; therefore, it is wise to consult point 3. 5. Provision of medical advice online; a liability: It is natural to want to help a patient or even a friend online, if the question seems simple. Please know, however, such a practice can place you and your office at significant risk as this may form a doctorpatient relationship where the doctor now owes a duty to the patient and creates unnecessary liability. 6. Inflating credentials. Your credentials should precisely represent the content of your diplomas and certificates hanging on the wall in your office. 7. Be aware of content and how it can be misconstrued/ misunderstood. IF you do consider posting health information online, consider posting references supporting the information. Information posted on the internet is frequently not factual and it is wise to personally fact check information if you are considering sharing it with your social media followers. 8. Understand the rules and regulations (Federal and State) related to social media usage. New federal and state guidelines concerning social media are frequently developed and staying current with regulations that affect your social media use is advised. ◆ Source: http://www.acatoday.org/level2_css. cfm?T1ID=10&T2ID=117#135

MCA Journal September/October 2013

24

Wulff on Law

WULFF on law How to Write Narrative Reports Identify the Sources of Information Reviewed Your opinions can be attacked if it can be shown you are unaware of any important fact. Therefore, your report should identify the sources of information you reviewed. This should include your medical records; the records of all providers seen by your patient for the injury in question and prior to the injury in question; any summary provided by your patient’s attorney; your patient’s deposition transcript; and anything else your patient’s attorney asks you to review. Indicate in your report that you have discussed this information with your patient to verify its accuracy. It is not your job to gather this information. Ask your patient’s attorney to provide this information. Prior Medical History Every case involves the issue of causation. You must have an accurate and complete understanding of your patient’s entire medical history and your narrative report must demonstrate that knowledge. Ask your patient’s attorney to provide you with the records and a summary of the relevant treatment she wants you to address in your report. You should verify the accuracy of the summary by actually reading the records, but if the summary is accurate and thorough, you can simply cut and paste it into your report. Set forth a chronological history of any treatment of conditions identical or similar to the injury in question. Be as factual and accurate as possible. Do not sugarcoat in an attempt to minimize prior treatment. Quoting important symptoms, exam and diagnostic findings, and diagnoses from the records is best. History of Injury in Question Explain in detail your understanding of how your patient’s work-related injury or motor vehicle collision occurred. This should be documented in your initial examination notes. Consider talking to your patient to verify the details. This description needs to make plain from a biomechanical perspective how the trauma caused the injuries you diagnosed. Describe the symptoms your patient experienced immediately after the trauma; later that evening; the next day; and over the course of how ever many days before your 25

MCA Journal September/October 2013

patient first sought treatment. This is especially important in cases where your patient did not immediately seek treatment. Did they experience immediate symptoms but felt they were not severe enough to require treatment? Or, was there a delay of several days or weeks before any symptoms occurred? The longer the delay between the trauma and the onset of symptoms, the more difficult it is to establish causation. Treatment of Injury in Question Set forth a chronological history of the treatment your patient has received from all providers including you. Be as factual and accurate as possible. Quoting important symptoms, exam and diagnostic findings, and diagnoses from the records is best. Highlight any exam or diagnostic findings you feel are particularly important. Do not cherry pick only the findings that support your patient’s claims. Identify and deal with any findings or statements that indicate your patient’s injuries were minor, temporary or caused by something other than the injury in question. If you maintained good records it should be easy to cut and paste the important entries from your notes into your narrative report. Do not include too much information. Hit the highlights. The judge or jury will be provided copies of your records for review so your narrative report does not need to repeat everything already in your records. Discuss the details of your treatment and why your treatment was reasonable and necessary. Explain your initial treatment plan, how it changed as your patient’s condition progressed, and why the modalities you used and the frequency you recommended was appropriate. Discuss the improvement your patient experienced as the result of your treatment, the relief they felt, and the importance of your treatment in enabling them to continue working. Point out the self-treatment techniques you taught your patient, demonstrating that you made efforts to wean your patient away from dependence upon your care and encourage selfreliance. Discuss the objective findings you recorded over the course of your treatment that support your opinion your patient’s injury is legitimate and permanent. Discuss any exacerbations your patient experienced that complicated and delayed their recovery justifying the

frequency and duration of your treatment. Discuss any referral you made explaining why you made the referral and what the consulting doctor recommended. Questions You Will Be Asked to Answer Diagnosis State your final diagnosis of your patient’s condition. Identify any diagnostic imaging that supports your diagnosis. Causation IMEs frequently opine that work-injuries or motor vehicle accidents either did not “cause” any injury or only caused temporary injuries lasting 3 months or less. You need to explain in your report why that is not true. When possible, point out that the IME has not correctly applied the standard of causation under Minnesota law. Under both WC and PI law, it is not necessary to establish that the trauma associated with the work-related incident or motor vehicle accident was the “cause” of your patient’s condition. The proper standard is whether the trauma substantially aggravated, accelerated or combined with any pre-existing condition to produce the symptoms, disability and need for treatment your patient experienced after the trauma. The existence of degenerative changes or prior similar injuries or symptoms will frequently be an issue. Properly understood, this is not a big problem. Explain how these pre-existing conditions made your patient more susceptible to injury from less severe trauma. Point out when possible that your patient’s condition was stable, relatively asymptomatic and non-disabling before their trauma, and how their condition and treatment pattern changed after the trauma. This demonstrates that the trauma substantially aggravated, accelerated or combined with the pre-existing trauma to produce the symptoms, disability and need for treatment. If the IME opined that your patient’s injury was temporary, explain that in order for an injury to be considered temporary the patient must return to their pre-injury status subjectively, objectively and in functional status. Then explain how your patient’s condition continues to be worse since their injury. Treatment to Date Explain why the treatment you have provided to date has been reasonable and necessary. Maximum Medical Improvement. Indicate whether or not your patient can reasonably be anticipated to experience any further significant recovery from or significant lasting improvement to their injury from additional treatment. If your patient has reached MMI, indicate the date MMI was reached. If your patient has not reached MMI, discuss the treatment that has a reasonable likelihood of resulting in further significant recovery or lasting improvement. Opinion on Permanent Functional Impairment Indicate whether your patient has suffered permanent functional impairment. In WC cases this means applying the appropriate section of the WC Permanent Partial Disability Guidelines in effect on the date of injury. In PI cases, some attorneys want a rating from the AMA Guides; some prefer

a more narrative description of the bodily motions and activities your patient will no longer be able to perform at all or without pain. Work and Activity Limits State in detail what work or activity limits your patient will need to observe due to their injury. Indicate whether you believe these limits will be permanent. Future Treatment Indicate what additional treatment your patient can reasonably expect to require into the future. Response to Opinions of IME Get a copy of the IME report. Identify subjective complaints and positive exam findings that support your opinions. Point out if the IME’s exam findings are inconsistent with yours or with those of other providers who have examined your patient. Respond to opinions point-by-point. Emphasize that you have examined and observed your patient’s condition on multiple occasions over a long period of time, whereas the IME has examined your patient once, usually long after the trauma. Point out that this simple fact puts you in a much better position to comment on your patient’s condition. If the IME says your patient fully recovered after 3 months, point out that such an opinion is pure speculation and that you were treating your patient at the 3 month point and can state unequivocally that your patient was not fully recovered. ◆ Disclaimer: Please remember that this article cannot be considered legal advice. Every situation is different and must be evaluated in light of the unique factual circumstances involved. If you have any questions concerning workers’ compensation law, no-fault law, or professional boundaries, please call David C. Wulff at 651-636-1900 or 800-949-8533.

MCA Journal September/October 2013

26

“MCA Members Talk” Popular Conversations on the Listserve. You Should See What You’re Missing.

Posting Job Positions on Craig’s List?

We have an opening for a chiropractic assistant coming up at the end of this month. In the past, we have utilized the newspaper classifieds. Has anyone experimented with the alternative forums to advertise seeking employee(Craig’s List, etc)? What kind of results did you have?

Can someone tell me if we have to sign the Medicare notes elHIPAA Violation or Not?

American family Insurance just called our office and asked us if (I am making up a name here) Bill Smith is a patient here. My CA put him on hold, checked the computer (no such person was on record) and told him Bill is not a patient here. Is this against the law? If Bill was a patient here, could she have legally said he was?

Codes for Adhesive Strapping?

Who among you can tell me the best codes for adhesive strapping? Basically, I want to know how I can code for doing Kinesio taping. Any help would be appreciated.

Sports Physicals?

Just got told by coach at our community college that a MD must do pre season sports physicals. Is this true?

Align Networks – Work Comp

I received an authorization from Align Networks stating that they require an update on our patient every two weeks and if I am recommending additional treatment beyond that I need an MD referral to submit to Align. How would you recommend I proceed?

Why Should I Become of Member of the MCA Today? MCA Benefits

Member Cost-$780

Non-Member Cost

List Serve

Included

$900

Find a Doctor

Included

$1,200

Public Media Campaign

Included

$3,200

Members Only Website

Included

Not Available

Discounted Education Classes

10-50%

Full Price

Convention Discounts

10-50%

Full Price

Lobbying and Advocacy

Included

Includec

MCA Journal

Included

Not Available

ABM Discounts on Products and Services

Included

Full Price

Single Point of Contact

Included

Not Available

75% of Dues are Tax Deductable

($585)

$0

Infinedi Clearinghouse Services

Included

Varies

Chiropractic Assistance Certification

$319

$339

Discounts on Advertisements

Up to 20%

Full Price

Credit Union Access

Included

Not Available

$195

$5300+

and more Actual Cost of Membership

Please Note: Costs are Based on the maximum full year membership 27

MCA Journal September/October 2013

MCA DC Member Application ____YES I want to become member of the MCA! The only association for my profession in the state that provides key benefits not found elsewhere. Clinic Name: _________________________________________________________________________________________________________________________ Full Name: ___________________________________________ -______________________________________________ Birth date_______/________/_______ Mailing Address: ______________________________________________________________________________________________________________________ City: __________________________________________________________________________________________________________________________________ County: _____________________________________________________

St

Years in Practice: ______________________________________________________

Phone: _________________________________________________

Fax: _______________________________________________________________________

Mobile: ________________________________________________

Email: ______________________________________________________________________

Clinic Website: ________________________________________________________________________________________________________________________ MN Legislative District (Clinic) ___________________ MN Legislative District (Home) ____________________________ (Call MN House Information for your legislative district numbers 651-296-2146) Chiropractic College: ________________________________________________ Year Graduated: _______________________________________________ DC Date Licensed: _______/_______/_______

DC License Number: ______________________

Top 4 Techniques Practiced: ___________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________ I hereby apply for membership in the Minnesota Chiropractic Association for the purpose of serving the whole chiropractic profession of the State of Minnesota and for the benefits I may receive from such a membership. Once approved as a member I agree to comply with the Bylaws and Code of Ethics of this Association and all present and future regulatory measures as set forth by the Association. I understand that as a member of the MCA I will be held to a high standard of professionalism and agree to work with the association in regards to its initiatives. I acknowledge that while our profession may have differences of opinion, we will make the most impact when we work together respectfully, joining resources, talents, and time to create a better, healthier world. I will embrace these differences and continue to work toward the goal of “Chiropractic for All”. I understand that to remain a member and receive membership benefits including all group insurance programs, discounts, and marketing program rights I must maintain my dues account as current. I relinquish all my membership benefits if my dues are thirty days past due. Signed: ______________________________________________________________ Date: _______________________________ Membership Dues Annually: Variable. Please see dues information below. Please mail this form with payment to: MCA 8120 Penn Ave. S., #270 Bloomington, MN 55431 Or Fax to: 952-882-9397 Or Email to: nborgen@mnchiro,com Make Checks Payable To: The Minnesota Chiropractic Association or MCA Credit Card Authorization for Payment Name on Card: _______________________________________________________________________________________________________________________ Billing Address: ________________________________________________________________________________________________________________________ City: __________________________________________________________ State: _______________ Zip: ____________________________________________ Credit Card Type: � Visa

� MasterCard

� American Express

� Discover

Credit card number: ______________________________________________________ Expiration Date: ___________________________________________ Charge my card the following amount: � ________/Month

� ________/Quarter

� ________ One-time charge

Non-Practicing DC Member ..................................................................................................................................................... $157.50 Retiree ........................................................................................................................................................................................... $80.00 Out of State Member ..................................................................................................................................................................... $50.0 College Faculty Member.........................................................................................................................................................$105.00 Practicing Doctors MTH QTR YEAR Same Year Licensed............................................................. ............................................ 0.00....................................... $42.25 1 Year Licensed..................................................................... .......................................... $42.25.................................... $169.00 2 Years Licensed ................................................................... .......................................... $84.50.................................... $338.00 3 Years Licensed ..............................................................$47.50 ................................... $142.50................................... $570.00 4+ Years Licensed ............................................................$65.00 ................................... $195.00................................... $780.00 Practice Relief (Part Time Dr)............................................... .......................................... $92.50.................................... $370.00

28

Classified ads The original state-wide vacation and practice relief provider is available in Minnesota for short or long term basis and emergencies. Logan graduate, providing over 31 years of excellent, reliable and specialized services and techniques on behalf of many satisfied doctors. Insured. ChiroCare®, and HSM credentialed. References available. Contact Dr. Rick Hueffmeier at 651.256.2256 or toll-free 888.755.6056. Practice For Sale: Shoreview area. Solid practice for sale, poised for additional growth. Exceptional lease location. Contact Loren Martin, Practice Opportunities Inc. 952-953-9444, email: [email protected]. Practice For Sale: Established 20 year Activator practice 45 minutes NW of the TC metro area. Must sell due to injury. Busy referral practice with low overhead. Call 763-753-3126 or 763856-0870. Practice For Sale: Fantastic career opportunity. This is a chance to own a chiropractic practice in a Northern Minnesota small town hospital setting. You will work with medical professionals to integrate chiropractic into mainstream medical practice. This is a casual, friendly community to work in and a great natural environment to live in. Please e-mail inquiries to 4salechiro@ gmail.com. Stressed Out?: Providing practice relief services since 2001. NWCC 1985 graduate. Professional and personalized quality care. References available. Contact Dr. Dennis French at 612-817-6406. TAKE A BREAK AND AVOID BURNOUT! Experienced Practice Relief: NWCC graduate with 30 years private practice and relief service experience available for practice relief services in Minnesota. Credentialed with most management companies. References available. Insured. Contact Dr. John Knox at 952-451-2032. Female practice relief – specializing in maternity leave: 20 years experience. Excellent adjusting skills utilizing diversified, activator, drop and SOT blocks. Acupuncture certified. Background in wellness and holistic care. Reasonable rates. Available short or long term. Great references. Dr. Heidi Klosterman, 612-743-6512, [email protected]. Associate wanted in beautiful Buffalo, MN. Salary, percentage and eventual ownership! Call 763-682-1471 or write: Dr. Rita Varner-Otness, 110 Division Street E, Buffalo, MN 55313. Associate wanted: Williams /Intergracare Clinic is looking for a motivated chiropractor to join our clinic. We are a true multidisciplinary clinic with DC’s, PT’s, MD’s and NP’s. The position is fulltime, no evenings or weekends. Full benefits. Send resume to [email protected] or call Dr. Williams at 320-251-2600. Practice relief throughout metro and out state Minnesota. Serving as a “bridge” in the doctor’s absence to assure treatment continuity, patient retention and staff productivity. References available. Insured with NCMIC. Dr. John Hoklin jhoklin@ hotmail.com 952.297.6888. MCAJournal Journal January/February 20112013 September/October 29 MCA

2013 MCA Golf Outing Driving It Home for Chiropractic! Thursday, September 12, 2013 StoneRidge Golf Club 13600 N. Hudson Blvd. Stillwater, MN 55082

THANK YOU SPONSORS Lunch Sponsored by: Center for Diagnostic Imaging Carts Sponsored by: T & K X-Ray Consultants

Includes:  18 holes of golf with cart  Lunch and Dinner Buffet  Prizes, Prizes & Prizes!  Hole in One Games  1st Place- $400/ 2nd Place - $200  more!

*All proceeds go to the MCA Warchest/Fairshare Fund

MCA Associate Business Member Directory Company Acurad Technidal Services, LLC

Contact Steve Danielson

Phone (612) 781-2218

Beacon Accounts Management

Nancy Boehmer

(952) 233-2011

Cancer Treatment Centers of America

Patti O’Donnell

(773) 680-4701

Center for Diagnostic Imaging

Jay Champine

(651) 216-5992

Chiropractic Compliance Solutions

Dr. Jeff Sandquist

(651) 558-1578

Chiropractic Federal Credit Union

Anne Blain

(248) 478-4020

ChiroTouch

Erin Aguilera

(619) 488-9798

Consulting Radiologists Ltd

Tim Kratzke

(952) 285-3720

Creative Comfort, Inc

Judy McDonald

(651) 200-3051

DMG Financial Group

Derrick Gerard

(952) 446-3305

Fairview Health Services

Shari Miller

(612) 706-4571

Future Health Software

Steven Kraus

(712) 792-3344

HighPoint Environmental

Tim Guimond

(763) 757-4920

Hockert Sales

Chris Hockert

(763) 434-2350

IC System

Chad Lindsay

(651) 481-6553

Infinedi, LLC

Dawn Martinez

(800) 688-8087

K-LaserUSA

Phil Harrington

(866) 595-7749

Lake Superior X-Ray, Inc

Nicole Murray

(218) 525-3393

Law Office of David Wulff

David Wulff

(651) 636-1900

Martineu, Gonko & Vavreck

Chris Gonko

(612) 659-9500

Medical Billing Done Right, LLC

Bonnie Flom

(763) 546-2455

Medical Business Consulting, Inc.

Cathi Hammond

(763) 862-5855

Meyer Business Consulting/Eclipse Software Bonnie Meyer

(612) 210-6630

Minnesota Craniofacial Center PC

Kim Ledermann

(651) 642-1013

Move One Degree - Chiro-Connect

Kevin Ebben

(763) 442-3526

Mutual of Omaha

Kyle Luebeck

(763) 639-1324

NCMIC Group, Inc.

Mike Whitmer

(515) 313-4500

Noran Neurological Clinic

Kelly O’Neill

(612) 879-1675

Nutri-Dyn

Greg Peterson

(763) 479-3444

Nutri-West

JJ Munro

(715) 381-9990

Off-Site Office Solutions, LLC

Kathy Altman

(763) 670-1224

Physicians Diagnostics & Rehab Clinics Tracy Rheineck

(952) 908-2715

Practice Brokers

Jerry Peterson

(952) 938-0092

Practice Opportunities Inc.

Loren Martin

(952) 953-9444

S & R Insurance Services

Phillip Scheiber

(952) 649-0504

Schuler Shoes

Cathy Marxen

(763) 515-5988

Standard Process Nutrition of Minnesota Tracy Foley

(651) 226-5864

Staples Advantage

Lucas ​​ Zwieg

(651) 639-4709

T&K X-Ray Consultants, Inc

Terry Hart

(218) 940-6152

UAS Laboratories Inc

Dr. S.K. Dash

(952) 935-1707

Woodhill Financial

Milt Edgren

(763) 746-8686

Advertising Index CDI . . . . . . . . . . . . Inside Front Cover Woodhill Financial . . . . . . . . . Page 6 Chiropractic FCU . . . . . . . . . . Page 8 Cancer Treatment Centers of America . . . . . . . . . . . . . . . . Page 9 Richard Wolf Medical Instruments Corporation . . . . Page 16 NCMIC . . . . . . . . . . . . . . . . . Page 18 Noran Neurological Clinic . . Page 20 Loren Martin Practice Opportunities . . . . . . Page 22 Nutri-West . . . . . . . . . . . . . . . Page 23 Acurad Technical Services . . . Page24

Advertisements The contents of advertisements that appear in the MCA Journal are solely the responsibility of the advertisers. Appearance of an advertisement in the MCA Journal does not constitute an endorsement by the association or the MCA Journal of the goods or services offered. Publication of any advertisement may be subject to review by the MCA Journal Communications Committee. For more information on advertising in the MCA Journal, call 952-882-9411. MCA is a proud sponsor of the Foundation of Chiropractic Progress.

Search for us on Facebook Minnesota Chiropractic Association

MCA Journal September/October 2013

30

Minnesota

Chiropractic Association

8120 Penn Ave. S. #270 Bloomington, MN 55431 952.882.9411 1.800.864.3769 Fax: 952.882.9397 www.mnchiro.com

PRSRT STD U.S. POSTAGE PAID PERMIT NO. 32324 Twin Cities, MN

The MCA recently updated its WEBSITE! Help potential patients find you by updating your information on the MCA website today.