Category: Special Feature

 

:dropcap_open:E:dropcap_close:very financial manager will tell you that in order to hedge inflation, a volatile stock market and to meet expectations without jeopardizing your principle capital, diversify. Some recommend more stocks, while others more bonds, yet others urge you to invest in government notes.  These are all wise strategies in order to stand the test of time in your long-term strategy-based investment goals.

In practice, the strategy is no different. In the 1980’s, I had 50% of my practice covered by the Empire Statewide Plan and I was making a great living. Unfortunately, overnight, without prior warning, every policyholder got a notice that said chiropractic services were available for only “in-network” providers and I wasn’t one of them. It turned out that the president of the state organization became the consultant for the insurer and only a few of his handpicked “cronies” were added to the panel, leaving the rest of us “schlubs” to fend for ourselves!

It was a vital lesson in practice and although it was an expensive lesson, it was one that has served me well over the remainder of my career. I learned that you cannot rely on one carrier or financial class for survival in practice. You need to have a mix of patients in your practice. This means you need patients from every arena, managed care, Medicare, workers compensation, personal injury and fee for service (cash) .

With that being said, you have to closely examine the level of reimbursement for each financial class. In today’s economy, managed care and Medicare are low payors. Workers compensation, depending upon your state, fluctuates greatly and can fall anywhere in the spectrum. Cash patients are great, but you are at the whim of the economy and then there is personal injury.

Personal injury is by far the last place for a doctor of chiropractic to earn a very good living. If you refer back top to this publication’s February, 2011 issue, I chronicle by state the best and worst reimbursement states for personal injury in combination with cost of living factored into the equation. There is one caveat; you have to be the best-of-the-best at what you do in order to survive in each class.

If  you want to thrive in sports chiropractic, then you will have a predominantly managed care practice and you need to excel in treating those types of injuries. The same with Medicare; you need to be expert in geriatric chiropractic as that has its own set of nuances. This also holds true with personal injury and Medicare. You need to be expert in trauma and have the requisite credentials behind you with an admissible “formal” curriculum vitae. The legal community will not take you seriously otherwise. Yes, they will take your referrals and yes, they will accept your invitations to dinner, drinks and ballgames. However, unless you are the “real deal” on paper and in practice through clinical excellence, they will never refer to you even if you refer to them. Why would they want to work with you if you are a liability to their cases? Things are tough for lawyers also, economically.

Deciding on the best way to spend your time, energy, and money is to determine your ideal practice mix and create the perfect scenario for success in that financial class. It is my experience and recommendation that there be a minimum of 60% personal injury with 15% cash and for the rest, be prepared to work a whole lot for a whole little. Many DC’s nationally have gone from 10% personal injury to 40 % personal injury and have tripled their incomes, reducing the financial stress in their practices. All of these doctors have one thing in common, they all became expert in trauma care and working in the medical-legal arena. You cannot just decide to get more personal injury cases without the requisite training. Lawyers aren’t ignorant. You will get 1 or 2 of tier clients to work on and if you don’t have the required training, as soon as they talk to you or see your documentation, you should be prepared to be a 1 and done. They will work with you once and never work with you again.

It is sometimes better not to take a personal injury case if that will create a bad reputation. A good reputation is easy to create if you have none; it is quite difficult to overturn a bad one. The solution is to become expert in all things “personal injury” and that has nothing to do with treating your patients. It is about becoming a good diagnostician and expert at triaging cases. This has nothing to do with your practice philosophy because it has little or nothing to do with the care of your patients. The hard truth is that lawyers do not value a case based on your care. They put less value on technique and more on documentation. They live in the world of “what’s wrong ” and the documentation of that in an admissible format.  That is what you need to become expert in order to succeed in the medical-legal environment in today’s economy.

As an advertising agency we are always approached with a common question amongst DC Medical practices…”I’ve been in business for so long, why should I advertise?”  We always answer their question with a question…”Have you ever heard of an international fast-food chain that uses Golden Arches as their trademark…and go by the name McDonald’s?” Their response is always a “yes” and it usually comes with a smile, knowing that our next comment will be…”so why do they still advertise?”  The truth is that if McDonald’s never spent a single dollar in advertising, people across the world would still know who they are. However, it has taken the McDonald’s company, since their first television campaigns in 1963, decades to produce such a worldwide recognizable model and yet they STILL ADVERTISE!

So then “Why advertise?”  As a DC practice you have a “product” that can benefit your clients, both existing and potential. What do they know about you?  Does the community your business resides in know anything about your practice? How can your practice make their lives better or promote a healthier lifestyle? Let’s be honest, long-gone are the days of a single practice in a “one store town.” Everywhere we look people are moving in or out of cities, patients pass away, new businesses are still starting up (even in our current economy) and not to mention the future DCs that are graduating every year…in the thousands.  If you don’t think you have competition, then it is fair to say that you have been left behind.

There are many effective media outlets to successfully promote your practice. Planning the right strategy and implementing it effectively will always work. However, the most important factor in any media campaign is to track your marketing dollars. If you are not taking the time to sit down at least once a week and gauge your advertising efforts, then you are throwing your money away. Don’t be afraid to make media changes in the middle of your campaign. Look to see what outlet(s) are creating a better return on your investment and stay there. If one or more media outlets are not producing the results you need, cancel them and move on to an outlet that is better suited for your practice. Every media outlet should give you a two week clause to get out.  This is where utilizing an advertising agency is effective.  An advertising agency which specializes in medical practices will have checks and balances in place and will faithfully keep you abreast of all your marketing dollars, especially advising if any changes need to be made.

Television advertising can be the most effective tool when promoting your practice. A false expectation is that TV advertising is very expensive and unaffordable for many doctors.  A strategic advertising plan can place you in front of thousands of viewers, on the right show for a minimal amount.  As an agency, we’ve seen clients execute an effective TV campaign for as little as $500. Here is the catch…it was an agency who made the media purchase. An agency should always work effectively to get you the best rates possible and disclose them to you.  Nine times out of ten, an agency will have better rates for your practice than you can get on your own.

What about a commercial? Don’t be afraid to lend a helping hand in your creative commercial. It is your practice and you should try to convey it with as much integrity as you can in a 30 second commercial. However, let me be very honest here…NOT every doctor needs to come out in their commercial. Your presence as a professional in person is completely different than your presence on camera or on television.  Do not fall into “it’s my practice and I want to be in the commercial” syndrome…you, on camera, can actually hurt your business if the commercial doesn’t agree with you.  Again, always seek the advice of professionals and allow them to guide you, they should have years of experience in this matter.  Give them the message you want to convey and let them determine how the message will be promoted.

The internet is one of the most impactful tools currently used in our business strategy. It has replaced local yellow pages advertising. Yellow page advertising, even if you were on the back cover of one, is no longer effective like once before. Think, when was the last time you used your local yellow pages to search for a restaurant or a local business?  Internet presence is a non-negotiable tool your practice must have, regardless of your years in practice.  The internet can also help you track who is looking at your website, capture their information and send them email campaigns about your practice. This somewhat new technology of capturing someone’s specific internet interest is called Advanced Target Marketing and literally follows the habits of a person on the internet who is looking for a practice like yours. There are also many other ways to utilize internet placement and advertising. Being on the right page, for the right demographic and at the right time of day is crucial. In other words, having a link on a local gas station’s website most likely won’t get very many hits.  When planning an internet campaign always keep in mind the amount of impressions you want to target and if those impressions fall into your target market.

Social networking, Facebook and Twitter to be specific, has come and changed the way we keep in touch with family and friends. It has also developed into a tool that we use every day in how we send messages to each other, communicate what we like or dislike, or refer someone to.   Creating a Facebook page for your practice is free but it isn’t enough to do just that. You must commit yourself or someone in your office to a couple of hours a week to keep your page updated and fresh. Invite friends and patients to like your page and request other business pages as friends.  You aren’t looking to see how many friends you can claim, but instead how to effectively get your practice name out to your community.  Advertising on Facebook has also become an effective way to brand your practice.

Quick Response codes (QR) are specific bar codes that are readable by smartphones. QR codes are now the hot thing in media. These easy-to-generate boxes can be placed on just about any type of printed media where people can scan them with their smart phones and be sent directly to your website. A QR code is a low-cost addition to a campaign, and it’s a great way to get potential clients to interact directly with your practice/website. Here is a side note on smartphones: U.S. smartphone penetration is expected to hit 50 percent by the end of this year, according to Nielsen. There are currently 73.3 million smartphone users, according to eMarketer.  A recent survey by the marketing firm MGH found that 72 percent of smartphone users said they would likely recall an ad with a QR code. Seventy percent said they planned to use a QR code again or for the first time. 

Utilizing a media agency will help to communicate your practice to the public and help you with all of your marketing plans. They will also take the time to understand your practice and who your customers are, their age and gender and where to successfully reach them. Most agencies already have marketing pieces in place, including media buying, TV commercials and print ads…the tools you will need to create a successful marketing campaign.  Let them do all the work as they have the specific expertise. Look for one that specializes in medical practices and watch your business grow.

 

William Salazar is the founder and CEO of the Vallejo Media Agency, a full-service, bi-lingual agency that specializes in medical practices.  The agency focuses on building successful campaigns while educating its clients on current media outlets. For more information go to www.vallejoagency.com; or email [email protected].

:dropcap_open:D:dropcap_close:r. Carraway graduated from Life Chiropractic College in 1985 and recently celebrated his 25th year of practice along with his wife of 30 years, Diana, by his side as his office manager.

After ten years of practice he began the coursework towards becoming a Chiropractic Neurologist.  After successfully completing the New York Chiropractic College Chiropractic Neurology program, he sat for the neurology board examination in 1999 and became a Diplomat of the International Board of Chiropractic Neurology.  A few years later Dr. Carraway was awarded a Fellowship from the International Academy of Chiropractic Neurology.

He has had the pleasure of serving as a treating physician in several studies comparing the cost and effectiveness of chiropractic treatment compared to medical treatment for low back pain in adults, most notably, with Duke University Medical School.  He is a charter member of the National Institute of Chiropractic Research.

In 2007 he took note of the wide range of work being done with low level laser therapy and the mountain of positive peer reviewed research available.  After several positive personal experiences with laser therapy, he began using laser therapy in his daily practice.  The results were impressive and he began to write case studies and articles on laser therapy and chiropractic.  Presently Dr. Carraway serves on the Medical Advisory Board of Multi Radiance Medical.  He also serves as a Senior Clinical Consultant for Multi Radiance Medical and is currently working to help author a laser therapy college curriculum to be used by chiropractic colleges around the nation.

In addition to being a Certified Laser Specialist, Dr. Carraway is a Continuing Ed. Certified Laser Therapy Instructor.

He is a regular lecturer on internet webinars, discussing a variety of laser therapy related topics and has fully integrated laser therapy into his practice.  Dr. Carraway is the director of Advanced Laser Integrations, which is dedicated to helping other practitioners transition laser therapy into their practices.

 

TAC: What inspired you to become a chiropractor? Do you have a specific story?

CARRAWAY: I suffered from severe headaches as a child and found relief through chiropractic adjustments.  By the age of eleven I had made my career choice and decided that I too wanted to be a Doctor of Chiropractic and help others as I had been helped.

 

TAC: What type of patients do you generally treat or attract? What are the top five conditions you most often treat in your office?

CARRAWAY: My practice focuses on various chiropractic/neurology related issues as well as the general types of patients typically seen in a DCs office.   For the last few years, with the addition of laser therapy, I have begun to help hundreds of patients with chronic degenerative joint disease(s), as well as using laser therapy to speed the patient’s recovery from musculoskeletal conditions and complicated neurological issues.

 

TAC: Which techniques do you use and why?

CARRAWAY: I use the Activator Methods Chiropractic Technique exclusively.  I have not found it necessary to incorporate any other adjusting techniques into my practice.  I also use low level laser therapy extensively, with 90% of my patients receiving laser therapy as part of their care.

 

TAC: What type(s) of diagnostic testing procedures do you use and why?

CARRAWAY: I use standard radiography techniques and studies and prefer to refer out for specialized diagnostics.

 

TAC: We understand that you are treating all kinds of different diseases with the laser. Could you tell us a little bit more about your experiences?

CARRAWAY: There is a wide variety of maladies which readily respond to laser therapy.

Ranging from Bells palsy, sciatica, carpal tunnel syndrome, migraines, cervicogenic headaches, TMD, peripheral neuropathies, fibromyalgia, brachial neuralgias, rotator cuff injuries, most all sporting type injuries, shingles,  along with an endless list of musculoskeletal conditions.  Laser therapy is excellent for pain abatement and; let’s face it; pain is what drives most of the patients to our offices.  Pain is a great motivator.

 

TAC: Tell us two or three of your most amazing patient success stories.

CARRAWAY: Four times this year I have been able to use laser therapy to completely abate a patient’s pain from shingles (herpes zoster) with one five minute laser treatment.  In each case, the pain was gone within one hour after a 5 minute session.  Furthermore, the classic rash and blisters began to dry and heal within a matter of days, not weeks.

:dropcap_open:Laser therapy is excellent for pain abatement and; let’s face it; pain is what drives most of the patients to our offices.  Pain is a great motivator.:quoteleft_close:

I had a patient who had suffered from glossopharyngeal neuralgia, a disabling condition affecting her face, ear, throat, tongue, etc.  She had been plagued with this condition for 10 years.  I was able to adjust her and use laser therapy to resolve her glossopharyngeal neuralgia in under three treatments.   She has been pain free for 2.5 years now.

Another patient had lost all sensation in her lower legs bilaterally from her knees to her toes as the result of a botched spinal tap.  She could not tell the difference between carpet and hardwood floor.  She could not feel her socks or shoes, nor hot or cold water in her tub.  This had been an issue for 6 years.  I did not hold out any hope that she would respond to laser therapy, but she did and in a matter of just a few treatments she regained all normal sensory function in her lower legs.  I was just as surprised as she was with her response.

I have been able to keep some patients from knee replacement surgery by treating them with laser, and have put a smile on many patients’ faces who suffer from plantar fasciitis.

 

TAC: What has really impacted your growth as a chiropractor and that of your practice?

CARRAWAY: I practice 4 ½ days a week and stay pretty busy as a general rule.  I have built my practice on my specialization in the Activator Technique, my additional neurology background and most recently my laser therapy pursuits.  I see an ever-growing laser therapy practice in my future.  I hope to practice well in to my 90’s if the government does not completely suck the joy out of practicing.

 

TAC: What marketing strategies do you use to attract new patients?  And to keep current patients?

CARRAWAY: My marketing strategy is very simple.  Give the best care I can and follow through in detail with each patient.  My patients seem to recognize this and readily refer others.  95% of my new patients are referred from other patients or medical doctors who appreciate what I do and how I follow through with their referred patients.  We do some minimal advertising including yellow pages and newspaper ads, but very little else.

As far as keeping patients, I have a growing base of patients who wish to protect the progress they have achieved with chiropractic care, laser therapy or both and come for regular monthly maintenance care.

 

TAC: With your practice being Medicare, insurance and cash based multidisciplinary, cash-based, can you tell our readers your advice about setting up and maintaining such a practice in today’s healthcare system?

CARRAWAY: Advice: The population is aging and we need to become more focused on geriatric conditions and proper care.  People are living longer and wanting to have a better quality of life.  This is not going to be brought about with pharmaceuticals.  They want to golf, sail, play tennis, and play with their grandchildren forever.  We cannot give them “forever”, but we can add life to the years that they do have.  I think that there is a great void to be filled here and we are just the profession to do it.

 

TAC: What single piece of advice would you give a new chiropractor just starting out?

CARRAWAY: Brace for impact.  When I started practice 25 years ago, about once a year some new rule or requirement would crop up that we would have to change some office function to comply with.  Now these rule changes and compliance changes are coming like machine gun fire and staying up to date is a real chore.  I am constantly finding some new requirement or regulation we have to address.  Sticking your head in the sand is a sure way to lose your rear-end.  The colleges are not keeping up with all the changes.   They are happening too fast and no one source has all the answers.  It is a daily challenge.

 

TAC: What general advice would you give an established chiropractor whose practice might be struggling?

CARRAWAY: If what you are doing is not working, get busy reinventing yourself.  The number one complaint that sends patients to a doctor is the common cold.  What is number two?  LOW BACK PAIN!!!  And it is a close number two.  Nobody, in any other profession, is as well-equipped as we are as chiropractors to successfully treat back pain.  Recently three different medical sources published that chiropractic care was not only effective treatment for back pain, both acute and chronic, but was cost effective and demonstrated few relapses.  I know nutrition is important and that white sugar and flour is bad for you, foot orthotics can help and so can hair analysis, etc.  I do not want to step on anyone’s toes here.  But the big piece of the pie that is available to you is back pain.  Embrace chiropractic for all it is worth and focus on the second most common physical complaint to adults, low back pain.  The need is great and the care that we offer is second to none.  Science backs this up again and again.

 

TAC: Where do you see the future of chiropractic headed?

CARRAWAY: The face of healthcare is changing and changing rapidly.  I hear rumblings that healthcare is going to be outcome based in the future.  This can be great for us as DCs.  Start waving the scientific research flag high and proudly.  It  could be a boom for us.  Big pharma and the AMA are not going to suddenly lay down.  I fear more of the same old political end fighting and backdoor dealings that we have seen for years are going to continue to be stumbling blocks.  I  see more and more evidence that third parties are trying micromanage patient care by limiting visits and cutting benefits.  I would hope that we are going to experience a smooth transition into what healthcare is becoming.  But I am wary of every step that is taken.

 

TAC: Any final words for our readers?

CARRAWAY: In closing, work hard and love what you do.  I must add a thought from a talk given by Max Lucado.  He was once faced with two very exciting things to do: a weekend signing books, or giving a speech to a huge group; actually, three things to do, including spending time with his family.  He weighed out the pros and cons.  Then the thought struck him.  Who of all these people would be crying the hardest most at my funeral?  The answer was then clear.  He knew where he wanted to spend his time…with his loved ones.  So, while you are making your professional way in this world, do not forget the ones who are with you day in and day out, your family.

 

You may contact Dr. Chris Carraway at [email protected]

 

:dropcap_open:A:dropcap_close:n independent medical examination (IME) is performed by a doctor that has not previously been involved in the treatment of a given patient. Historically, they become involved in the case because of a request by an insurance company and are provided by an independent company retained by the insurance carrier. This allows for a level of insulation between the carrier and the IME doctor, as the carrier can now claim they did not perform any evaluations.

In a perfect world, the IME doctor renders a second opinion that allows for necessary care of covered issues of injured patients. However, in the real world, an IME doctor rarely gives an opinion that is in the best interest of the patient. In my 30 years of experience as a practicing doctor, a medical consultant, a medical-legal consultant that speaks to doctors in 46 different states and a former IME doctor, I have witnessed that the truth is usually not told by the IME doctor. The IME opinion usually sides with who writes the paycheck and, as the adage goes, it’s always about the money!

IME abuse has gone mostly unchecked, because both the patient and the treating doctor have allowed it to for too many unacceptable reasons. Regardless of the past, the time to correct the problem is now and the following is one person’s opinion.

When your patient has an IME, suggest that he/she bring a friend who goes into the examination room during the examination. Filming is fine, but a witness will ensure a less hostile environment and, in my experience, will never be denied access upon your request. After the IME, either you, as assignee of benefits, or the patient must request a copy of the IME report. Upon receipt of the IME report, sit with the patient and review everything the IME doctor documented having done.

Explain how a Foraminal Compression test or a Lasegue’s test is performed and ask, “Did the doctor perform this test?” Should the doctor have documented doing so, but not performed the test, a VERY common occurrence, the IME doctor lied. In legal terms, the IME perjured him/herself and needs to be brought to justice. You have to remember that the only reason the doctor did this was to make money with complete disregard for the welfare of your patient.

Inform your patient of his/her right to render a complaint against the doctor’s license and direct him/her to the website of your state professional conduct board. On that site is a complaint form against the doctor’s license. I have previously informed the patient that if he/she chooses to render a complaint, he/she should also state that a witness was in the room, so that it is not the doctor’s word against his/hers. (Note: This wasn’t done against the treating doctor, so you have no complaint.) In my experience, almost 100% of patients chose to render a complaint.

Upon receipt of the complaint, the state is obligated to investigate and create a file on the offending doctor. Simultaneously, if your patient has a personal injury or workers compensation case and he/she has legal representation, the patient should send a copy of the complaint to his/her lawyer. This is critical in leveling the playing field in his/her third party case  so that the lawyer can present to the carrier and, eventually, the jury to cast doubt on the integrity of the fraudulent IME examination and examiner.

The carriers will not be pleased and, should they receive enough complaints against a doctor, they will eventually fire that independent IME company or request that doctor not be used any further. It’s always about the money and the best way to ensure removing bad doctors is to hurt their employers financially; losing in court will be a big financial loss.

Another tactic IME doctors utilize is not commenting on testing performed. In every instance, the carrier has copies of all tests performed and, commonly, those tests are not referred to in the report. Part of the time, the IME doctor has a copy of the report or the actual test results and, the balance of the time, the carrier has not forwarded the report to the IME doctor because they realize it will significantly influence the results of the examination. In absence of having all of the results, a doctor cannot accurately report on a condition of a patient and, in many states, licensure boards would consider that misconduct. To do it purposely for personal gain should be criminal. The way to show intent is for numerous complaints to be filed against the same doctor or carrier showing a pattern of abuse.

Another improper tactic is to retrospectively have an IME performed well after care has ended (6-12 months) with the conclusion that the previous care wasn’t necessary. Although I would probably lose my license for treating without a timely history and physical, as I would need a clinical basis for my diagnosis, prognosis and treatment plan, so does any doctor rendering an opinion. Crystal balls were banned from medicine a century ago and only “charlatans” can look far into the past to determine the necessity for care. This is an opinion well after the care was rendered and the patient has healed or the wound has been repaired in the interim. A doctor can render an opinion for the “right now” and even for the recent past (a few weeks ago) to determine if either more care is necessary or if the recent care was necessary, as the current clinical picture is applicable. However, to render an opinion 4, 8 or 12 months into the future is grossly irresponsible and cannot be accurate in the musculoskeletal arena.

I am of the belief that many of these complaints will go without disciplinary action. However, they will begin to create a profile on the offending IME doctor and put the carriers and courts on notice about the integrity of the report, the independent IME contractor and the IME doctor. There are many ways to counteract fraudulent IME examination, but the only way to put an end to it is to remove the funding source for continued abuse. A very real parallel is that, if we removed the funding source for terrorism, we wouldn’t have any.

 

:dropcap_open:I:dropcap_close:f you’re a chiropractor, chances are you’ve heard mention of Medicare’s Electronic Health Records incentive program. The wealth of information about Meaningful Use (MU) can be overwhelming: state associations, advertisements, solicitations, webinars––you name it. And the new lingo for EHR standardization is becoming something we all deal with daily: quality measures, numerators, denominators, certifications, decision support, electronic prescription, patient reminders, exclusions, etc. There’s a lot going on out there, and with new regulatory requirements comes demand for expert services. This new field of expertise is called Health Information Technology (HIT), and its goal is not just to help navigate the paper pile, but to send it the way of the Dodo bird through computerized automation.

In the coming years HIT services will inevitably supplement your current IT infrastructure. IT focuses on hardware and software configuration, things like passwords and security, routers and networking. An HIT professional, on the other hand, provides consulting for office workflow, meaningful use requirements, staff training and software interoperability; HIT takes IT to the clinical level.

In addition to the EHR incentive program, the Office of the National Coordinator (ONC) has started HIT training programs across the country. From what we’ve seen already, the diversity of the technical expertise among the first wave of HIT professionals is impressive. I’ve talked to graduates from these programs that have backgrounds in database administration, technical sales, IT consulting, medical billing, and programming. To a person they’ve gone through months of in-depth meaningful use and HIT training, which speaks to the level of importance being placed on HIT development moving forward.

The ONC has identified six areas that HIT professionals will be able to serve MU practitioners: Clinician/Practitioner Consultant, Implementation Manager, Implementation Support Specialist, Practice Workflow & Information Management Redesign Specialist, Technical/Software Support Staff, and Trainer. These are the basic roles required to successfully implement an EHR. Large hospitals may assign each HIT role to a team of individuals and a smaller clinic will likely enlist the services of someone that can take on most or all of these tasks.

Successful EHR implementation is complimented by HIT services. I’d even go so far as saying that getting software fully certified for meaningful use is easy part. The real ingenuity comes with designing a training program that HIT professionals can use to assist each clinic in showing MU. If you plan on demonstrating the meaningful use of an EHR you’ll receive HIT services from professionals who will translate meaningful use requirements and help your practice implement MU. Meaningful use brings many new requirements to your practice, but with the proper training and guidance, you and your staff will be able to understand and demonstrate MU with ease.

What is full certification?

The biggest buzzword around the Medicare incentive program is “Full Certification.” When considering an EHR experts are advising consumers to only entertain “fully certified” systems. Medicare offers two types of certification for EHR: Full, and Modular. Certification of an EHR is done in sections referred to as “modules.” The testing procedure for each module is well documented and the order of certification of each module has a precise workflow and expected result. The testing procedure happens like a giant, multi-layered checklist. To receive full certification qualified EHR software must demonstrate, measure, report, and pass 100% of the modules that make up meaningful use. If an EHR is missing a certification for just one module then that EHR only will only receive modular certification. Fully certified systems have a significant advantage because they have demonstrated every module for MU and will have documented procedures to accomplish each one.

The process of getting our EHR fully certified was straightforward. Our test proctor started with the very first module, we walked him through the process, and moved onto the next module. We went through every module, one-by-one, and demonstrated meaningful use of our EHR for every applicable measure. Thankfully for them, Eligible Providers (EPs) will not have to be as thorough as we were. EPs will have a number of exclusions they can make and measures that they can selectively demonstrate. We’ve created instructions for how each module is demonstrated and measured to make it easier on our user base. Successfully completing the certification allowed us to design an HIT training program that meets or exceeds any and all testing requirements.

What makes “meaningful use” meaningful?

Creating a reliable method of medical information exchange is one primary goal of meaningful use. Other goals are the “pay for performance” model that Medicare has been pursuing for years, and providing decision support and educational materials at the point-of-care with reliability and consistency. Ultimately, meaningful use is a broad set of rules that helps gather, analyze, and share medical information, and it establishes guidelines for future flexibility of electronic health records.

When we outlined the meaningful use requirements for Chart Talk, we were able to classify every measure into three basic categories: Patient Information, Interoperability, and Quality Measures. MU measures that fall into the same group share common features such as required percentage reporting, file type and structure, alerting capability, and other factors. Your HIT providers will be able to clearly define each of these measures and how your clinic will apply or exclude them when demonstrating meaningful use.

From the distance the task can look as insurmountable as the High Sierras, but don’t stop now, ‘cause there’s gold in them there hills. Keep from getting your back to a wall with the assistance that’s available to you. The new HIT programs are beginning to put trained professionals into the work place, your local regional extension center (REC) is set up to help EPs implement MU, and your EHR vendor should have HIT services available. Use whatever resources you have at your disposal; with the right HIT partner, teamwork in your clinic, a willingness to modify some of your workflow, and a 49er attitude, you will be able to demonstrate meaningful use and keep your clinic running smoothly.

 

Matthew Richard is Vice President of Mighty Oak Technology, Inc. Matt championed the “50 Days ‘Til Friday” initiative, a plan that saw Chart Talk receive full meaningful use certification in 50 days. Matt received his BS in Physics from Southern Oregon University and now lives in Minneapolis, MN.

 

References:

» Six areas for MU professionals

http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__competency_examination_program_%282%29/1809

» CMS FAQ 17

» http://healthit.hhs.gov/portal/server.pt/community/onc_regulations_faq

 

:dropcap_open:D:dropcap_close:r. Corey Mote started off in high school training for sports such as football and track with weight training.  By his eleventh grade year, he decided to compete in powerlifting competitions. Within one year of powerlifting, he won the National title for his weight division as a teenager.  After the Powerlifting Nationals, he decided to go into Olympic-style weightlifting, an entirely different type of lifting and training.  He ended up doing rather well with this sport as well, placing 2nd in the Georgia Games with pre-Olympian competitors. After a couple years of Olympic-style weightlifting, he decided to go into bodybuilding. His first show was in 1999 at the Association of American Universities Mr. Teenage America in Cleveland, Ohio, where he ended up placing 3rd in the competition. He then went on to compete and win the Nationals Bodybuilding Championship’s National Physique Committee Teenage Georgia the following year. After that, he competed and won several other shows before he decided to put a hold on competitions—although staying in shape for future contests—for a few years, so he could focus on school and other priorities.  He started back competing in September 2010, and, this time, it was in another country altogether.  He competed in the Musclemania Britain in St. Albans, a city just outside of London.  He ended up winning both for his weight class and the Overall, earning the status as a Professional natural bodybuilder. From that point on, his sights were set on making an impact at the pro level in the sport. He immediately began training for the Musclemania Universe that was to be held in Miami in June 2011. Here he would make his pro debut, and he wanted it to be special. It was. He ended up placing 3rd in the Pro Heavyweight division, shocking a lot of people, including himself.

 

TAC: How did you first get involved in chiropractic?

MOTE: I was first exposed to chiropractic in my second year of college, upon having a sacroiliac sprain that I could not shake alone. I saw a chiropractor for it, and he corrected it within two to three visits. I then realized I needed to make use of chiropractic more often with all the training I was undertaking. I decided to do just that, and it elevated  my performance in the gym to new heights. From that point on, I knew becoming a chiropractor was in my future.

:dropcap_open:I first came to a chiropractor to relieve pain, but the doctor I went to explained to me the importance of using chiropractic for optimal physical function and thankfully, I listened.:quoteleft_close:

TAC: So is that what led you to seek out chiropractic as a consequence of pain, or more to enhance function?

MOTE: I first came to a chiropractor to relieve pain, but the doctor I went to explained to me the importance of using chiropractic for optimal physical function and, thankfully, I listened. I do not think I would have been nearly as successful with bodybuilding had  I not used chiropractic care.

 

TAC: Have you been doing Bodybuilding your entire life?

MOTE: To an extent, yes. I began exercising at the age of four, by doing push-ups, sit-ups, sprinting, 1-mile run. I owe it to my mother and father for that, as they taught me the importance of being healthy, active, and fit at a very young age. As far as bodybuilding as a sport, well I’ve been specifically training for that since I was a teenager, right after graduation from high school.

 

TAC: What was it that led you to choose Life University for your studies?

MOTE: I chose Life University when I found out that Dr. Guy Reikman was hired on as the new president. I read so many good things about him and the philosophy he holds so dear, and I wanted to be a part of Life University at that point, as I saw that they were looking to do great things for the chiropractic profession.

 

TAC: So you’re 30, is that old or young for a bodybuilder? Can you tell us why that is?

MOTE: 30 is actually a great age to begin one’s professional natural bodybuilding career at. As a bodybuilder who trains intensely, he/ she develops more muscular density with age. More definition in the musculature is present, and this is very important in competitions.

 

TAC: Do you currently maintain an active practice? If yes, what kinds of patients are treated, and treatments used?

MOTE: I currently own and run Performance Chiropractic and Rehabilitation in Clarkesville, Georgia. I graduated from Life University in September 2008, and began my practice in March 2009. I see mostly personal injury and sports injury patients. Along with manual spinal manipulation, I use various modalities, such as E-stim, ultrasound, traction, flexion distraction, and therapeutic exercises in my practice.

 

TAC: How much time does that leave you to train every day?

MOTE: I only need 90 minutes a day, five days a week to train.  Many people believe that a top-level bodybuilder must stay in the gym four hours a day, every day, to attain such a level. This is certainly not true. Proper diet and rest are equally as important as training. Training more than what I currently do would be over-training, which is something that should be avoided if trying to build muscle mass without overuse injuries.

 

TAC: Who is your greatest bodybuilding mentor?

MOTE: I would have to say my greatest bodybuilding mentor is Lee Apperson, an IFBB pro bodybuilder that I had the honor to train with in the summer of 2003 in Daytona Beach, Florida. His formula for winning is very similar to mine, in that his main advantage on stage is his definition, proportion, and symmetry – not size.

 

TAC: And your greatest chiropractic mentor?

MOTE: My greatest chiropractic mentor is Dr. Richard Rosenkoetter of Chiropractic and Sports Injury of Atlanta. I interned with Dr. Rosenkoetter for nine months before setting up my own practice an hour north of Atlanta, basically running my practice as similar to the way he runs his as I can. He is a phenomenal chiropractic physician, and it was truly an honor to intern under him.

:quoteright_open:It would soon become America’s (and the world’s) most popular natural bodybuilding competition.:quoteright_close:

 

TAC: What is it that you find unique about Musclemania, as a venue for body building?

MOTE:  Musclemania is the premier federation for natural bodybuilding. No other natural bodybuilding federation comes close to Musclemania in terms of publicity or worldwide exposure of the athletes, and there are many amateur Musclemania shows around the world, all leading up to the two biggest natural bodybuilding shows in the world: Musclemania Universe (in Miami)and Musclemania World (in Las Vegas). With exclusive, international television coverage by ESPN International, TSN RDS Canada, Sky Sport Britain, Star Sport Asia and other worldwide networks, Musclemania is more recognized than any other natural contest worldwide.

Musclemania began in 1991 as bodybuilding’s first and only tour of world class level staged competitions. Early on, Musclemania took a bold and challenging step forward by declaring that this exciting event would become a natural event. It would soon become America’s (and the world’s) most popular natural bodybuilding competition.

 

TAC: What is the last book that you read?

MOTE: The last book I read was The Secret. I have probably read it ten times now. I truly believe what the book teaches—that we attract what we dwell on. If one has a positive outlook on things, he or she attracts more positive things into his or her life. The same goes for negative thinking. A pessimist has a difficult time ever achieving his or her goals in life, basically because he or she is consistently viewing things in life as undesirable or unfavorable.

:dropcap_open:A:dropcap_close:s I drove to an appointment in the neighborhood the other day, while stopped at a traffic light I noticed a marquee across the street on the corner advertising chiropractic care. The sign blared:  “$49 First Visit, for Chiropractic, Acupuncture, or Massage”.  I cringed and made a mental note to drop my business card off at that office on a future visit. It’s not the first time I’ve seen such an offer on a street sign, or newspaper ad, or even on Facebook. I chalk it up to the widely mistaken belief that it must be OK because everyone is doing it. Nothing could be further from the truth.

In certain states, there are written rules of conduct about advertising. They spell out what you can and can’t do. Some chiropractors must not list themselves as physicians, while, in other states, there are rules about offers that you make. In fact, one state requires that any offer you make must allow the patient to change his/her mind within 72 hours, not unlike buying a car! Yet, all of the state level rules and regulations do not take into account an even more important rule. That is the complex set of Federal prohibitions against certain kinds of marketing that supersede every state rule when it comes to federally insured patients, like Medicare.

The Office of Inspector General (OIG) published a Special Advisory Bulletin (SAB) on August 29, 2002, entitled Offering Gifts and Other Inducements to Beneficiaries. This type of publication is essentially a fraud alert. It signals a clear enforcement priority against improper marketing and patient inducements. The patient inducement prohibition under federal law states:  “Any person…that offers or transfers remuneration to any individual eligible for benefits under [Medicare or Medicaid] that such person knows or should know is likely to influence such individual to order or receive from a particular provider, practitioner or supplier any item or service for which payment may be made, in whole or in part, under [Medicare or Medicaid]…shall be subject to…a civil money penalty of not more than $10,000 for each item or service…and damages of not more than three times the total amount of remuneration offered, paid, solicited or received.”

Blah, blah, blah. “What does it all mean, Basil?” as Austin Powers would say. Several important terms must be defined in order to understand the parameters of this prohibition. The term “remuneration” is defined in the statute as follows: “…the waiver of co-insurance and deductible amounts (or any part thereof), and transfers of items or services for free or for other than fair market value.” Accordingly, free X-rays, free examinations and any gift certificates for free or other valuable services offered or given to Medicare, Medicaid or other beneficiaries of federal programs violate this exclusion.

Now, take our friend with the street corner marquee; clearly he was offering valuable services for less than fair market value. We all know that a typical first visit in a chiropractic office is far more than $49.  So taking this a step further, one must ask if this is afforded to all potential patients. Does this offer apply to anyone, including federally insured patients? What if the patient has insurance? Will you bill only $49 to that carrier?

:dropcap_open:The OIG also establishes what they call “bright line guidance” concerning the nominal gift exception.:quoteleft_close:

The OIG also establishes what they call “bright line guidance” concerning the nominal gift exception. Free items or services that have retail value of no more than $10 individually, and no more than $50 in the aggregate annually per patient, are an exception. For example, a new patient gift bag, that all new patients receive, that includes a tube of BioFreeze, or a branded coffee cup, wouldn’t likely be seen as a violation of this rule.

Other state-level rules have to be taken into consideration, of course but, remember, just because your state has laid out rules for marketing, don’t forget to include these federal rules, too.  Marketing is important to your practice, but compliance with federal and state laws is clearly more important than a successful marketing program that ignores the law and places your practice at risk for severe sanctions.

Here are some items to consider:

1)  Social media has changed the doctor-patient relationship. “Friending” our patients and communicating with them online about special offers, discounts or, worse, their condition, can lead to trouble. Recently a Colorado doctor who happens to be a friend on Facebook offered $15 adjustments for any friend who may have strained him/her self shoveling after a recent snowstorm. Such inducements are a serious violation, and should be avoided.

2) Offering a pre-acceptance interview, or other such procedure for ALL patients, helps you to avoid the violation of “Free Consultations”. If your compliance procedure outlines the fact that you offer pre-acceptance interviews to ALL new patients, then it is less likely to be seen as an inducement when you offer a meeting with the doctor to determine whether the patient is a good candidate for chiropractic care. At an appointed time, the billable section of the visit begins only if the patient okays moving forward at that time.  For more information on pre-acceptance interviews, check the Resources and Archives section of www.kmcuniversity.com for a fact sheet and scripting.

3) If you prefer to use more of a capped or maximum fee for your uninsured, under-insured, or partially insured (like Medicare) patients, check out a Discount Medical Plan Organization (DMPO) like ChiroHealthUSA or others. Offering discounts only to a covered group, like members of a DMPO, helps you avoid the snare of inducement. Just like offering special pricing to a group of covered individuals like BCBS members, offering your discounts to DMPO members helps you clear the hazard of inducement beautifully.

Just because everyone does it doesn’t mean you should. While we all have our own risk tolerance, there are many reasons not to follow the pack.  Higher new patient numbers should not come at the cost of potential fines, sanctions or even your license.

 

Kathy Mills Chang is a Certified Medical Compliance Specialist (MCS-P) and, since 1983, has been providing chiropractors with hands-on training, advice and tools to improve the financial performance of their practices. A well-known and sought-after speaker, Kathy has served in national and state level chiropractic organizations, sits on diverse boards and advisory councils related to the profession, and is frequently invited to address chiropractors in important conferences and seminars around the country. In 2007, KMC University was created to streamline, develop and offer a broader range of chiropractic solutions in the areas of coding, insurance, patient financial procedures, Medicare and compliance. She can be reached at 888-659-8777 or [email protected]

:dropcap_open:M:dropcap_close:alpractice—a word any medical practitioner shudders to hear. However, in today’s ever increasingly litigious society, it’s really not a question of if you’re going to be sued but, rather, when. Even if you have the best practice in the country, with the most careful examinations and advanced treatments, eventually you are likely to be involved in a malpractice suit of one kind or another, warranted or otherwise.

Basics of Chiropractic Malpractice Insurance:  Though it’s hard to generalize when it comes to insurance policies, there are a few things that you can expect from any basic modern chiropractic malpractice insurance policy. First, there are two types of policies: occurrence and claims-based. An occurrence policy will cover incidents that occur while the policy is still in effect, while a claims-based policy covers any claims that are submitted to you in writing during your policy period—i.e., it can cover you retroactively. There are benefits to both kinds of policies, so be sure to do your homework and shop around before you choose.

As far as basic policies go, liability coverage can range from 100,000 to several million dollars, depending on your policy and on the regulations in your state. Different policies are available to cover only basic claims, claims of negligence, and even claims of sexual misconduct, which chiropractors are unfortunately sued for fairly often.

Finally, many newer policies are offering coverage for those chiropractors who also work as massage therapists or acupuncturists. This can be a godsend for alternative chiropractic practitioners, since they no longer have to buy three policies for one practice.

Areas of Concern:

There are several areas of concern when it comes to chiropractic malpractice suits. Since chiropractors do so much work with the spine, it is fairly common for them to be sued for aggravating a disk. Additionally, chiropractors often come under fire for allegedly causing strokes by their adjustments, since they do often work with areas so closely connected to the brain.  Besides that, patients who feel more pain after a treatment often sue their chiropractor for malpractice, as do those who are simply unsatisfied with how long the treatment is taking.

Unfortunately, many patients base their claims solely on how they feel, especially when it comes to issues of timing or pain relief. Even if a patient is progressing as quickly as their condition will allow, or even if they themselves are causing their treatment to proceed slowly because of their lifestyle or refusal to change certain habits, they could sue simply because they feel disappointed in the way in which you handled their situation.

There are several other nebulous areas that are “danger zones” for chiropractors as well, notably, failure to diagnose and failure to refer. Cases have been brought to court for as little as a chiropractor’s failing to instruct a client to seek an alternative treatment for a sprain. In another real-life example, a patient who went to a chiropractor for long-term pain became disappointed with the treatment and sought another practitioner, only to be diagnosed with a herniated disk. The other practitioner convinced the patient that the chiropractor caused or failed to diagnose the herniated disk, thus leading them to sue the chiropractor.

One of the top ten causes of chiropractic lawsuits is for alleged sexual misconduct. Though this is not the primary reason that chiropractors are sued—contrary to the widespread rumor, it is a major cause of concern and a risk area for chiropractors.

How You Can Limit Risk:

Though all of this may sound very intimidating, there are ways that you can limit your risk when it comes to being sued for malpractice suits. The first and by far the most important thing you can do is to keep appropriate documentation. When it comes to nebulous claims of the time it takes to complete a treatment, the effectiveness of your treatment plan, or your diagnosis, documentation will be your best defense.

By keeping clear and accurate notes about each and every session with your patient, the treatment plan that you decide on, how that patient is progressing, and the patient’s understanding of that plan, you can save yourself an infinite amount of trouble in court. In fact, many cases are dismissed out of hand because of good documentation. This is extremely as simple as using a comprehensive easy to do with all the new chiropractic Electronic Health Records with outcome assessments, SOAP note macros, and online patient intake forms and documentation built right in software.  So there is really no excuse for not keeping the best possible documentation you can.  Developing a relationship with your clients can also help to prevent malpractice claims.  Each person in the practice should make it a point to be polite and approachable to clients in order to develop the best relationship possible with them and prevent any event which could foster resentment in any kind of situation.

Additionally, chiropractors need to be very clear with their expectations and treatment plans when it comes to working with patients. If you have clear documentation that you have shown the patient a treatment plan (for example, you have them sign off on it every time they come in for treatment, or have them write a brief assessment of each session on your SOAP notes), then it is very hard for anyone to claim that they didn’t know what you were going to do or believed that you had an irresponsible treatment plan.

The Takeaway:

With a good insurance policy in place, and as long as you avoid your “danger zones” while keeping good accurate, thorough and up-to-date documentation, the vast majority of malpractice claims will not stand the test of court.

:dropcap_open:T:dropcap_close:his quote from Ken Hutchins, researcher and President of Super Slow Exercise Guild, represents the common thread binding the various health care disciplines. Orthopedic surgeons, chiropractors, physical therapists, athletic trainers and others involved in the delivery of health care services may differ on a particular approach to an athletic or industrial injury in the corrective context. But, in the restorative or rehabilitation context, it is generally agreed that passive care will only take the patient to a certain level, usually below the functional level needed to return to competition or prevent further injury. Without a properly designed exercise program to increase the tensile strength of the injured tissue, rehabilitate the neurological elements of the injury, and increase strength and mobility in the kinetic chain, we only place the athlete in a position where re injury can and, most likely, will occur.^1,10

With the above in mind, we find ourselves in a difficult position as health care providers. With a shrinking health care dollar, a health care model focused on symptom reduction, insurance companies who have placed corporate profits above needed services, and a system driven by the pharmaceutical industry which contributes significantly to our elected officials, how do we provide these needed rehabilitation services in a cost effective manner. We can no longer invest in expensive resistance equipment and a staff to administer the programs. Yet, there is a compelling need. The challenge is how to meet the need in a cost effective manner that gives a reasonably good chance for a positive outcome.

:quoteright_open:We know through research that gripping causes recruitment and tight gripping actually can cause vascular problems.:quoteright_close:

I believe there are presently products and companies that allow us to serve the patient in the area of active care protocols at minimal cost with evidence based protocols. Exercise systems utilizing surgical tubing or bands,¹² grip free cuffs³, and stability balls offer resistance training with neurological inroads for every orthopedic and sports injury based on scientifically defensible protocols.⁷

In rehabilitation, we want to amplify a number of factors. One is isolation. In an exercise rehabilitation program, recruitment is the enemy of isolation. When recruitment occurs, the targeted tissue suffers from both a somatic and neurological standpoint. We know through research that gripping causes recruitment and tight gripping actually can cause vascular problems. Noted author Rene’ Calliett, MD, points out in his book on shoulder injuries that gripping while performing Codman’s passive motion exercises actually activates the shoulder muscles, thus decreasing the effectiveness of the program.^1,2 Dave Lemke noted EMG tech and NMT from San Antonio in research done at Northern Idaho Bio Performance Institute demonstrated a 300-500% greater EMG activity in the targeted muscles using grip free technology.³ We further know, through research, that exercise done on an unstable base amplifies the input to the nervous system and enhances outcomes.^4,5 Surgical tubing or bands provide variable resistance that research has determined to be necessary to optimize strength  based on the kinesiological  principle that all joints move in a circular pattern and the forces generated vary according to the movement arm (the distance from the fulcrum). Remember weight times arm equals moments of force. Stability balls or discs offer an unstable base. Utilizing the above, we have all the elements necessary to develop an evidenced based rehabilitation protocol for our patients.

So, what’s the bottom line? Health care providers who deal with soft tissue and athletic injuries MUST be involved in active care protocols.^8,10,11 In fact, every Chiropractor, Physical Therapist, and Athletic Trainer, if we are to responsibly treat our patients, must, in the course of patient care, be able to transition a patient into an active care protocol. The days of just articular joint manipulation, soft tissue treatments, or passive modalities throughout the course of care are over. Science has taught us the need for active care protocols to move our patients to the next level.6. If we fail to properly rehabilitate, we have, in the final analysis, failed the patient.^9,13

Here is the practical approach I have adopted. I must first state that I recently sold my entire Nautilus/Hammer fitness center. This was primarily due to decreased reimbursements and constraints placed on us by managed care companies, such as limitations on the number of visits ( forgetting that research has shown it takes a minimum of 3 months of active care to reverse the glycolytic changes in the somatic tissue secondary to a low back sprain).⁴ In addition, multiple co pays, high deductibles and the current economic climate make it almost impossible to provide the needed rehabilitation services we once were able to deliver in house. But with systems and products available to the practitioner, we can still provide the services in an evidenced based program that is cost effective and will provide the same outcomes as the more sophisticated rehab centers. Remember, results are what counts.

These systems will cost the practitioner a minimal amount, and can be sold to the patient at a reasonable margin. They have all the necessary equipment to provide a total body workout or a rehabilitation program. In fact, once rehab is completed, they can then be used in a maintenance or supportive care program.^5,8,13 There are applications on file to get some of these systems qualified as durable medical equipment, which will save the patient a portion of the cost. But, it is a great deal regardless, about the cost of one visit to the Physical Therapist or two months membership in a gym. The physician gives the patient home exercises specific to the injury to be performed concurrent with any passive treatment delivered in the clinic.  On subsequent visits, as symptoms permit, the exercises are expanded on in both increased range of motion and resistance. You bill the 97110 code with each visit that includes the addition of exercises or the modification of exercises. The administration of the program does require the practitioner to gain training in exercise rehabilitation. This is necessary to guarantee desired outcomes in a safe manner.  Companies are developing these programs and instruction in seminar formats to prepare the practitioner to develop active care protocols in his or her practice.

The health care system is broken in terms of the model that provides money and services ad infinitum to a drug based approach to every injury, ignoring the evidence that no drug can do for the patient what a properly administered exercise program can do in areas of providing quality of life and functional return to activity. The program outlined above, utilizing already available products, can meet all the needs of the patient in a cost effective manner.

 

Dr. Dolbin is certified as strength and conditioning specialist (NSCA), and  a certified fitness instructor (NSPA). He has served as the Chiropractor for the Villanova University sports medicine department from 1993 to 2003, and was Chiropractor for the University of Maryland gymnastic team from 1997 to 2002  For more information you may contact Dr. Dolbin at [email protected]

 

References:

1. Calliet, Rene: Soft Tissue Pain and Disability: Ch. 6 Pg. 155-156

2. Rubin: An Exercise Program for Shoulder Disability: Cal. Med. 106: 39-43

3. Kemke, David NMT, sEmg. Northern Idaho Bioperformance Institute. Study on Grip free Reisitance training.

4. Active Therapy for Chronic Low Back Pain: Spine, 2001 Apr 15; 26(8): 9009-19

5. Evaluation of Functional and Neuromuscular changes after Exercise Rehabilitation for Low Back Pain using a Swiss Ball. J Manipulative and Physio. Therapeutics 2006 Sep; 29(7): 550-60

6. The Efficacy of Active Rehabilitation in Chronic Low Back Pain. Spine: 1999 May 15,24(10): 1034-42

7. Muscle activation changes after exercise Rehabilitation for Chronic Low Back Pain. Arch Physical Med. Rehabilitation. 2008 Jul; 89(7): 1305-13

8. Active Therapy for Chronic Low Back Pain. Effects on Muscle Activation, fatigability and Strength. Spine. 2001 April 15;26(8): 897-908

9. Back and hip Extensor strength in Chronic Low Back Patients. Arch Phys Med Rehabilitation. 1998 April; 79(4); 412-7

10. The Association of Low Back Pain, Neuromuscular Imbalance and Trunk extension strength in Athletes. Spine J. 2006 Nov-Dec; 6(6); 673-83

11. The Efficacy of Active Rehabilitation in Chronic Low Back Pain. Spine. 1999 May 15;(10): 1034-42

12. Posterior Cuff Strengthening Using Theraband in a Functional Diagonal Pattern in Collegiate baseball Pitchers. J Athletic Train. 1993. Winter; 28(4) 346-354.

13. Neuromuscular Fatigue during modified Biering-Sorensen Test in Subjects with and without Low back Pain. Journal of Sports Science and Medicine (2007) 6, 549-559.

 

:dropcap_open:D:dropcap_close:r. Jeffrey E. Poplarski, a chiropractor with a practice in Amityville, NY, was the Wellness Team Chairman for the 2011 U.S. OPEN Golf Championships held this year at the Congressional Country Club in Bethesda, Maryland.

Dr. Poplarski recruited 108 volunteer health care professionals that came to the event to man the three wellness tents positioned throughout the grounds.  Massage therapists, physical therapists, and other Doctors of Chiropractic came from 13 different states to help with treatments for the players, caddies, and the thousands of volunteers of this year’s esteemed event.

As you can imagine, Dr. Poplarski and his Wellness Teams have become popular figures around the grounds, especially now since the teams have become so recognized.  Poplarski first brought a wellness team to the 2002 U.S. OPEN Championships at Bethpage, NY and he continues to be invited back.

The acceptance of the Wellness Team’s complementary and alternative approach to medicine remains a testament to the popularity of integrated, holistic care.  With the complement of the various CAM (Complementary & Alternative Medicine) health professionals on the team, each individual during the event requiring assistance was able to have the treatment tailored to their specific health needs.  Even Hyperbaric Oxygen Therapy was offered  for those looking for new heights!

The repertoire of specific patient care that the team can provide is a primary reason they keep getting invited back, which is why Dr. Poplarski has already started his recruiting for the 2012 U.S. OPEN Championships at The Olympic Club in San Francisco.  He stated he would be flying out multiple times (NY to SF) to recruit local health practitioners, and for the state of California, he will be able to add Acupuncture to his wellness team.

As Chairman, Dr. Poplarski had a full schedule of tasks before and after the Championship began.  The construction of the wellness team remains the main endeavor and started well in advance. This year’s event had about 70% of the health practitioners recruited from the home state of Maryland, which he has done since the beginning of his tenure for the Open Championships that changes sites every year.

Jeffrey also oversees the supplies of the wellness tents and what goes into the Healthcare Providers gift bags, the Player Spouse gift bags, and the all-important Caddies gift bags.  Because of the respect Dr. Poplarski and his Wellness Teams have gained over the years, these gift bags have become a valued prize.  “I have become a walking billboard”, the Doctor expressed to me when mentioning the number of healthcare providers receiving the bags.

When approached by the practice of Dr. Jeffrey Edward Poplarski, Sombra was thrilled to be part of such a great and historic event.  We have been involved in the complementary and alternative health markets of today for over two decades now and we are greatly honored to have the Sombra Natural Pain Relieving Gels brought to the Congressional Country Club for such a memorable event.  Congratulations Rory Mcliroy for your first major championship!  And thank you Dr. Poplarski for all your support.

 

Jeff Baskett is the Global Marketing Manager for Sombra Professional Therapy Products and has been in that position for over 7 years now.  He is an avid multi-sport athlete, including golf, and understands the value of complementary and alternative medicine for all his therapeutic needs.  Jeff can be contacted through Sombra at [email protected].

 

Resources:

Jeffrey Edward Poplarski, D.C., LLC

217 Merrick Rd. Ste. 204

Amityville, NY  11701

http://www.drjeffpoplarski.com