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Texas Chiropractic Association

The Voice of Chiropractic

 

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News

Current events, news and alerts that affect your health, our healthcare system and the chiropractic profession.
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  • Posted on 31 December 2008 at 11:32:57 by Chip Kent
    The Texas Department of Insurance has issued a data call for workers' compensation and other carriers for fourth quarter 2008 experience.

    Compliance is mandatory under Section 38.001 of the state Insurance Code, the department said. The data call is designed to provide the department with immediate access to market condition information. The information will be submitted to the governor's office and certain members of the state Legislature.

    Carriers must respond by Feb. 15. Underlying data, individual source documents and other information utilized in the development of call responses must be maintained in your records for a minimum of three years after Feb. 15, the department said.

    Forms for the data call are in a fill-in electronic format using an interactive portable document format (PDF). The forms, affidavit, and instructions should be downloaded from the department’s website. The bulletin is located here:
    http://www.tdi.state.tx.us/bulletins/2008/cc78.html
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  • Posted on 18 December 2008 at 10:48:42 by Chip Kent
     (Arlington, Va.) -- A coalition of non-MD provider
     organizations, led and originally founded by the American
     Chiropractic Association (ACA), recently contacted
     President-elect Obama and key members of Congress regarding
     the issue of health plan discrimination. 
     
    The coalition, known as Patients' Access to Responsible
     Care Alliance (PARCA), outlined its stance in a letter dated
     Dec. 1, 2008.  
     
    As noted in its letter, PARCA seeks inclusion of language
     into any national health reform plan that would ban
     discrimination against entire classes of non-MD health care
     providers with respect to participation in insurance
     companies and plans. Importantly, the provisions would also
     prevent insurance plan discrimination as it relates to the
     fair reimbursement of services provided by non-MD health
     professionals.  
     
    While ACA remains focused on many chiropractic-specific
     legislative initiatives, there are certainly some areas
     where the profession shares common concerns with a larger
     body of health care providers, said ACA President Glenn
     D. Manceaux, DC.  When common ground exists, ACA feels
     its vitally important to make full use of the potential
     power and influence of a coalition of provider
     organizations. Through our participation in PARCA and other
     alliances, were working toward meaningful and beneficial
     health care reform not only for doctors of chiropractic, but
     also the patients they serve.
     
    PARCAs letter to President-elect Obama and members of
     Congress stated in part: 
     
    we are aware that all too often policy makers and
     government leaders tend to center their attention almost
     exclusively on the concern of the medical doctor community,
     while overlooking the important role played by the large and
     diverse group of non-MD/DO providers that comprise a major
     part of our healthcare delivery system...
     
    In todays delivery system, health plans routinely
     discriminate against whole classes of healthcare providers
     based solely on their licensure or certification.  We
     believe such discrimination is not only wrong in principle,
     but is anti-competitive in nature, denies patient choice and
     access to a range of beneficial providers, and in general,
     results in a less than ideal and optimal delivery
     system
     
    As you go about the important work of improving the
     existing employer-based reimbursement system, and work to
     establish new protections related to pre-existing
     conditions, patient health status, transparency and other
     important features of reform, we request that you lend your
     support to the adoption of appropriate legislative
     provisions that would prevent existing healthcare plans, as
     well as any new federal plan, from discriminating against
     classes of healthcare providers with respect to plan
     participation, indemnification, and reimbursement based on
     the class of health provider, and the providers licensure
     or certification.
     
    PARCA coalition members, including the ACA, have long
     expressed concern that many insurance plans routinely pay
     non-MD providers fees that are significantly lower than
     those paid to MDs and DOs, even when the non-MD/DO provider
     furnishes an identical covered service.  
     
    Excluding entire classes of providers from participating
     in health plans is preposterous as are the many schemes
     that attempt to shortchange non-MD providers with regard to
     fair reimbursement, Dr. Manceaux said.
     
    The PARCA coalition also plans to raise concerns about what
     is currently being dubbed the medical home model of
     health care, say ACA officials, a concept that continues to
     remain vague and ill-defined.  While the medical home
     concept is intended to save money and better coordinate a
     patients overall health care, PARCA members fear it could
     lead to the establishment of a super-class of MD
     gatekeepers, who may act in ways that would further deny
     patient access to services provided by specialists and
     non-MD health professionalsincluding doctors of
     chiropractic. ACA officials predict the medical home
     concept, once better understood and further fleshed out,
     will prove to be one of the more controversial elements of
     national health care reform.
     
    About the Patients' Access to Responsible Care Alliance
     (PARCA)
     PARCA is a coalition of organizations that represent the
     interests of millions of patients and non-MD/DO health care
     providers. It aims to provide federal policymakers with
     access to information from all areas of the health care
     community, in order to assist in the formulation of
     responsible, well-rounded health care policy. The coalition
     is committed to quality, cost-effective care, and ensuring
     patients have options in the delivery of such care.
     
    Michael Taylor, DC, DABCI
     Oklahoma ACA Delegate

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  • Posted on 17 December 2008 at 15:56:55 by Chip Kent
    The state agency charged with representing injured workers’ interests in the Texas workers’ compensation system has recommended repealing Labor Code provisions setting a 90-day period for determining maximum medical improvement (MMI) in favor of using 104 weeks – the time allowed for workers to receive temporary income benefits.

    Some stakeholders see the proposal as an attempt to get lawmakers to reverse their decision in 2003 to allow a 90-day period.

    The Office of Injured Employee Counsel (OIEC) is arguing for the change, in part, based on a court case that it says could overturn the 90-day rule as unconstitutional. The office included the proposed change among a series of policy and legislative proposals in a 129-page report to the 2009 Legislature that the agency posted on its website last week.

    Austin attorney Stuart Colburn of the Downs-Stanford law firm told WorkCompCentral Friday the provision can operate for or against injured workers, carriers and employers.

    Colburn, who chairs the State Bar’s Workers’ Compensation Section, said he can “understand the arguments on both sides” regarding changing the provision.

    Initially, Colburn explains, the former Texas Workers’ Compensation Commission created the rule, and the commission’s appeal panel “generated exceptions” to it. That resulted in a court challenge, which determined that the appeals panel didn’t have the authority to make exceptions — with the commission passing an emergency rule in response.

    That rule was challenged on the basis that there was no statutory language allowing the commission’s action, with the Texas Supreme Court striking down the 90-day rule, Colburn said.

    The Legislature subsequently created the 90-day provision by passing a bill that included most of the “fairly large” exceptions for injured workers, Colburn said. “An injured worker can find a way out most of the time,” he said.

    The 90-day provision has been less of an issue in recent years than it was during the 1990s, Colburn said.

    While the provision often may work against an injured worker, it also can work against a carrier, as in instances where designated doctors’ determinations on a worker’s impairment isn’t challenged by a carrier within the 90 days, Colburn explained.

    From the standpoint of carriers and employers, “there needs to be some finality. ... They need to be able to close a file,” he said.

    Otherwise, Colburn noted, a worker could come back after almost two years seeking a change.

    “It’s like a statute of limitations,” Colburn said. “Sometimes, it is going to be unfair … Sometimes an injured worker may not dispute a determination and may get stuck with an impairment rating lower than they could or should have had.”

    However, Colburn said, the exceptions in the current provisions do provide safeguards to keep that from happening.

    OIEC notes that Labor Code Section 401.011(30) currently provides that “maximum medical improvement” means “the earlier of (A) the earliest date after which, based on reasonable medical probability, further material recovery from or lasting improvement to an injury can no longer reasonably be anticipated; (B) the expiration of 104 weeks from the date on which income benefits begin to accrue; or (C) the date determined as provided by Section 408.104” (spinal surgery after the expiration of 104 weeks).

    OIEC notes the Texas Supreme Court, in a 1995 decision in Texas Workers’ Compensation Commission v. Garcia,  considered an equal protection challenge to the statutory limitation of 104 weeks for a claimant to receive temporary income benefits. At that time, the Workers’ Compensation Commission had not adopted a 90-day provision and it was not a part of the statute.
     
    In the Garcia case, the court stated that the act’s definition of maximum medical improvement “merely establishes what is, in essence, a two-year cap on temporary income benefits for all claimants.”

    The court also noted that two years was “not an arbitrary place to draw the line, as there was medical testimony at trial that most workers will actually reach maximum medical recovery within that time period.”

    In Fulton v. Associated Indemnity Corp., the 3rd Court of Appeals (Austin) in 2001 considered another challenge to the state's 90-day rule.

    “The challenge asserted that the requirement that a claimant must dispute a determination of maximum medical improvement with a concurrent impairment rating within 90 days was beyond the commission’s rulemaking authority,” OIEC wrote.

    As it happens, the claimant in the Fulton case was represented by Norman Darwin, the Public Injured Employee Counsel and head of OIEC, prior to Darwin being appointed to his current position. Darwin was traveling on Friday and could not be reached for comment.

    The court in Fulton stated that “the Supreme Court noted that temporary income benefits are ‘a major benefit’ under the act, and restricting those benefits to a two-year period was justified only by medical testimony that most workers’ conditions stabilize within that time frame.”

    The appeals court commented that under the Supreme Court's rationale, "a rule that cuts off temporary income benefits before the worker’s condition has had two years to stabilize might be deemed arbitrary" and thus unconstitutional by adversely affecting the worker's benefits.

    OIEC noted the 2003 Legislature amended the Labor Code to state that an employee’s first certification of maximum medical improvement and impairment rating would be final if not disputed “prior to the 91st day after the date written notification is provided to the employee and the carrier by verifiable means.”

    The change provided for a claimant to dispute after the 90th day if there was a “significant error” by the certifying doctor, a “mistaken diagnosis or a previously undiagnosed condition” or “improper or inadequate treatment of the injury.”

    OIEC argues the Garcia and Fulton courts “both recognized that having 104 weeks for the injury to stabilize is a major benefit to the injured employee.”

    “In essence, the Fulton court asserts that if the 104-week period were procedurally shortened, it would call into question the constitutionality of the Texas Workers’ Compensation Act.”

    OIEC calls for the 90-day provision to be repealed, saying there is “no discernible justification for the 90-day provision other than to deprive the injured employee the full 104-week period for their condition to stabilize.”

    “A serious constitutional issue is presented by denying the injured employee an opportunity to receive a reasonable substitute for the loss of his constitutional right to seek redress for his injuries,” OIEC concludes.

    However, the Insurance Council of Texas believes the Fulton decision was addressed by House Bill 2198 in 2003.

    HB 2198 was authored by Rep. Burt Solomons, R-Carrollton, who carried HB 7, the 2005 workers’ compensation reform legislation.

    The Insurance Council reported HB 2198 “specifically granted the Texas Workers' Compensation Commission (TWCC) rulemaking authority to implement the 90-day rule.”

    “The Division of Workers' Compensation continued the new rule after the TWCC was abolished,” the council notes.


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  • Posted on 11 December 2008 at 09:43:18 by Chip Kent

    By Charles Bankhead, Staff Writer, MedPage Today
    Published: December 10, 2008
    Reviewed by Zalman S. Agus, MD; Emeritus Professor
    University of Pennsylvania School of Medicine.


    WASHINGTON, Dec. 10, 2008 -- Almost 40% of U.S. adults use some type of complementary or alternative medicine, according to a government survey. But they don't use the remedies much for colds any more.

    The most commonly used therapies were nonvitamin and nonmineral "natural" products, followed by deep-breathing exercises, data from the 2007 National Health Interview Survey showed. Issued by the National Center for Health Statistics, the results followed up on an initial survey in 2002.

    The use of complementary and alternative medicine to treat colds decreased from 9.5% in 2002 to 2% of the 2007 participants.

    The survey report, "Complementary and Alternative Medicine use Among Adults and Children: United States, 2007," reflected responses from 23,000 adults. Additionally, responses from 9,400 adults speaking on behalf of minors showed that more than 10% of children and adolescents (ages 17 and younger) used complementary and alternative medicine.

    The survey results "reinforce the need for rigorous research to study the safety and effectiveness of these therapies," Josephine P. Briggs, M.D., director of the National Center for Complementary and Alternative Medicine (NCCAM), said in a statement.

    "The data also point out the need for patients and healthcare providers to openly discuss [complementary and alternative medicine] use to ensure safe and coordinated care."

    Comparison of the two surveys showed that use of complementary and alternative medicine has remained stable over the past five years, increasing slightly from 36% of adults in 2002 to 38% in 2007.

    According to the new survey, almost 18% of adults used nonvitamin, nonmineral natural products, led by fish oil and related products, glucosamine, Echinacea, flaxseed oil or pills, and ginseng. Almost 13% reported practicing deep-breathing exercises during 2007. Other frequently used therapies were:

        * Meditation (9.4%)
        * Chiropractic or osteopathic manipulation (8.6%)
        * Massage (8.3%)
        * Yoga (6.1%)

    Use of certain therapies increased markedly from 2002, including acupuncture, deep-breathing exercises, massage therapy, meditation, naturopathy, and yoga.

    Consistent with the 2002 survey, the 2007 interview showed that complementary and alternative medicine was used more often by:

        * women (42.8%) than men (33.5%)
        * better educated individuals (55.4% of participants with advanced or professional degrees)
        * the more affluent (43.3% versus 28.9% of poor respondents)
        * those living in the West (44.6%)
        * people who quit smoking (48.1%)

    The 2007 survey showed that 11.8% of children had used complementary and alternative medicine during the previous 12 months. However, the rate was twice as high (23.9%) among children whose parents used complementary and alternative medicine. Children most often used nonvitamin and nonmineral natural products (3.9%), chiropractic or osteopathic manipulation (2.8%), deep-breathing exercises (2.2%), and yoga (2.1%).

    Authors of the 2007 report are Patricia M. Barnes and Barbara Bloom of NCHS and Richard L. Nahin, Ph.D., of NCCAM.

    Primary source: National Center for Health Statistics
    Source reference:  Barnes PM et al CDC Advance Data Report #343. "Complementary and Alternative Medicine use Among Aldults and Children: United States, 2007" Dec. 10, 2008.
    http://www.medpagetoday.com/PrimaryCare/AlternativeMedicine/12105

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  • Posted on 11 December 2008 at 09:41:19 by Chip Kent

    The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that two (2) new educational resources on the 2009 Physician Quality Reporting Initiative (PQRI) have been posted to the PQRI webpage on the CMS website.

     2009 PQRI Quality Measure List- This reference list outlines the 153 quality measures which were published in the in the Medicare Physician Fee Schedule (MPFS) 2009 final rule on November 19, 2008.  To access the 2009 PQRI Quality Measure list, visit http://www.cms.hhs.gov/PQRI/15_MeasuresCodes.asp#TopOfPage on the CMS website.  Once on the Measure/Codes page, scroll down to the “Downloads” section and click on the “2009 PQRI Quality Measures List” link.

    The detailed measure specifications will be available on this webpage on or before December 31, 2008. 

    Registry Requirements for Submission of 2009 PQRI Data on Behalf of Eligible Professionals- This document describes the high-level requirements for a registry to qualify to submit under the registry-based reporting alternatives for 2009. This document also outlines how a registry can become qualified for 2009 data submission. To access the Registry Requirements for Submission of 2009 PQRI Data on Behalf of Eligible Professionals document, visit http://www.cms.hhs.gov/PQRI/20_Reporting.asp#TopOfPage on the CMS website. Once on the Reporting page, scroll down to the “Downloads” section and click on the “Registry Requirements for Submission of 2009 PQRI Data on Behalf of Eligible Professionals” link.

    To qualify to submit data on behalf of eligible professionals seeking incentive payments for 2009, registries are required to go through a self-nomination and vetting process if they are new to PQRI registry reporting or to notify CMS of their desire to continue PQRI data submission in 2009 if they were qualified in 2008. Selected registries must meet certain technical and other requirements specified by CMS.

    Detailed information on the 2009 PQRI, including the 2009 Registry Requirements, may be found in the final 2009 Medicare Physician Fee Schedule rule with comment period (73 FR 69817 through 69847) that was published in the Federal Register on November 19, 2008.  The final rule with comment period can be found in the “Related Links Outside of CMS” section of the Physician Quality Reporting Initiative website at:  http://edocket.access.gpo.gov/2008/pdf/E8-26213.pdf on the CMS website.

    Geanelle E. Griffith, MSW

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  • Posted on 5 December 2008 at 12:13:08 by Chip Kent

    The Texas Division of Workers’ Compensation has recommended the Legislature restructure and continue a return-to-work pilot program for employers with 50 or fewer employees, which was created under House Bill 7 in 2005, in an effort to entice more employers to use the program.

    But since the implementation of the program in February 2006, DWC has received five applications for reimbursement under the program – and has made only two reimbursements.

    Two applications did not meet the statutory requirements for eligibility and one application was withdrawn “due to some unexpected medical issues that arose for the injured employee,” the division said in its report posted online Thursday.

    Feedback from the two employers reimbursed under the program “indicated that they were very pleased with the process and outcome of using the … program,” the report states. The program was intended to encourage return-to-work efforts by businesses.

    HB 7 created the pilot program for eligible small employers to reimburse them for allowable expenses, up to $2,500, that they
    incurred making workplace modifications necessary to accommodate an injured employee's return to modified or alternative work.

    Workplace modifications may include special equipment, tools, furniture or devices, or “other associated adjustments that can allow an injured employee to stay at or return to work,” the division noted.

    The legislation also established a reimbursement fund of $100,000 per year, financed through administrative penalties.

    House Bill 886, passed in 2007, modified the pilot program to include a preauthorization option for employers that guarantees applicants reimbursement of the expenses incurred in implementing the modifications and changes, unless the division determines that the modifications and changes “differ materially” from what was preauthorized.

    The current pilot program funding expires Sept. 1, 2009.

    The report recommends to increase participation in the program that the Legislature:

    • Extend the program for two years.
    • Increase the current maximum reimbursement amount from $2,500 to $5,000.
    • Restructure the program to allow employers to receive some or all of the funding in advance.
    If advance funding is approved, DWC staff “would need to verify the modifications that are made by the employer to ensure that the funds were used for the intended modifications,” the report comments.

    The division noted that it has “marketed the … program to thousands of businesses in Texas, (but) very few employers have availed themselves of this resource.”

    “These recommendations, if implemented, would strengthen the agency’s ability to market the program,” the report states.

    The division said it would “continue to work with stakeholders to identify specific injured employee populations and employers who would benefit” from the program.

    The division reported it has mailed approximately 2,700 brochures and sent approximately 7,400 e-mails to Texas
    employers with less than 50 employees and chambers of commerce, issued news releases and published articles about the program and collaborated with the Texas Workforce Commission in promoting the program.

    The program also was promoted at various meetings and seminars.

    To reach the report, go to http://www.tdi.state.tx.us/wc/rtw/documents/rtwpilotrpt08.pdf.

    Source: Texas Division of Workers’ Compensation