Take advantage of an exciting opportunity for ANJC members to expand their practice

Transcription

1 Publication of the Association of New Jersey Chiropractors Winter 2013 Volume 9 Number 1 ANJC Launches Webinars Become Eligible to Perform DOT Exams as Certified Medical Examiner Take advantage of an exciting opportunity for ANJC members to expand their practice and become certified and registered by the National Registry of Commercial Medical Examiners (NRCME) and the Federal Motor Carrier Safety Administration (FMCSA). This can be accomplished by completing the ANJC webinar series, which will allow you to sit for the Board examination. It has been a long time since a federal program with such potential has included our profession. As a CME you can expand your patient base, increase your services to the community, and become part of a federal program. This is an opportunity I don t want any ANJC member to miss Dr. Sig Miller, ANJC Executive Director Continued on Page 27 ANJC to Launch Separate CA Membership ANJC is establishing a new membership category for CAs designed to help improve their skills and to assist with all aspects of ANJC member practices: from front to back office, therapeutics, philosophy, and insurance billing and coding, including Medicare. ANJC recently completed a survey and members overwhelmingly wanted this type of benefit introduced. In launching this effort, fees will be setup on a per office basis based on the number of CAs employed. ANJC Member Website Redesign Close to Completion Association of New Jersey Chiropractors 3121 Route 22 East Suite 302 Branchburg, NJ U.S.A. See inside for details! ANJC is in the final stages of redesigning our membership website with some of the most advanced technology. Most importantly, with an advanced search function, members can enter key words and immediately locate information needed. PRSRT STD U.S. POSTAGE PAID PLATTEVILLE, WI PERMIT NO.124 NEW Continued on Page 25 ANJC Assists Members Affected by SUPERSTORM SANDY Almost every ANJC member was affected by Superstorm Sandy this past October. Many members struggled with power outages, resulting in disruption of their practices, while others sustained office damage or complete devastation. ANJC jumped into action, providing tips on what to do if you sustained office damage, but were able to function, as well as tips for those who suffered complete devastation. Additionally, ANJC set up a member matching program to assist our doctors in need of office space and equipment. Continued on Page 20 Free 6 Seminars See Page 4 for more information ANJC Coding and Reimbursement Institute Launches SAVE the DATE March Next Nutrition 14 Education Seminar ANJC Spring Convention March 28 ANJC Sports Council ANJC Looks Back, Looks Ahead Dr. Joseph D Angiolillo page 3 ANJC Coding & Reimbursement Institute Launches Series of Six Free Seminars page 4 Chiropractic & Oncology Dr. Jeffrey Sklar page 11 Five Keys to Making Better Adjustments Dr. David I. Graber page 13 Essentialization of Chiropractic Care in New Jersey Dr. Mike Kirk page 14 Are You Reporting or Selling? William D. Esteb page 14 The Power of Pulling Together Dr. K. Jeffey Miller page 17 Nutritional Considerations of Chiropractic Adjustments Dr. Steve Lavitan page 17 EHR Meaningful Use: To Do, or Not To Do Dr. Jeff Brown page 19 PQRS Sheet Update page 20 Featured Articles Headquarters Update... 4 Billing & Coding Q & A... 6 Legal Q & A... 6 It s Just Business With the New Doctor in Mind...10 ChiroAssist Foot Loose Insurance Update Research Updates Sports Shorts Medicare Q & A Legal Ease MAY 4 th & 5 th Incredible Line-Up Includes: june 27 Inside: Technique: Hands-On Dr. Ted Carrick Dr. Larry Markson Dr. Greg Doerr Dr. Kevin Jardine Dr. Mitch Mally Dr. Chris Bump Dr. Marty Kotlar

2 Winter NEW ANJC Looks Back, Looks Ahead By Dr. Joseph D Angiolillo - President Introducing the Every.Which.Way. Biofreeze 360 Spray I write this letter to the profession feeling elated that we just finished our ANJC Board of Director s strategic planning session last weekend, while at the same time feeling frustrated that as the calendar advances to January 1, 2013 we will be moving closer to Obamacare and we have no idea what the future changes in this legislation will bring. What I do know is that the ANJC Board of Directors had a very productive weekend session where the framework for the direction of our society was laid out. As most of you expect, the primary focus was centered on improving the services to our members, as well as formulating strategies to increase the chiropractic market share in New Jersey. Budgets were discussed in the broad sense along with revenue generation to support the expanded services. Rest assured the ANJC is on a strong financial footing and you can expect another sensational year of seminars, webinars, and conferences. Something many of you may also be aware of is that the ANJC is the strongest chiropractic association in the northeast. As such we have been playing an active role in regional, as well as national issues critical to the chiropractic profession. At times our leaders and consultants are requested to weigh in on legal opinions and reimbursement issues. The ANJC has become a quasi-consultant to the profession. Since the ANJC has been drawn into playing such a role, the ANJC Board has also had to consider its commitment to this position. The ANJC Board realizes that in order for our members practices to be successful we must also have strong and successful regional state associations. With that said, a part of our strategy has to incorporate how to bolster success among our adjacent states. We believe that creating strength in our region will pay back huge dividends in the insurance arena as well as politically. As I alluded to in my first sentence, we have no idea at the moment what impact national healthcare will have. Our insurance director, Matt Minella, is constantly scanning the briefs as they come out searching for more information. One of the goals the ANJC Board set for the coming year is to create an educational platform for Obamacare, with seminars and webinars. Be certain the ANJC will keep you up to date on all critical information. Last year the ANJC launched the Nutrition Education Council, which was hugely successful. This year the ANJC will be launching another program designed to expand your clinical competency into another, often overlooked area of practice, the Department of Transportation. All over the road truckers, and bus drivers with a CDL, are required to have periodic examinations to maintain their license. There are millions of drivers in the United States who possess a CDL. Very shortly, in order to comply with federal law, only those physicians who have received a DOT certification may perform these exams. Doctors of Chiropractic may perform these exams, and the ANJC is the source for your certification. Look to receive further information on this program in the near future. Another program that the ANJC will be launching this year pertains to our paraprofessionals, our CAs. A complete program with participation from our local chiropractic offices, as well as national experts familiar to many of our CAs will be providing this valuable information. This course is designed similar to the NEC program, with several modules scheduled throughout the year, encompassing many of the critical issues that a Chiropractic Assistant will be challenged by in daily practice. As we conclude 2012, I thank each and every one of you for your support of the ANJC and for your participation on our committees and at our conferences. I look forward to another successful year for the ANJC, and I wish all of you success in ANJC State Board of Directors meets monthly planning for what lies ahead in MILLION Reasons to be with NCMIC 360 SPRAY > best spray technology works from any angle CONTINUOUS SPRAY > much easier than repeated pumping UNIFORM SPRAY PATTERN > for optimal coverage Best. Biofreeze. Ever. Now in gel, roll-on, and spray Policyholders of NCMIC s Malpractice Insurance Plan will soon receive a premium dividend for the 17th year in a row. As of 2013, NCMIC will have returned more than $112 million to policyholders. The premium dividend is just one of many reasons our D.C.s appreciate NCMIC. Take it from Dr. John D Amanda: I don t know of any other companies that give back through a premium dividend. With NCMIC, you support the company and they support you. John D Amanda, D.C. Crossroads, Texas Find out all the ways you can benefit from being with the NCMIC Malpractice Insurance Plan. Call , ext biofreeze.com Like ice, only better Premium dividends are not guaranteed. We Take Care of Our Own is a registered service mark of NCMIC Group, Inc. and NCMIC Risk Retention Group, Inc NCMIC NFL Biofreeze is a registered trademark of The Hygenic Corporation. Unauthorized use is strictly prohibited The Hygenic Corporation. All rights reserved. PO5762 Rev 1 P05762_TAB_NJChiro.indd 1 12/31/12 1:05 PM

3 4 Winter BREAKTHROUGH: World s 1st 3D ANJC Coding & Reimbursement Institute Launches Series of Six Free Seminars (Free CEUs) Imaging System from Foot Levelers Begins January 2013 Foot Levelers has done it! We have developed the world s first 3D Imaging T he primary goal of ANJC s Coding &Reimbursement Institute is to provide members and their staff proper documentation and compliance techniques that will ensure the clinical encounter is consistent with the profession s standards of care. In addition, we are committed to providing the doctor with the essential information that will help with their under- I just reviewed Dr. Healy s PQRS webinar. Thank you for getting this info to us and thanks for Dr. Healy s simple, brief and concise explanation in documenting the PQRS measures. No one does a better job and is more knowledgeable in presenting Medicare to ANJC than Dr. Healy. Dr. Dennis Long Emerson, NJ standing of ethical and proper coding, which is the language of the nation s healthcare system. To signup or for more information info@anjc.info or call HQ at All seminars are being held 1-6:30p at the Lakeside Manor in Hazlet. Module I Documentation & Coding / January 17th Module II Billing & Insurance / February 21st Module III Compliance / March 28th Module IV Medicare / April 18th Modules V (Part I) ICD-10-CM / June 13th Module VI (Part II) / July 25th Device for Chiropractic 3D BodyView. It interacts seamlessly our innovative Patient Communication software offering with you the ability to illustrate to your patients WHY they need Stabilizing Orthotics and HOW QUICKLY they can get them. Our system, along with our exceptional customer service and research-proven 2013 EVENTS ANJC has a number of great events lined up for 2013, including the NEW ANJC Documentation & Coding Institute (six seminars w/free CEUs); Technique Seminars; Nutrition Education Council (NEC) seminars; Department of Transportation (DOT) webinars; Spring (May 4-5) and Fall (Nov ) Conventions; and a robust series of webinars throughout 2013 featuring FREE CEUs. Visit the ANJC website for more information: Stabilizing Orthotics, allows you to deliver breakthrough technology and wellness to all of your patients. When patients know why, they comply. Let us help you build your practice. We guarantee you will be happy. Why Upright MRI of Cherry Hill? Dedicated, highly trained, friendly staff and convenient hours. Most reports are sent to your physician s office within 24 hours of your study. Accredited by American College of Radiology. The Fonar Upright MRI, at 0.6 Tesla, is twice as powerful as most other open MRI scanners and yields high-quality, routine MRI and MRA studies as well as our unique positional studies. Most insurances accepted including workers comp and MVA cases. Accommodates patients up to 500 lbs. Scans done in your position of pain: seated, standing, lying down or bending. Claustrophobic? No worries. At Upright MRI of Cherry Hill, you won t lie in a tube for your scan. NO MORE TUBE. Instead, you ll be able to sit and relax while watching a 42 inch flat screen TV during your scan. Conveniently located at 701 Route 38 East, Cherry Hill, NJ phone se habla español fax Visit us on the web! WEBSITE REDESIGN UPDATE The ANJC website redesign is in full swing, and is scheduled to go live sometime in February. The new site will feature a search function, videos, hot news topics, easily accessed insurance information, legislative updates, and much more. For more information, contact info@anjc.info. Chairman & CEO, Foot Levelers, Inc. Patient Compliance Software MEMBERSHIP CARDS As a member of ANJC, you should have now received your new Membership ID Card. These cards contain a barcode with your license number, which can be used for CEU credit scanning at all live ANJC events. If you have not received your card, please contact ANJC HQ at , or info@anjc.info. INSURANCE QUESTIONS? A great benefit you have as an ANJC member is assistance with the myriad of issues and questions surrounding insurance. Should you need assistance, please contact ANJC s new director of insurance, Matt Minnella, at matt@anjc.info. Matt is working with ANJC s insurance consultants to keep you informed and up-to-date on the latest news in the vast insurance arena. NUTRITION EDUCATION COUNCIL (NEC) The NEC, which has close to 300 members, has a number of 2013 events lined up, along with a talented Board of Advisors led by Chair Christopher Bump, DC. Be sure to check out the NEC website to learn more about the goals of the organization, upcoming events, and how you can join: First-ever Pronation Stability Index Know Their Number V7+ Body Assessment G. Tom Morea, MD, our Board-Certified Radiologist, is one of the most experienced MRI physicians in the world with over 25 years providing unparalleled MRI expertise. Embedded videos explain the Why Height mapping accurate up to 300 microns Captures 900,000 data points Order your 3D imaging device today! FootLevelers.com 2013 Foot Levelers, Inc. FLA ANJC3DBV.indd 1 The Posture Specialists 12/28/12 11:27 AM

4 6 Winter LEGAL EASE Jeffrey Randolph, Esq. ANJC General Counsel A Fish Story Q: Is there a particular course I must take to qualify as an expert that can interpret MRIs in court? No, there is no specific course that you must take. The Rules of Evidence require experts to have the proper education, training and experience to testify in court as to matters requiring expertise to assist the jury. The Rules are necessarily vague and delegate to the trial judge broad discretion to determine whether a particular doctor meets these criteria on a case-by-case basis. Thus, the same doctor could theoretically qualify to testify as to MRI findings in Bergen County while not being permitted to do so in Passaic County based upon each judge s particular findings and determination. What you must do in any case is actually review the films and not just rely on the radiologist s interpretation, which is considered inadmissible hearsay. It also is helpful to have an updated curriculm vitae that details all of your education, including post-graduate courses, and experience in interpreting MRIs and using them in the daily treatment of your patients. Q: My patient was injured in a slip and fall accident. Can I submit my bills to her health insurance carrier? Yes, you are permitted to do so but payment will depend on the coverage provisions of the patient s particular health plan. Some plans exclude coverage of injuries caused by third parties who may have insurance coverage to pay the bills. Thus, you can also explore submitting bills to the insurance carrier of the party at fault for causing the injury if such a plan has medical payment coverage provisions. However, most third party carriers will not voluntarily issue payments unless their insured is clearly at fault and may wait until the third party liability case is settled or tried to do so. You also should note that, depending upon whether the health plan is an ERISA or non-erisa plan, your patient may have to pay back their health plan for any payments it made to you as well as other health care providers for bills related to the injury upon conclusion of their slip and fall case. You should check with the patient s personal injury attorney to see if this is the case and discuss this with your patient. Q: Can a chiropractor in New Jersey sign a disability determination or treatment certification in support of a short term disability of family medical leave act application of their patient? Yes, since as far back as 1951 there is Appellate Division case law that permits you to do so in the case of short term disability determinations. The Appellate Division of the New Jersey Superior Court held in their 1951 decision titled Thomas v. Carlton Hosiery Mills, 14 N.J. Super. 44 (App. Div. 1951), that chiropractic physicians are physicians as defined under state disability laws. The Appellate Division further held that a patient under the care of a chiropractic physician complied with the statutory mandate of the Temporary Disability Law to be under the care of a legally licensed physician to qualify for short term disability benefits. Id. at 47. Chiropractors may also issue certifications under the Family Medical Leave Act (FMLA). The FMLA, 29 C.F.R (a), requires the issuance of a certification by a health care provider of a serious health condition that prevents the employee from being able to perform one or more of the essential functions of his or her job to qualify a family member to leave under the Family Medical Leave Act. A healthcare provider is expressly defined by the FMLA to include chiropractic physicians. See, 29 C.F.R (a) (2004). Q: Can a chiropractor delegate massage & electrical stimulation modalities to a chiropractic assistant? Massage is a modality that cannot be delegated to a Chiropractic Assistant (CA) in New Jersey as CAs are considered unlicensed assistants. This is subject to one caveat. You could delegate massage to a CA if they are also a massage therapist who is certified by the New Jersey Board of Massage, Bodywork and Somatic Therapy, which is a subdivision of the Nursing Board. This would be the only scenario that such delegation would be permissible. With regard to Electrical Stimulation, CAs are permitted under New Jersey regulations to setup the patient for Electrical Stimulation and to remove the pads following treatment but may not adjust the settings or turn the machine on or off; this must be performed by the chiropractor. For further reference the Chiropractic Regulations located at N.J.A.C. 13:44E-2.7 list the modalities that may and may not be delegated to CAs and other unlicensed assistants. You Can Believe! Take control of airborne allergies! For those who suffer as a result of pollens and mold spores, outdoor bliss can quickly turn to misery as the onset of seasonal symptoms ensue. For those affected, targeted nutrition may offer substantial benefits. and specific botanicals are recognized as effective agents in supporting the body s immune response. HistoPlex-AB provides a targeted array of botanicals recognized in supporting the respiratory system, as well as providing immunomodulating effects. The herbs included in this formula provide both antitussive and expectorant actions. All Biotics Research Products are Gluten Free! (800) Follow us on These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease. By Dave Klein, CPC, CHC ANJC Insurance Consultant Q: I have a question about billing for therapeutic exercise (97110). If I were to set up an office with three stations side by side in view of my front desk for constant supervision by staff, a life cycle, a tread mill, and a shoulder exercise station, would I be able to bill for therapeutic exercise one-on-one for 15 minutes if they perform that activity for the required amount of time? A: Unfortunately, DC in New Jersey are not permitted to delegate therapeutic exercise to ancillary personnel so the doctor must be one-on-one with the patient during the procedure. If more than one patient is supervised at the same time then group therapy (97150) should be used. Q: Currently when I bill a or for example I do not use a modifier 25 and it s not getting reimbursed; just the manipulations and modalities for that day. I've been hearing different stories about using the modifier 25 to get reimbursed on the same day I perform CMT. I want to know if this is the proper way to use modifier 25 especially for BCBS in order to get reimbursed for my evaluations if I use the 25 modifier will it draw a red flag? A: The -25 modifier should be used when you are indicating that the evaluation and management service (E/M) is above and beyond the assessment included with CMT code. Typical scenarios where this can occur are for new patients, re-evaluations, new conditions or exacerbations. Unless you are over-utilizing the E/M codes (e.g. using them on every visit) you should not throw red flags. Additionally you will not be paid for the E/M service unless you add the -25 modifier. Q: I frequently come into the office to treat patients on a Sunday or my off day. I will bill the visit using code 99050, which is the correct code I believe for an emergency treatment when not in normal office hours. I am finding that the insurance companies are denying the visit/code so it is not getting paid. One carrier recently denied the code. When we called them on it, they said that they do pay for this service but would not tell us the correct code. Now another carrier denied the code stating provider of this type cannot perform this type of service. Is there another code I should be using and can I appeal these denials? Thanks. 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5 8 Winter Winter ANJC Platinum Sponsors Directory ANJC Platinum Sponsors Directory Continued from page 8 ANJC Platinum Sponsors are trusted business partners who have supported ANJC for many years. Their valuable contributions help to achieve ANJC s goals in serving membership and their patients. These business partners meet the highest standards regarding quality of products and services, and they are sensitive and responsive to the personal needs of our members. ANJC Platinum Sponsors have a proven track record in assisting NJ chiropractors Billing/Coding & Collections CB&C Inc. Lynette Contreni CBCteam@CBCbilling.com Description: Specializing in Chiropractic, CB&C offers consulting, training and a full range of Billing/ Collections services, which are tailored to your needs. Also, we offer a verifications department which assists your office in obtaining maximum reimbursement, & handling contracts. EClaims, Inc. Kristi Andarews Kristi@zyantus.com Description: With EClaims OS from Zyantus, you will experience electronic insurance claims processing that is easy, efficient and economical. With firsthand experience in electronic claims we have created a solution to claims processing that is compatible with many forms of technology and current with today s government requirements. MD On-Line Tom Schweizer tschweizer@mdon-line.com Description: Provide clearinghouse services to facilitate the electronic transfer of healthcare transactions and information between providers and payers. Business/Financial Services C&A Financial Group Robert Pendergist V.P rob_pendergist@ca-strategy.com Description: A full service financial firm focused on cash flow and quality of life. Key products and services: Business succession planning, disability overhead, life insurance, stock and bonds, mutual funds, commercial mortgages long term care etc. We also provide exit strategies in and around business ownership. Chiro Finishing School Ashleigh Mooney amooney@chirofinishingschool.com Description: Chiro Business Finishing School teaches chiropractors to implement The 12 Foundational Principles of Business. These principles help chiropractors leverage their time and grow their revenue. Cooperative Communications, Inc Lou Lombardi service@cvpcom.net Description: Cooperative provides Telecommunication and internet services to businesses. We specialize in competitively-prices voice, data, equipment, telephone systems (hosted and non-hosted) and cellular services. David Lerner Associates Bill Stolow bstolow@lymenet.org Description: Building and preserving assets for 35 years with a conservative investment philosophy offering income producing securities and avoiding the money pitfalls of the stock market. Key Products: Municipal Bonds, Real Estate Investment Trusts, and Insurance Products. Guardian Life Insurance Company Anthony Campanile Anthony_campanile@planningalliance.com Description: Guardian Life Insurance Company has been providing doctors with disability and life insurance and investments for over 150 years. Key Products and services: Disability Insurance, Life Insurance, Investments. Mid Atlantic Resource Group. LLC Donna Scallo X 167 donna.scallo@margfinancial.com Lesley Weiner x 329 Lesley.Weiner@margfinancial.com Description: 2008 ANJC Business Partner of the Year. ANJC member discount on comprehensive Disability and Long-Term Care Insurance. Life, Disability, Long Term Care, Employee Benefits, Retirement Planning. Independent Insurance and Investment Services firm since The Omar Group, CPA Salim Omar, CPA salim@omargroupcpa.com Description: Specializing in providing accounting and tax services to chiropractic practice owners. Chiropractic Equipment/Supplies & Patient Education BIOFREEZE /Performance Health health@biofreeze.com Description: Performance Health is the maker of market-leading Biofreeze and Thera-Band products, as well as other vital clinical brands. Key Products: Biofreeze and Thera-Band. ChiroHCG. Frank Zoletich frankz@chirohcg.com Description: ChiroHCG is a professional doctor supervised weight loss company. ChiroHCG uses the strongest form of US derived and manufactured homeopathic HCG and includes a complete Turn- Key Marketing System containing both print ads and TV commercials at no cost. ChiroMatic Sleep Systems Debbie Carlitz info@chiromatic.com Description: Developed with help of chiropractors, ChiroMatic mattresses provide ultra premium support and comfort. Chiropractic Leadership Alliance (CLA) Jasmine Forsyth ext Jforsyth@subluxation.com Description: CLA is focused on equipping chiropractors around the world with the profession s best selling technology, the Insight Subluxation Station for patient assessment and education. Elite Medical Supply of New York, LCC James Matthews j.matthewsdc@gmail.com Description: Since 1997 Elite medical Specializes in Providing Chiropractors and Surgeons with quality spinal bracing, traction, electrotherapy products assisting their patients on the road to recovery. Erchonia Melissa Morningstar mmorningstar@erchonia.com Description: Erchonia is the global leader in low level laser healthcare applications. All Erchonia lasers are proven safe and effective through independent clinical trials. Key product and service: Low level laser therapy. Excellence Shock Wave Therapy Denise Ashcraft denisea@eswtusa.com Description: Excellence Shock Wave Therapy provides full service in-office ESWT, certification training, and technician services. Offer ESWT with no cost to your office. Foot Levelers Kent Greenawalt service@footlevelers.com Description: Exclusive provider of custom-made Spinal Pelvic Stabilizers and other healthcare products. Harlan Health Products, Inc. Harlan Pyes Harlan@HarlanHealth.com Description: We provide leading edge modalities as well as the training and support so our customers attain the very best clinical outcomes. We also provide tables, rehab equipment, and all the supplies you need. Key products: Laser therapy, Electric Stimulators, Full line of supplies. K-Med Services, Inc. Ken Viafora kmed@optonline.net Description: Full-service chiropractic supply and equipment company. Levinson Medical Specialties Charles Levinson charleslevinson@aol.com Description: Suppliers of physical therapy equipment, supplies, chiropractic tables, service, serving the profession for nearly 50 years. Key Products: Physical therapy equipment, Chiropractic tables and service. Patient Media, Inc. Bill Esteb bill@patientmedia.com Description: Patient Media, Inc. supplies chiropractic patient education resources created by Bill Esteb that feature high-impact graphics and short, patient-relevant text. Key Products: Chiropractic patient education videos, chiropractic patient education brochures and chiropractic patient education posters and charts. ScripHessco Heather Zdan x7408 hzdan@scripco.com Description: ScripHessco has been a trusted resource to health care practitioners for over 40 years. ScripHessco features over 10,000 products and is the largest distributor of reconditioned tables. Key Products include: Electrotherapy Equipment, new and used adjusting tables and traction, and chiropractic supplies. The Vitality Depot Mark Mandell Info@thevitalitydepot.com Description: Your #1 chiropractic supplier for SpiderTech, TENS and electrodes, Lasers, Clinical Stim Units, Whole Body Vibration, GreensFirst, Tables, SmartStep Wellness Mats, Back Braces, Cold Packs, Pillows, Biofreeze, Sombra and the most innovative equipment at extraordinary value. X-Ray, Diagnostic Imaging Services & Equipment Digital Radiographic Equipment, Inc. Allan J. Rubert drei@ptd.net Description: D.R.E.I. has over 60 years of knowledgeable experience servicing the chiropractic profession. Providing quality and affordable chiropractic equipment, such as X-ray, tables, P.T. Eqpt, Decompression-Traction units and Chiropractic supplies and accessories. with reaching their individual practice goals and in staying on the cutting edge of the health and wellness revolution in their communities. For all they do for ANJC members, you owe it to them to first take a look at their products and services before going elsewhere. Many offer substantial discounts and value-added services to ANJC members. Remember when buying from ANJC Platinum Sponsors, you are supporting ANJC, it s that simple! LiteCure Medical Gioacchina Randazzo grand@litecure.com Description: LiteCure is a medical device company offering advanced laser products and innovative technology to healthcare, rehabilitation and training professionals. Drug-free, Surgery-Free, Pain-Free Relief. Spinal Kinetics, LLC Dr. Bill Puglisi spinalkineticsllc@yahoo.com Description: The most advanced Computerized Radiographic Mensuration Analysis that helps prove subluxation, objectively and accurately. Key Products: C.R.M.A., DMX, and Free Lectures and education Stat RiverWinds Joseph Jarrett josephjarrett@hotmail.com Description: We offer High Field Open MRI and X- Ray Services. 24 turn around time for reports and Same Day Appointments and STAT Reads. Tilton Dynamic Imaging Norm Brettler info@tiltondynamicimaging.com Description: Our company features the Upright MRI. 2 nd location: Ocean Upright MRI 864 Rt. 37 West Toms River, NJ Upright MRI of Cherry Hill Marge Beck margebeck@comcast.net Description: At Upright MRI of Cherry Hill, patients can be scanned weight bearing, seated, standing, bending or lying down to permit the best visualization possible of their problem. Key Products: MRI Scans Nutrition & Wellness Anabolic Laboratories Bob Rosenberg Clinical Consultant anabolic_bob@msn.com Description: Anabolic Laboratories, founded in 1924, is an active pharmaceutical manufacturer that specializes in the standardization and concentration of natural ingredients to assist with patient management, healing and pain relief. Available exclusively through healthcare professionals. Key Products: Nutritional Supplements for Pain and Inflammation, Nutritional Supplements for general wellness, and condition specific Nutritional Supplements. Biotics Research Debra Fish Ex dfish@bioticsresearch.com Description: Biotics Research Corporation was formed in 1975 and from day one the foundation has been Innovation and Quality. Our goals remain unchanged - innovative ideas, carefully researched concepts, and product development with advanced analytical and manufacturing techniques to develop and produce nutritional products of superior quality and effectiveness available exclusively to healthcare professionals. Health Centers of the Future Warren Philips Practice Building questions@hcfseminars.com Description: Our events infuse cutting edge testing and support protocols for common conditions. The systems you learn can be applied in your office the next day. Nutritional Frontiers Michael Antonelli alternativewellnessinc@gmail.com Description: Our Mission is to create, develop and provide safe, effective therapeutic natural solutions and educational programs to chiropractors and their patients with excellent quality, integrity and service. Science Based Nutrition. Dr. Van Merkle mail@sciencebasednutrition.com Description: Our Mission is to set a standard or objectivity in nutritional healthcare. We strive to help reach their optimum health so that they in turn, can reach their fullest potential in life. Key Products: Discounted blood testing, discounted hair analysis and detailed test reporting. Standard Process Inc. Bruce Poritzky info@standardprocess.com Description: For more than 80 years, Standard Process, headquartered in Palmyra, Wis., has provided health care professionals with high-quality, nutritional whole food supplements. Standard Process offers more than 300 products through three product lines: Standard Process whole food supplements, Standard Process Veterinary Formulas, and MediHerb herbal supplements. The products are available only through health care professionals. Take Shape for Life John Dowling, DC jdadvisor@comcast.net Description: The #1 Doctor recommended, clinically proven and effective optimal health program in the country for fast, permanent weight loss and medication use reduction. VerVita Products, LLC Dawn Hoezee vervita@um.att.com Description: VerVita serves to bless communities with a passion to heal and achieve wellness through Nutritional products and essential oils. Nutritional simplicity for maximum effectiveness. XYMOGEN Richard Malkin Senior Functional Medicine Consultant Richard.malkin@xymogen.com Description: Wellness and Nutrition Integration Programs-Clinical Research, Education and Product Development- 22 Years Proudly Serving New Jersey Practitioners Laboratory Services NeuroScience Pat Dorsey pat.dorsey@neurorelief.com Description: NeuroScience, Inc. is a research-driven company committed to improving human health through a deep understanding of the interconnectedness of the neurological, endocrine, and immune system. Key products and services: Neuro-Endo- Immune Testing, GI Repair System. Sterling Clinical Laboratories Inc. Naveed Aschfaq drnaveed4@hotmail.com Description: A blood testing lab licensed in New Jersey and Pennsylvania with 36 employees including pathologist, quality control consultants and zero deficiency in state inspections. Specializes in blood tests, hormone studies, thematic evaluations, and all allergy testing available. Consultants/Practice Management Breakthrough Coaching Debbie Olinger BTCDeb@aol.com Description: Chiropractic Consulting services. ChiroHealth USA Ray Foxworth, DC rafdc@chirohealthusa.com Description: Want to practice with peace of mind? Our network model eliminates worry about dual fee schedules, improper time of service discounts and OIG violations for offering discounts on noncovered services. KMC University Kathy Mills Chang info@kmcuniversity.com Description: KMC University, a chiropractic training and implementation company, specializes in delivering solutions to a broad array of reimbursement problems and obstacles that DC practices across the nation face every day. Positioned to serve as the ultimate DC ally, KMC University strives to always deliver beyond their clients expectations always assisting to improve their bottom line. That explains why in average, their clients increase their reimbursement levels by 27%. Positive Impact Coaching and Consulting Services Dr. Michelle Turk michelle@positiveimpactcoaching.com Description: Positive Impact Coaching is a company focused on helping you grow towards professional success and a balanced personal life. Via coaching and practice development services, we ll help you define and attain YOUR point of positive Impact. We also offer dynamic speaking engagements for groups and organizations on a variety of practice building and personal growth topics. Target Coding Marty Kotlar info@targetcoding.com Description: Experts in helping chiropractors document properly, get paid properly and in audit prevention. The Rothenberg Group Jess Rothenberg, DC jrapip@optonline.net Description: Assist doctors with collection services and advice for auto accident patients. Continued on next page ANJC Disclaimer: The company or persons providing the within goods or services, though an ANJC sponsoring entity or individual, is an independent organization of the ANJC and its structure, views, techniques, materials and methods are not authorized, reviewed for accuracy, or otherwise approved or endorsed by the A.N.J.C. The content of the materials and services has not been reviewed or approved by the ANJC for accuracy, completeness or compliance with the various governing statues, regulations, ordinances, or other controlling laws and should not be viewed as a direct or indirect endorsement or verification of the accuracy or legality of the goods, services, or delivery model. The application and impact of laws can vary widely based on the specific facts involved. Given the changing nature of laws, rules and regulations the A.N.J.C. does not engage in rendering legal, accounting, tax, or other professional advice and services. As such, the sponsor s association with the ANJC should not be used as a substitute for consultation with professional accounting, tax, legal or other competent advisers. Before making any decision or taking any action, you should consult an appropriately trained professional prior to utilizing the sponsor s goods or services. Medical/Clinical Services Advanced Center for Special Surgery Montville Health Dr. David Saint DSaint@montvalehealth.com Description: A freestanding state of the art licensed multi-specialty ambulatory surgical center offering a wide range of out-patient surgical procedures Alliance Medical Surgical Group Sean Hajo seanhajo@optonline.net Description: Interventional pain management and Neurodiagnostic services. Key product: Interventional Pain Management, Neurodiagnostic Services and Orthopedic and Orthodontic Surgery. Allied Neurology & Interventional Pain Practice Jack Koczarski jack.koczarski@gmail.com Description: Interventional pain management is the discipline of medicine devoted to the diagnosis and treatment of pair related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent and intractable pain, independently or in connection with other modalities of treatment. Cancer Treatment Centers of America Rocco DeCicco Rocco.DeCicco@ctca-hope.com Description: Cancer Treatment Centers of America (CTCA) provides a comprehensive, patientcentered treatment model that fully integrates traditional, state-of-the-art medical treatments with scientifically supported complementary therapies such as nutrition, naturopathic and chiropractic medicine, psychological counseling, physical therapy and spiritual support to meet the special, whole-person needs of advancedstage cancer patients. With a network of cancer treatment hospitals and community oncology programs in Philadelphia, Phoenix, Suburban Chicago, Tulsa and Seattle, CTCA encourages patients and their families to participate in treatment decisions with its Patient Empowered Care model. Clearly Beautiful Laser Solutions Dr. David Zuckerman info@clearlybeautifulnails.com Description: Clearly Beautiful Laser Solutions is a company offering high powered diowave laser technologies (10-30 watts), coupled with our turnkey marketing program, to enhance patient education/outcomes and financially augment your practice. Hackensack Injury & Wellness Center Damon J. Noto, MD snoto@usa.net Description: A health clinic focusing on pain management and minimally invasive procedures to help patients with orthopedic and spinal disorders. MUA Educators, Inc Dr. Don Alosio drdonalosio@msn.com Description: Comprehensive training in MUA Techniques resulting in the awarding of a Certificate of training in MUA (30 hours). Union Anesthesia & Pain Management Julia Kovach jkovach@uaapain.com Description: Union Anesthesia & Pain Management specializes in Laser Spine surgery- our physicians cohesively work together to provide you with effective pain management and comfortable experience. Insurance Services/Risk Management John C. Crilly Agency John C. Crilly jccrilly@gmail.com Description: Recipient of ANJC 05 award for Outstanding Effort and Commitment, we offer the following insurances: Professional Liability Malpractice Insurance, business owners, employee benefits, employment practices liability, life, disability, long term care, workers compensation and Health Insurance. LTC Global Joel S. Allen jallen@ltcglobal.com Description: LTC Global has a long term care insurance program available to all association members, their employers and their extended family members. NCMIC Mike Whitmer mwhitmer@ncmic.com Description: We Take Care of Our Own NC- MIC has grown to become the largest provider of Chiropractic malpractice insurance in the nation, covering more than 37,000 DCs. Key Products: Chiropractic Malpractice Insurance, Equipment Financing and Merchant Processing. OUM Chiropractor Program Tamara Jackson tjackson@oumchiropractor.com Description: OUM s extensive malpractice insurance policies offer broad protection that cover the range of professional chiropractic services you provide within your state s defined scope of practice. Key Products: Malpractice Insurance Legal Services Davis, Saperstein & Salomon, PC Garry Salomon sue@dsslaw.com Description: Davis, Saperstein & Salomon is a plaintiffs personal injury law firm representing injured clients for over 25 years. Its twelve attorneys have built solid relationships with the Chiropractic community and welcomes their referrals. Law Office of E. Vicki Arians, LLC E. Vicki Arians, Esq ellenav@msn.com Description: Law firm concentrating in PIP arbitration, insurance company audits and healthcare. Law Offices Of Jeffrey Randolph Jeff Randolph, Esq jrandolph@jrlaw.net Description: Specialize in healthcare law and complex litigation. Law Offices of Sean T. Hagan, LLC Sean T. Hagan seanthagan@hotmail.com Description: Specializes in NJ PIP Recovery and Arbitrations at no costs to you, practice management consultation and handles personal injury cases throughout all of New Jersey. Pond Lehocky Stern Giordano Gina Terzolino gterzolino@pondlehocky.com Description: Pond Lehocky Stern Giordano dedicates its practice to Workers Compensation and Social Security Disability matters. The attorneys at the law firm of Pond Lehocky have over 75 years of combined experience representing injured workers and the disabled. The Firm has three convenient office locations in Center City Philadelphia, Northeast Philadelphia and Pennsauken, New Jersey. For more information, or to set up a free consultation, please call or Toll Free at 866 Injury Law ( ) or visit us online at Pondlehocky.com. Educational Institutions Bloomfield College Dr. Alice Ann Sayler alice_sayler@bloomfield.edu Description: Bloomfield College is an independent liberal arts college offering Bachelor of Arts and Bachelor of Science degrees. The college offers a customized Pre-chiropractic Program leading to a BS Degree in Biology with preferred admission to chiropractic colleges around the country. Collaborans Dr. Nick Tsaggarelis drtsaggarelis@collaborans.com Description: COLLABORANS provides multimedia education for healthcare providers and fitness professionals. Our product offerings include on-line education, webinars, hands-on courses, DVDs and training manuals. Software Practice Management Cash Practice, Inc. Dr. Margie Smith x220 drmargiesmith@cashpractice.com Description: Cash Plan Calculator- customized patient financial plans with compliant discounting options. Auto-Debit System- schedule recurring payments and make one-time payments. Drip-Education Marketing System- systematized patient education. Life Systems Software Paul B. Bindell, DC, or Avi Bindell LSISALES@LifeSystemsSoftware.com Description: Life Systems Software provides certified EHR that increases income while providing audit and collection protection. It is Chiropractic specific designed for your practice. Key Products: Certified ChiroSuiteEHR electronic health record system, Certified ChiroPadEMR SOAP & narrative software, ChiroOffice management and billing software PayDC David Klein info@paydc.com Description: PayDC is a fully integrated EHR solution designed to manage your practice and the entire course of patient care. Quick Notes Ken Schenley sales@qnotes.com Description: Easy-to-Use solutions for Portable SOAP Notes and Electronic Medical Records (EMR). Fully-compliant charting on a PDA or ipad. Templates and Voice Recognition tools. Quick Notes has been supporting Chiropractic in New Jersey for 23 years. Silver Sponsorship Directory ANJC s Nutrition Education Council and Silver Sponsors work together to educate members on the latest nutritional research, protocols and nutritional supplements. NEC offers Silver Sponsors a unique opportunity to focus on ANJC member doctors who have shown a strong interest in incorporating nutrition into their practices. Dr. Christopher Bump, NEC chair states, The vision and mission of the NEC is to develop and promote the NEC as the preeminent nutritional education organization within the Chiropractic profession, and to facilitate and organize access to clinical nutrition education and resources. Anabolic Laboratories Bob Rosenberg anabolic_bob@msn.com Description: Highest quality manufacturer of general wellness and condition specific nutritional supplements. Key Products: Pain and Inflammation Supplements, Pharmaceutical GMP s and Highest Quality Products in the Industry. Cancer Treatment Centers of America Rocco DeCicco Rocco.DeCicco@ctca-hope.com Description: Cancer Treatment Centers of America (CTCA) provides a comprehensive, patient-centered treatment model that fully integrates traditional, state-of-the-art medical treatments with scientifically supported complementary therapies such as nutrition, naturopathic and chiropractic medicine, psychological counseling, physical therapy and spiritual support to meet the special, whole-person needs of advanced-stage cancer patients. With a network of cancer treatment hospitals and community oncology programs in Philadelphia, Phoenix, Suburban Chicago, Tulsa and Seattle, CTCA encourages patients and their families to participate in treatment decisions with its Patient Empowered Care model. Health Centers of the Future Warren Philips questions@hcfseminars.com Description: Our events infuse cutting edge testing and support protocols for common conditions. The systems you learn can be applied in your office the next day. NeuroScience Pat Dorsey pat.dorsey@neurorelief.com Description: NeuroScience, Inc. is a research-driven company committed to improving human health through a deep understanding of the interconnectedness of the neurological, endocrine, and immune system. Key products and services: Food Sensitive Testing, Neuro-Endo-Immune Nutrition Program, GI Repair System. Nutritional Frontiers Michael Antonelli alternativewellnessinc@gmail.com Description: Our Mission is to create, develop and provide safe, effective therapeutic natural solutions and educational programs to chiropractors and their patients with excellent quality, integrity and service. Standard Process Bruce Poritzsky bporitzky@standardprocess.com Description: For more than 80 years, Standard Process headquarters in Palmyra Wi has provided health care professionals with high-quality, nutritional whole food supplements. Key Products and Services: Supplementswhole food based, Herbal Supplements, Education. Sterling Clinical Laboratory Naveed Ashfaq drnaveed4@hotmail.com Description: Sterling Lab provides excellent mobile home draw service for patients and performs all kinds of diagnostic tests in huge discount prices. Key products and services: All kinds of blood tests, urine and stool tests, hormones, allergy, pneumatic and nutritional tests. XYMOGEN Jennifer Watters jennifer.watters@xymogen.com Description: Wellness and Nutrition Integration Programs-Clinical Research, Education and Product Development- 22 Years Proudly Serving New Jersey Practitioners

6 10 Winter Winter In your burgeoning chiropractic business you may have taken on some debt to fund growth. But are you amassing the wrong kind of debt for your practice? Choosing the wrong kind of debt or having too much debt can be detrimental to the success and lifespan on your practice. So what might we consider the wrong kind of debt for chiropractors? Credit card debt Vehicle loans and leases from car dealerships High mortgage balance Personal loans at high rates Really, the wrong kind of debt is any debt that s either: a) not necessary, or; (b) can be refinanced at more favorable terms. Taking an honest look at your practice, can you say you re carrying some bad debt? You re not the only one. Not by a long shot! But you can get smart right now and start doing things differently immediately. Start with a plan to remove bad debt from your practice. Take a rainy Saturday to systematically review every outstanding loan. For each, find a way to either pay it off without compromising growth, of course or refinance at a lower rate. If you have expensive debt, such as credit card balances, you should work to determine what other financing options are available to your practice. If your practice is profitable or is showing strong signs of coming profitability it s likely that lenders will work with you to refinance at a lower rate. You should consider this particularly if you have expensive debt By Salim Omar, CPA The Wrong Kind of Debt for Chiropractors such as credit card balances. Work to uncover other financing options available to your practice. But when asking lenders to refinance to get you that lower rate, don t think of it as them doing you a favor. Instead, think of it as good business for the lender. Financial companies are in business to make money from loans. If you bring to the table a good credit history and a viable business record, they ll seriously consider lending you money and getting you out of those unnecessarily high payments you re making. Doing so will make your chiropractic business all the more profitable. On an annual basis, you should address the debt your practice is carrying. Set a reminder to take a look at this the same time next year. True, it will save your practice money on an annual basis. But it can also save you money in the long-term, when you re seeking capital financing or even a potential business sale. Yes, it will take time to organize your debts and search for options that are more attractive to your business. But will it pay off in the long run? Absolutely. Salim Omar is a Platinum Sponsor of the ANJC and President of The Omar Group, CPAs in Cliffwood, New Jersey. He is also a sought-after speaker and the author of Straight Talk About Small Business Success in New Jersey: How to Maximize the Growth, Cash Flow and Profitability of Your Small Business. He can be reached at salim@omargroupcpa.com or at (732) With the New Doctor in Mind... The Single Most Important Ingredient for Success By Dr. James W. Campbell I was so fortunate to grow up without advantage. It inspired me to do more, work harder, and light the fire that to this day spurs me on for greater success. In my early teens, I began to notice that some people were struggling, and their families had difficulties, while other families were well off and always seemed to have new cars, great family vacations, etc. So, I wanted to know why some people were remarkably successful, wealthy, and happy, while others were not. I began to study the phenomenon of success, and read every book that I could find on the subject. As anyone who s ever read books on success knows, you find so many different ideas, concepts, and roadmaps to achieve what you re looking for, that it can be daunting to discover the formula. After reading a hundred or so books, you begin to see some common elements involved in individual success. Many ideas such as having a vision/dream, running the movie in your head, keeping a positive mental attitude (PMA), etc., have become de rigueur for success courses. But there is one thing that is more important than any other: PERSISTENCE. If you look carefully, you ll find that every successful person, whether in business, sports, or Hollywood, has had to endure difficulties and hardships on their way to achieving success. Many have made several comebacks from seemingly impossible circumstances. Every successful person that I know would be able to start over if they had to, and achieve the same or even greater level of success. The wealthiest man of his time, Sam Walton, told a close friend that the secret to success is to get after it, and stay after it. The oft quoted President Calvin Coolidge probably said it most succinctly when he said: Nothing in this world can take the place of persistence. Talent will not; nothing is more common than unsuccessful people with talent. Genius will not; unrewarded genius is almost a proverb. Education will not; the world is full of educated failures. Persistence and determination alone are omnipotent. New doctors often ask: Where s a good place to practice? Those of us that have set up successful practices recognize an important teachable moment. I tell them that the single most important factor in locating your practice, is to decide WHERE DO YOU WANT TO LIVE! You see, choosing a place to practice based on some statistic or demographic (like a growing community with good insurance coverage) is like choosing a spouse that has the best genetic sequencing! Something that looks good on paper usually does not translate into a successful location. In order to be successful, first you must decide where exactly you want to live more than any other place in the world. Because no matter where you set up your practice, it is going to take an enormous amount of persistence, over a much longer time than you think it should take, in order to be successful. So you re going to need to want to be in that place more than any other if you are to be willing to do what it takes to be successful in practice. Many times I tell the story of the Vikings. When they would invade a country by ship, they would land all of their troops, unload all of their supplies and then assemble on the beach. A Viking would row out to the ship, and proceed to set it on fire, while the assembled troops would watch it burn to the waterline. They then knew that they had no other choice but to be successful and conquer the new territory. The Vikings knew how the mind works. Retreating to a safe harbor when situations become difficult is something most of us are all too familiar with. So first, choose where you want to live and set up your practice there. Then, as Winston Churchill said it best in the darkest days of World War II, Never give in, never give in, never; never; never; never in nothing great or small, large or petty never give in except to convictions of honor and good sense. Dr. James Campbell has been in practice in East Brunswick for 23 years. He is a Diplomate in Chiropractic Acupuncture, and serves on the ABCA board as their treasurer. He can be contacted at or at drc@ campbellchiro.com. Chiropractic & Oncology Knowing When to Collaborate with Other Professionals By Dr. Jeffrey Sklar The curricula at chiropractic colleges and universities are quite comprehensive. However, through the course of studies in basic sciences, diagnostics, imaging, chiropractic science and clinical education, there is not a tremendous amount of focus on nutritional supplements. Moreover, to become an expert in nutrition and competent enough to recommend the right amount and combination of nutritional supplements leaves the practitioner with the onus to continue their nutritional education throughout their career. Furthermore, many chiropractors recommend supplements as a form of disease prevention. Certainly, there is nothing wrong with that. To the contrary, it is an excellent way to help patients stay well or recover from illness faster. What remains paramount is the chiropractor s responsibility to the patient. One must know where the expertise ends and the need to refer and collaborate with other colleagues begins. This is part of patient centered care. The chiropractic profession prides itself on placing the patient first and foremost above other needs that are more material and ego based. The American Chiropractic Association s code of ethics ( cfm?cid=719) is based on the acknowledgement that the social contract dictates the profession s responsibilities to the patient, the public, and the profession, and upholds the fundamental principle that the paramount purpose of the chiropractic doctor s professional services shall be to benefit the patient. Furthermore, it is stated that doctors of chiropractic should willingly consult and seek the talents of other health care professionals when such consultation would benefit their patients or when their patients express a desire for such consultation. Having this tenet as a model to operate a chiropractic practice offers a pathway of dedication to the patient s present and future health concerns, while maintaining a professional character built on integrity. In looking at areas that are typically outside the chiropractic scope of practice, cancer stands out. It is the second most frequent cause of death in this country. In 2010 over 500,000 people died from cancer. The World Health Organization reports that by 2020, 15% of deaths worldwide will be due to cancer. The staggering numbers of this dramatic disease should bring serious concerns to the uninformed practitioner about treatment. With so many chemotherapy drugs and radiotherapy options now being utilized by oncology centers around the United States, it takes an expert to know which type of vitamins and nutrients may facilitate proliferation of cancer cells. There are some supplements that may protect tumors from radiation. There are some that may increase the rate of cancer cell replication. For instance, Aminah Keats, ND, Director of Naturopathic Medicine for Cancer Treatment Centers of America in Philadelphia, lists the following naturopathic contraindications for patients undergoing radiation therapy are not part of standard chiropractic education: Beta Carotene > 5000 IU, Vitamin E over 200 IU,Nacetyl-l-cysteine, Alpha-lipoic acid, Coenzyme Q10 >300 mg daily. Moreover, although folic acid may be recommended for patients that are experiencing skin irritation from chemotherapy, this vitamin should be avoided with patients on Xeloda. There many other supplement/treatment interactions that could jeopardize a cancer patient s health status. Hopefully, the point has been made that if a chiropractor has a patient that is currently undergoing cancer treatment, it is essential that oncology records be available for the DC. Contrary to the alert for caution in recommending supplements to cancer patients, the issue of quality of life is one that is essential for chiropractors to address with their cancer patients. Schneider and Gilford stated in Journal of Manipulative and Physiological Therapeutics, 2001; 24(1):52-57, The chiropractor provides noninvasive and non-pharmacologic options for decreasing pain and improving function. Moreover, Holt points out in ICA Review, (Holt FJ, Kent C ICA Review Nov/Dec 1990;46(6):43-45) that cancer does not release chiropractors from the responsibility to find and correct vertebral subluxation. He states that the clinical challenge facing the chiropractor is selecting adjusting techniques that are safe and effective in such circumstances. Additionally, there are many side effects to chemotherapy and radiation that will affect the patient s quality of life and can be addressed by chiropractors. The chiropractor can assist in the treatment of the complications of prolonged bed rest, chronic pain related to radiation fibrosis, chemotherapy-related neuropathies and gait or functional abnormalities, thereby decreasing the patient s reliance on pain medication (Schneider and Gilford, You are unique. Don t you deserve to have malpractice insurance that meets your individual needs? We understand chiropractors and realize that no two are the same. Contact us to see how our malpractice coverage is a perfect fit for your practice. OUM and OUM Chiropractor Program do not refer to a legal entity or insurance company but to a program or symbol of a program underwritten, insured and administered by either PACO Assurance Company Inc. or PICA, both with Excellent ratings (A- and A, respectively) by A.M. Best. 2001). More visceral side effects from cancer treatment may certainly be addressed with natural remedies such as calendula, Castor oil, or aloe vera for radiation induced dermatitis. Patients experiencing nausea or vomiting may find relief with ginger root powder (J Ethnopharmacol: Continued on Page 19 Above are a number of drug and herb/supplement interactions to be aware of. A bird of a different feather. (888)

7 12 Winter Winter Your Most Valuable Asset: Your Team By Kathy Mills Chang, MCS-P Getting a Grip on SI Joint Pain By Brian D. Jensen, DC Five Keys to Making Better Adjustments By Dr. David I. Graber We ve all been there: you re in the next room and you overhear your Front Desk CA say something completely incorrect to a patient at the counter. Perhaps you ve heard your staff mumble or get caught up on what to say when trying to set a new patient appointment. Do you find yourself quietly pondering, Was that apathy I sense in her tone? It is time to take back your office. Remember that your staff is often a potential patient s first impression of your office and of you. Of course, many of you have amazing staff, but if you find yourself frustrated more often than not it may be time to implement some quality control. Step One: Assess the Current Situation Determine what needs to be addressed to make sure your patient is receiving quality customer service from your team members. If the doctor is running the gauntlet in the back office all day, it s possible that the team members are seen only a few times a day! Find out what is really going on during a given day. What areas may need improvement? Here are some examples: Phone skills Do your CAs come across as rude or rushed when answering the phone? What is the tone of voice? Face to face skills Does the team greet patients as they walk in the door, usually by name, and answer their questions politely? Again, is the tone pleasant and welcoming? Attitude check Does the tone in your office exude confidence and customer service? Do the team members leave problems at the door? Dynatronics Hill Tables MR4 Laser/Stim ErgoStyle Tables Chattanooga Eurotech Tables Dynatronics Hill Tables MR4 Laser/Stim ErgoStyle Tables The Best Products Get The Best Results Harlan Health Products, Inc. PO Box 8421, Pelham, NY (800) Proud ANJC Platinum Sponsor Let Us Help You With All The Products You Need... & The Personal Service You Deserve! ErgoStyle Tables Chattanooga Eurotech Tables Rehab Equipment Supplies Rehab Equipment Supplies Dynatronics Hill Tables MR4 Laser/Stim Lack of attention to detail Are there too many mistakes in patient information, data entry, or documentation? Is there a tendency not to return calls to patients who request information? Lack of knowledge Are you completely comfortable with the level of chiropractic education necessary for that team member to perform in their position? Can they answer appropriate questions, think on their feet or display their knowledge by proactively addressing situations? Take a few days to really listen and determine what is necessary for you to develop your dream team! Then, make a wish list of what improvements could be made to upgrade your office s attention to customer service and patient relations. Step Two: Develop a Plan After determining your wish list of enhancements, develop a plan that will be implemented to help each team member understand your expectations. First and foremost, you must have a system in place that you expect them to follow. If you have never explained this is how we do it here to your team, you can t expect them to follow your wishes. It may behoove you to ensure that your policies and procedures on performance expectations are updated. Fully express through these procedures and policies what the new accountability standards will be in your office. Here are some action steps necessary: Your Office Policy: If you do not have standing policies in place, create them. Determine what your office policy is on everything from greeting patients to releasing patients. This won t happen overnight, and your team should assist with the writing of the policies. Everyone on the team should assist with policy in their area of focus. Determine What Procedure is in Place: Once your policies have been written out, write or update written standard operating procedures for how these encounters should be handled, including any scripting that you expect your staff to learn. This can be time consuming and you may find that you can implement only one standard at a time, but working toward this goal, even in small increments, will prove to be valuable to you, your staff, and your patients. Here are some examples of what may be in order, once policy and procedure is in place, as you review various areas of your practice: Phone skills Randomly ask friends or family to call in as a potential new patient. Record the Continued on Page 21 The sacroiliac (SI) joints are recognized as the origin of many low back pain symptoms. The classic pattern describes unilateral pain extending from the lowest part of the spine into the buttock and down the back of the upper leg. This can vary significantly from one patient to the next. Effective chiropractic care of spinal problems can proceed only when the SI joints are evaluated and all subluxations and malfunctions are addressed. Sacroiliac joint pain can negatively affect standing, walking, lifting and changing positions. SI joints can develop into chronic back pain. Misdiagnosed patients may get little or no relief by undergoing a discectomy or spinal fusion surgery. Fortunately, most SI conditions respond well to chiropractic care, especially when accompanied by orthotic support and rehabilitative exercise. Sacroiliac Conditions and Care Acute sprain. The sudden onset of unilateral SI pain is usually caused by forceful twisting or heavy lifting, especially from a stooped position. Stepping off a curb, and even twisting in bed have also been reported as causes. The provocative tests for the SI joint such as Gaenslen s and Yeoman s are positive, increasing the local pain. Initial care consists of a protective support (trochanter brace), activity restrictions (especially weightbearing), and cryotherapy. Adjustments should be performed cautiously, to avoid overstretching the stabilizing ligaments (1). Once the acute phase has subsided, an in-depth evaluation of the biomechanics of the pelvis and lower extremities should be done. This should reveal any predisposing factors, such as excessive pronation, leg length inequality, or muscle imbalance. Caring for these factors prevents chronicity. Sacroiliac syndrome. Recurrent problems and non-traumatic subluxations of the SI joints are usually due to an acquired instability. These patients may be athletes, postpartum females, or in their middle age. Pain is usually aggravated by prolonged or repetitive weightbearing activities. These patients have a chronic dysfunction of the SI joint, which may now be undergoing degeneration. They often get dramatic relief from specific sacroiliac adjustments, but the condition tends to recur. A search for underlying gait asymmetries and biomechanical imbalances is needed (2). Other factors. It is very important to recognize the functional short leg, since providing a lift instead of an orthotic is likely to perpetuate the associated sacroiliac subluxations (3). A good clinical postural exam with lower extremity screening including shoe wear patterns is the only way to determine whether the leg is affected by a functional or an anatomical condition. Stabilizing Support with Orthotics Because the SI joints are so closely Recurrent problems and non-traumatic subluxations of the SI joints are usually due to an acquired instability. involved in gait, individually designed, flexible orthotic support for the feet is often a necessary component of SI joint care. Support for low arches and calcaneal eversion reduces pronation, which decreases the medial rotational stress on the SI joints. Correction of a functional or an anatomical leg length discrepancy diminishes the ground reaction forces being sent through the joint on the side of the longer leg. In addition, shock absorption from viscoelastic materials in the orthotic can ease the impact at heel strike (4). The additional padding is particularly necessary when there is instability, degeneration, or even an inflammatory arthritis in the SI joints. Rehabilitative Support Corrective exercises done at home to strengthen supporting muscles can be recommended as an adjunct to clinical treatment. Activity should focus on developing strength in the abdominals and supporting pelvic muscles. This can also enhance the shock-absorbing properties of the tissues. Adjunctive Care for Total Support The SI joints are closely associated with efficient gait and proper support of the spine. A patient with a sacroiliac dysfunction usually responds rapidly to chiropractic care. In many cases, individually designed stabilizing orthotics and rehabilitative exercise are needed for positive longterm results. References 1. Gatterman MI. Chiropractic Management of Spine Related Disorders. Baltimore: Williams & Wilkins 1990: Yochum TR, Maggs T. 100% of my patients get custom orthotics. What about yours? The American Chiropractor 2011; 33(8): Rothbart BA, Estabrook L. Excessive pronation: a major biomechanical determinant in the development of chondromalacia and pelvic lists. J Manip Physiol Ther 1988; 11: Nigg BM, Nurse MA. Stefanyshyn DJ. Shoe inserts and orthotics for sport and physical activities. Med Sci Sports Exerc 1999; 31(7 Suppl):S421-S428. Dr. Brian Jensen is currently the Associate Director of Professional Education at Foot Levelers. He speaks on a wide variety of topics, including orthotic therapy, posture, structural preservation, breaking free of the medical model of healthcare, and innovations in nutrition. Dr. Jensen can be reached at The skillful delivery of a chiropractic adjustment is essential to getting superb clinical outcomes in chiropractic practice. Recent research into spinal manipulation has brought out some potentially valuable insights for how to perform chiropractic adjustments. The following are five keys that any doctor can apply in their patient care. 1. Specificity. Level specificity is more important in delivering a spinal manipulation than specificity in the direction or line of drive. Contacting the dysfunctional segments at the lamina, which more directly affects the facet joints, gives greater neural responses than other vertebral contact points. 2. Speed counts. One of the effects of high-velocity, low-amplitude spinal manipulation (HVLA-SM) impulses is to stimulate proprioceptive afferents from paraspinal muscles. Impulse velocity is the most important factor to achieve this. An impulse duration of <or= 200 ms increases muscle spindle discharge. Typical HVLA-SM impulse durations last from approximately 30 ms to approximately 120 ms manually, and <5 ms with an instrument. 3. Cavitation is not necessary for a neurological effect of manipulation. While many patients and doctors like to hear a crack with every adjustment, it s not necessary for a manipulation to be successful. Maximal mechanoreceptor stimulation occurs at the end ranges of joint movement and the effects may be mutually exclusive to the goal of cavitation with a manipulation. Spinal manipulation that produces an audible response immediately down regulates the gain (i.e. decreases the sensitivity) of muscle spindles of the paraspinal muscles via the 1a reflex pathway. This produces a greater decrease in muscle spasm. Long lever HVLA techniques are more effective for producing cavitation. 4. End range manipulations appear to produce the most mechanoreceptor stimulation. Type 3 mechanoreceptors are stimulated by fully stretching ligaments and joint capsules stimulates. End range adjustments with very low amplitude (~2mm or less) in multiple directions appear to maximize this effect, as well as restoring full passive range of motion to the joint. 5. Regularly learn and use new manipulative techniques. Research by Triano has shown that adjusting skills stabilize after 1-5 years of practice experience. Manipulation skills used tend to narrow as time in practice grows, and unused skills take 1-5 years to relearn and become proficient. Regularly taking technique seminars or participating in a technique learning group with fellow chiropractic colleagues are the best ways to keep your skills sharp. Dr. David Graber is a Diplomate of the American Chiropractic Board of Sports Physicians and practices in Mountain Lakes, New Jersey. He teaches courses in spinal and extremity manipulation for New York Chiropractic College. He was the ANJC s 2012 Chiropractor of the Year.

8 14 Winter Winter PRogress Essentialization of Chiropractic Care in New Jersey By Matt Minnella ANJC Director of Insurance By Dr. Mike Kirk ANJC PR Chair ANJC leadership and staff descended on the Hilton Garden Inn in Edison, NJ during the weekend of December 1 to develop a three year strategic plan for our organization that spans 2013 through One of the overriding themes of the weekend was the essentialization of chiropractic care in New Jersey, a phrase that was coined by Dr. Jeannine Feinstein, ANJC board member, during the planning process. Each morning, without hesitation, residents across New Jersey wake up to brush their teeth as well as attend regular dental check-ups and cleanings. Why? Simply put, because they see value in the prevention of dental caries for themselves and their families. Not to mention that regular brushing and dental appointments have been engrained in our heads on a repetitive basis during our formative years. Not to discount the importance of good oral hygiene but isn t spinal care of equal if not greater importance to one s health and shouldn t all New Jersey residents be taking advantage of chiropractic care? That was the exact question ANJC leadership pondered during our recent strategic planning session. Our conclusion was that chiropractic care should be essential for all New Jersey residents. Now imagine a time when New Jersey residents wake up each morning to perform an activity that will improve their spinal health, as well as call an ANJC member to schedule a regular chiropractic visit for themselves and their families. This is one of the visions that ANJC leadership developed for chiropractic in New Jersey during our strategic planning session. It s time that chiropractic care should not just be seen as a luxury or secondary to other forms of healthcare. Instead, the time has come for New Jersey residents to recognize that the chiropractic lifestyle is a necessity for them and their families and that it is the principle form of healthcare. This endeavor of chiropractic essentialization in New Jersey will be a major focus for ANJC Public Relations in 2013 and the years to follow. While this is no easy task, it is certainly one that deserves immediate attention. To help us accomplish the essentialization of chiropractic care in New Jersey, we have developed several ideas. First, we are in the process of hiring a new public relations/marketing person who will bring with them the skills and expertise the ANJC will need to Are You Reporting or Selling? By William D. Esteb Many chiropractors pay for their practice twice. First, by borrowing six figures to learn what s needed to pass board examinations, and then again by hiring various practice management coaches to teach them what their chiropractic college didn t or wouldn t. Some who ply the practice management waters suggest that the Presenting the industry s best, all-in-one solution to manage and grow your chiropractic practice. But don t take our word for it. Take these chiropractors EASY: The training I was given by PayDC helps me process a new patient in five minutes with a care plan. J.M., New Jersey AFFORDABLE: I found that these products are easily the best I ve used in 13 years of practice. J.R., California AGILE: Their intuitive, user-friendly, and smartly designed interface makes keeping up with SOAP notes and other paperwork a breeze! M.W., Pennsylvania FAST: The PayDC software makes your care more effective and your notes more solid for retrospective third party review. J.K., Texas For a FREE, no-obligation demo and a Practice Analysis valued at $250, call or visit accomplish our public relations goals. This individual will assist in developing effective strategies to further educate the public at large about the benefits of chiropractic care. Secondly, we continue to build a strong and lasting relationship with the New Jersey Education Association (NJEA). The NJEA is a large organization that has statewide reach and appeals to hundreds of thousands of New Jersey families and students. They are a great partner with whom we can share positive chiropractic information and resources that will help us with the essentialization of chiropractic care across New Jersey. We continue to place relevant health and wellness information in various NJEA publications to help brand ANJC members as the go to providers of quality healthcare. In addition, we are currently in the process of developing a short video entitled The Well-Adjusted Teacher. This video will be utilized to help further educate teachers about the benefits of the chiropractic lifestyle as well as directing them to contact ANJC members for more information. To help you essentialize the need for chiropractic care in your local community, the ANJC is exploring the production of a member tool kit. The contents ultimate report of findings is one that prompts the patient to burst into tears upon recognition of the destructive nature of subluxation. Others teach word games to manipulate patients into saying yes to care they don t want. Still other groups have such a profound disrespect of patients they teach their clients to force-feed annual care plans to get patients to use chiropractic the right way. These shortsighted tactics place an inordinate amount of focus on the report of findings while practically ignoring the far more important consultation or pre-care interview. Why is the consultation so important? 1. This is where rapport is, or isn t, made. Establishing rapport is the first order of business. One of the most powerful ways to do this is to explain why you became a chiropractor. If you have a story that includes becoming a chiropractic patient yourself, share it. Be courageous enough to admit any concerns, fears or unfounded beliefs about chiropractic that you may have had back then. Don t have an inspiring story? Address their concerns more directly. Many people have some wrongheaded ideas about chiropractic. So, before we get started, I d like to put some of them to rest. of the tool kit will include professionally developed pieces and techniques that will assist you in educating your local community. Some possible ideas for the ANJC tool kit include: how to become a local media expert, sample press releases, how to leverage various social media platforms to build your practice, how to effectively communicate as well as other useful tools. However, before moving forward with this project, the ANJC will be reaching out to you for input in order to determine what tools you believe will be most valuable to you for effectively reaching your community. It has never been a better time to be an ANJC member. During the maturation process, the ANJC has faced numerous obstacles and has accomplished many goals that have ultimately positioned us as a nationally recognized model organization. The ANJC has now reached a stage of development where this year, as well as the years ahead, we are in a position to focus more of our efforts on the essentialization of chiropractic care in New Jersey and on branding ANJC members as the go to providers of quality healthcare. Hang on tight because it s going to be another exciting ride for the ANJC! 2. Begin the healing process. Assuring the patient that their particular problem is within the scope of your practice, and moreover, helping patients with their problem is so common as to be almost routine, is significant. Give hope without guaranteeing a cure; express your confidence. We see this sort of thing all the time. Chiropractic has been shown to be very helpful in cases like yours. I think you re an excellent candidate for chiropractic care. We re optimistic that we can help you and you should be too. We ve helped a lot of people with problems just like yours. Hope is an essential part of the healing process and it s something you can invoke even before a complete examination and report. 3. It s a flag planting opportunity. The consultation offers the opportunity to contrast their medical doctor experience with what they can expect in your practice. I think it s only fair that I explain a little about what I believe to be true, and the lens we ll be looking through as we evaluate your current problem and offer some help and direction for your improvement. Explain how chiropractic care differs from medical treatment, its nervous system focus Continued on Page 16 The ANJC insurance team of consultants, member experts, executive director, staff and I have been working many fronts to protect, enhance and inform membership on all matters related to insurance: Aetna/Triad Through the AN- JC s and DOBI s urging we have received reports that payments finally began to be issued more readily to providers from Triad. However, we are still in constant communication with Aetna and Triad with regards to many other issues that remain. Among these are the $3 fee for PPO claims, the clarity of the information proposed to doctors in the Triad Addendum, the three year look back with regards to utilization review, the consistently incorrect information presented by Triad via their website and customer service line, etc. Aetna It was previously brought to our attention that Aetna had ceased reimbursement for CPT code when billed in conjunction with Modifiers -25 and -59 do not override this edit. Originally, Aetna began this practice on September 1, However, per Aetna s December Provider Newsletter this will not go into effect until March 1, The ANJC will dispute this policy going forward, but it is important to note that if you have had denied on prior dates of service you can request they be reprocessed. You can call Aetna at or send a letter of appeal requesting reimbursement of these codes as they would have been erroneously denied prior to the Aetna stated implementation date of 3/1/13. Qualcare We surveyed membership and have now scheduled a meeting with executives at Qualcare to express your concerns face to face. Among the most common responses from members regarding Qualcare were their reimbursement cap being too low ($50), E/M codes were not reimbursed separately, no chiropractic care granted to patients under 18 years old, untimely payments (60 days or more), poor customer service and discriminatory reimbursement and communication practices towards out of network providers. PIP There are a number of new DOBI regulations regarding Personal Injury Protection claims and policies scheduled to go into effect January 4, Among these are several that are pertinent to chiropractic and further, there are several the ANJC strongly disagrees with. Two healthcare coalitions comprised of healthcare providers of various specialties have filed suit against DOBI for implementation of these regulations. The ANJC State Board of Directors voted to officially join and contribute funds to one of these coalitions the New Jersey Coalition for Quality Healthcare, which is being represented by the preeminent law firm of Wolf & Samson. Medicare/Novitas It has come to our attention that many offices are experiencing denials of their Medicare claims due to reason code 151 Payment adjusted because the payer deems the information submitted does not support this many/frequency of services. This denial code is the one used when you exceed the number of treatments on the diagnosis grouping or more than 30 visits in the year. For example, if you used a cervicalgia diagnosis and you used 12 visits and then the patient came back in for treatment of a lumbalgia for 10 visits, you were being denied because both of these diagnoses were listed in Group A and Novitas was stating that you used all 12 visits even though the conditions were different and the regions of the spine were different. This was an inappropriate implementation of the policy. With the help of the Medical Director of Novitas a correction was made to the claims edits and this should no longer occur. If you have received a denial of this kind in the past you should appeal the claim using the Redetermination Form (can be found in Membership area of the ANJC Website under the Insurance page, subsection Medicare). If you receive a denial of this kind in the future you should: 1. Make sure you have not used more than the visits allowed for that diagnosis group 2. Make sure that you have not used more than 30 visits combined for the year 3. Contact ANJC HQ so that we may act on your behalf to help resolve the problem 4. Appeal the denial as stated above In other Medicare/Novitas news, they have done away with the rolling calendar. The number of visits allowed for the year before documentation and appeals are needed is 30. This had been judged on a rolling calendar year meaning that the patient would not be allowed more than 30 visits as of today and at any time in the last 365 days. Going forward (starting Jan. 1, 2013) the 30 visit limit applies to the calendar year. In other words the patient would be allowed 30 visits without additional documentation from January 1, 2013 through December 31, Medicare PQRS Participation in Medicare s Physicians Quality Reporting System is not technically mandatory until However, if you do not begin compliance starting January 1, 2013 you will be penalized 1.5% of all your Medicare payments in 2015! The ANJC prepared a webinar presented by Dr. Rich Healy outlining all the details of the program. We also prepared a PQRS cheat sheet of the G codes and their meanings as a quick reference guide for your office. Both are available on the ANJC website on the Insurance page under the Medicare subsection. ERISA - ANJC has been working to understand and educate members about ERISA. ERISA is the Employee Retirement Income Security Act. This set of laws governs all self-funded employer sponsored health plans. This covers a large percentage of the population and these laws govern the vast majority of insurance plans that fall outside the jurisdiction of the New Jersey Department of Banking and Insurance. The ANJC commissioned national ERISA expert, attorney Jason Martin, along with ANJC insurance consultant and founder of CB&C Inc., Lynette Contreni, to create a series of brief webinars on ERISA. These explain the basics of ERISA, the first, second and third level appeals processes and what remedies are available beyond final level of appeal. These lessons will be available on the ANJC website Insurance page in early Obamacare (PPACA) The Patient Protection and Affordable Care Act, also known as Obamacare, will shape the future of healthcare in this nation beginning this year. As such, it is a central focus of the ANJC. We will direct a great deal of our time, effort and resources to understanding these laws; communicating them and their implications to the membership; and most importantly working to shape and interpret these laws in ways most beneficial to our membership and the profession in general. Regular updates will be provided throughout the year by , on the website and in this publication. These are some of the issues we have been and will continue to work on. I also want to comment on the role that membership plays in our insurance agenda. Most of the concerns that HQ addresses are discovered because the membership sent us a question about or an example of a new issue. Sometimes there are isolated incidents that only affect a few and can be easily addressed. But many times we are alerted to a new trend that requires our immediate action by concerned and active members. We at ANJC HQ work for you. There is no greater resource to identify what we should be working on than you, the members. So please, continue to share with me any questionable, troublesome or unusual new insurance situations and provide examples of pertinent documents. This way we can evaluate and address these situations as quickly as possible. You can me at matt@anjc. info, fax information to or call us at New Year, New Web Site! Check Us Out At User-Friendly; Super Easy To Understand & Navigate Product Literature, Protocols, Research, Articles, Seminar Schedules Free Webinars Available Online AND Order Online Call us today for more information (866) Nutri-West Mid Atlantic Toll Free Wilmington, Delaware

9 16 Winter Winter Are You Reporting or Selling? Continued from page 14 Research Updates By Anthony L. Rosner, PhD ANJC Research Analyst The Power of Pulling Together By Dr. K. Jeffey Miller and that adjustments don t treat their symptom but revive their ability to self-heal. 4. Patients determine how safe you are. Patients size you up during the consultation. Are you approachable? Will my secrets be safe with you? Will you make fun of my lack of understanding? Will you manipulate me with guilt or shame? Are you authentic? Patients take your emotional temperature during the consultation and make a determination whether they like you, trust you and will permit you to touch them physically and emotionally. The patient s interpretation of hundreds of subtle clues will determine the amount of influence you will be able to wield. 5. Patients decide if the myth is true or not. Virtually every new patient has heard the myth that once you go to a chiropractor, you have to go for the rest of your life. Put patients at ease by explaining how this myth originated because of the distinction between sick care (short-term diet of pain relief) and life care (wellness and health optimization lifestyle choice). How long you decide to benefit from chiropractic is always up to you. 6. You get to demonstrate your profound listening. The consultation is a time when you want the patient to do most of the talking. By demonstrating your ability to really listen repeating in your own words what you re hearing, and asking for clarification when patients use unusual or meaningful terms you communicate respect and understanding. Great communicators are great listeners. 7. Make the first and most lasting impression. You ve heard the old adage that you only get one opportunity to make a first impression. And let s not forget that the first impression is usually the longest lasting. This makes your The consultation offers the opportunity to contrast their medical doctor experience with what they can expect in your practice. paperwork, consultation and first visit procedures vitally important. Attend to these details up front and your report of findings can truly become a report of your findings, followed by a, So, shall we get started and see what happens as we reduce nervous system interference along your spine? The fact is, if a patient returns for their report of findings, they re yours. They rarely come back unless they re ready to move forward. So, overtures to get a commitment beyond their reason for initially consulting your practice are not only hard work, but unnecessarily strain your budding relationship. If you ve been selling chiropractic care at your reports, it ll probably feel uncomfortable using a softer touch. Worse, you may believe that it s been your hard sell that has produced the patient retention you ve enjoyed to date and you re wary of changing your approach. Relax. Frankly, you re not that good at sales. If you ve ever tried to change someone s mind about abortion, gun control or vaccinating their children, you re already keenly aware of the limitations of using mere words and rational arguments to change someone s beliefs and behaviors! Remember, people don t like to be sold. But they love to buy. Make it easy to buy chiropractic by explaining up front what it is and what it isn t. Whether you use a one-visit procedure or a two-visit procedure, get the buy-in earlier rather than later. William Esteb is the creative director of Patient Media, providing patient education materials to the chiropractic profession since Subscribe to Monday Morning Motivation and read his blog posts at Raritan Anesthesia Associates Providing the best treatment for neck and back pain From Left to Right: Randolph Kahn, D.O., Michael Wilcenski, M.D., Wayne Fleischhacker, D.O., Edward Novik, M.D., Steven Shane, D.O. Union Anesthesia Associates PAIN MANAGEMENT Union County 695 Chestnut Street, Union, NJ Somerset County 141 Main Street, South Bound Brook, NJ Middlesex County 40 Route 34 South, Old Bridge, NJ Board Certified Pain Specialists & Anesthesiologists Non-Surgical Techniques Minimally Invasive and Laser Spine Surgery Hudson County 654 Broadway, 2 nd Floor, Bayonne, NJ Essex County 40 Union Ave, Irvington, NJ Bloomfield Ave, Suite B, Bloomfield, NJ Injured in a motor vehicle accident or work related injuries? We can help! We participate with most major insurance plans. Call us for an appointment today: Se habla español ACETAMINOPHEN USE CONTRIB- UTES TO INCREASE IN ASTHMA PREVALENCE 1 A variety of observations have suggested that acetaminophen use has contributed to the recent increase in asthma prevalence in children. This is shown by (a) strength of the association, (b) consistency across age, geography, and culture, (c) dose-response relationship, (d) timing of acetaminophen use and asthma epidemic, (e) the inability to identify any other abrupt environmental change that could explain the effect, (f) the results of a double-blind trial of ibuprofen and acetaminophen for treatment of fever in asthmatic children, 2 and (g) the presence of a biologically plausible mechanism (glutathione depletion in airway mucosa). Associations of acetaminophen use and asthma have also been found in adults: (a) in a meta-analysis of six adult studies, the OR (odds ratio) was 1.74 (95% confidence interval ). 3 ; (b) in the Global Allergy and Asthma European Network, the OR was 2.87 (95% confidence interval ) McBride JT. The association of acetaminophen and asthma prevalence and severity. Pediatrics 2011; doi:10:1542/ peds Leska SM, Louik C, Vezina RM, Mitchell AA. Asthma morbidity after the shortterm use of ibuprofen in children. Pediatrics 2002; 109(20: cg/content/full/109/2/e Etminian M, Sadatsafavi M, Jafari S, Doyle-Waters M, Aminzaden K, Fitzgerald JM. Acetaminophen use and the risk of asthma in children and adults: A systematic review. Chest 2009; 136(5): Shaheen S, Potts J, Gnatiuc L et al. Selenium and Asthma Research Integration Project, GA2LEN: The relation between paracetamol use and asthma: A GA2LEN European case control study. European Respiratory Journal 2008; 32(5): MASSAGE ATTENUATES INFLAMMA- TORY SIGNALING 1 Massage therapy was administered to the quadriceps of 11 young male participants after they experienced exercise-induced muscle damage. Muscle biopsies were obtained from the vastus lateralis at baseline, immediately after 10 minutes of massage treatment, and after 2.5 hours of recovery. Massage was observed to exert numerous effects: (a) activation of focal adhesion kinase, (b) stimulation of extracellular signal-related kinase ½, (c) potentiation of mitochondrial biogenesis signaling, (d) reduction of the increase of the inflammatory intermediate nuclear factor (NF-kB) caused by exercise-induced trauma, (e) attenuation of tumor necrosis factor alpha, (f) reduction of the production of interleukin-6, and (g) inhibition of the phosphorylation of heat shock protein. Massage had no effect on the muscle metabolites lactate or glycogen. The conclusion of this investigation was that, when administered to skeletal muscle acutely damaged by exercise, massage appeared to be clinically beneficial by reducing inflammation and promoting mitochondrial biogenesis. 1. Crane JD, Ogborn DI, Cupido C, Melov S, Hubbard A, Bourgeois JM, Tarnopolsky MA. Massage therapy attenuates inflammatory signaling after exercise-induced muscle damage. Science and Translational Medicine 2012; 119ra13: doi: /scitranslmed MANUAL THERAPY FOR CHRONIC TENSION-TYPE HEADACHE 1 The purpose of this investigation was to evaluate the effectiveness of manual therapy on the frequency of chronic tension type headache (CTTH), use of pain medication, and impact of headache and cervical function compared to usual care by the general practitioner. In a multicenter, pragmatic, randomized clinical trial with partly blinded outcome assessments, 82 participants with CTTH were randomized to manual therapy or usual care by a general practitioner over an 8-week period. Usual care consisted of information, reassurance and advice, prescribed analgesics or NSAIDs with an average of 2-3 visits. Manual therapy consisted of a combination of mobilizations of cervical and thoracic spine, exercises, and postural correction with treatment durations of 30 minutes with a maximum of nine treatments. Superior outcomes of the group experiencing manual therapy were observed in frequency, duration, and intensity of headaches at 8 weeks and 26 weeks follow-up, as well as in cervical range of motion, algometry, and endurance of the neck flexors. 1. Castien RF, AWM van der WIndt D, Grooten A, Dekker J. Effectiveness of manual therapy for chronic tension-type headache: A pragmatic, randomised clinical trial. Cephalalgia 2011; 31(2): INSTRUMENT-ASSISTED SMT: ELECTROMYOGRAPHIC ACTIVITY, PRESSURE-PAIN THRESHOLDS 1 A repeated measures, single-blind randomized trial was conducted on 30 participants without a current history of low-back pain, using the protocol from Activator Methods or a sham procedure over two sessions. Outcome measures consisted of (a) Bilateral pressure-pain thresholds (PPTs) over the L5-S1 zygapophyseal joints, L5 dermatomes, and first dorsal interossei in hand, and (b) bilateral electromyographic activity (BEA) of the low back and neck region assessed by an operator blinded to the group assignment of participants. Results indicated that the Activator intervention led to a greater improvement of PPT irrespective of the side tested or side treated, as well as an immediate decrease in BEA in the paraspinal muscle on the pelvic deficiency side of the low-back region. The conclusion was that the application of the Activator instrument resulted in an immediate and widespread hypoalgesic effect with local muscle relaxation in asymptomatic participants. 1. Yu X, Wang X, Zhang J, Wang Y. Changes in pressure pain thresholds and basal electromyographic activity after instrument-assisted spinal manipulative therapy in asymptomatic participants: A randomized, controlled trial. Journal of Manipulative and Physiological Therapeutics 2012; 35(6): In July 2012, Virginia suffered a terrible storm that downed trees and power lines, leaving the majority of the state without power in sweltering heat. It took over a week for power to be restored to everyone and for normalcy to return. In late October 2012 Virginia suffered additional damage by the super storm, Hurricane Sandy. Damage was significant but nowhere near the damage seen in July. The damage was also minor when compared to the damage seen in the northeast, especially the damage seen in New Jersey and New York. Many people were upset with the response and effectiveness of power companies during these events. However, they really did a remarkable job considering the extent of the damage and the fact that many of the linemen were not from the areas of devastation and were not familiar with the power grids they were repairing. When catastrophes of this nature occur, power companies from across the country respond to help. After the July storm in Virginia, sixty percent of the linemen and equipment from Kentucky were sent to Virginia. Convoys of trucks from power companies in Louisiana, Maryland, North and South Carolina were seen in our area. Before Hurricane Sandy struck, trucks from out-of-state power companies could be seen sitting at restaurants and hotels in our area. The D.D. Palmer s first patient was deaf and his second had heart disease. The early chiropractors had incredible successes with a variety of conditions. Today s chiropractic patients are not as responsive. I postulate the most important reason for this trend is the nutritional status of society in general, and our chiropractic patients specifically. The best adjustment in the world means little unless it holds. There are five basic tissues supporting a typical adjustment: connective tissue, ligaments, muscles, bones, and nerves. The following is a review of how they can be nutritional supported. If connective tissue is considered separately as an organ, then it is the largest one in the body. The relationship between connective tissue disease and vitamin C was first established over 200 years ago by James Lind in his seminal book, Treatise on Scurvy (1753). He wrote of muscles and bones literally separating from contiguous structures on postmortems. Of greater relevance to our patients today is subclinical scurvy, where the connective tissue, although intact, is markedly weakened. This predisposes one toward herniated discs, arthritis and other types of degeneration. In these circumstances, vitamin C has been shown to have therapeutic effects as companies had responded in preparation to the storm once the governor declared a state of emergency. These same situations occurred in New Jersey and New York before and after the storm. Linemen responded from as far away as California. When power companies respond to these disasters they do so at their own cost. Local companies provide food and shelter in most instances but the expenses for linemen and equipment are covered by the responding companies. Responding companies do this knowing that the favor will be reciprocated if they are ever in a similar situation. The cooperation between the power companies is a great example of colleagues sticking together. Chiropractic as a whole can take a lesson here. It can also take a lesson from the Association of New Jersey Chiropractors (ANJC) and the Unified Virginia Chiropractic Association (UVCA). These organizations have pulled together in recent years as chiropractic weathers the storms of managed care, Medicare, government mandated regulations, and others. While the topic of unification is continuously discussed and advances have been made, we are still far from sticking together. More needs to be done as the storms rage on. There are still too many chiropractors who do not belong to state or it acts as an antioxidant in the body, and is required for the synthesis of collagen. In fact, Dr. McCormick stated that therapeutic use of the vitamin (C) be made a part of the non-surgical care of all such cases (Journal of Applied Nutrition, Volume 15, p.4-12). Ligaments, although sometime considered almost inert, have a rather dynamic function. If healthy, they use very little energy while holding osseous structures in place. What happens when they are deficient in an important nutrient? Two of the most important are manganese and choline. When they are missing it produces a parallel condition in poultry called perosis. Perosis, is a disorder of chicks, turkey poults, and young swans, characterized by enlargement of the hock, twisted metatarsi, and slipped tendons; it can be largely eliminated by adding manganese and choline to the diet, (Britannica Online Encyclopedia, 2012). Does that sound like any conditions that exists in humans? Years ago Major Bertrand Dejarnette, DC, DO and later George Goodheart, D.C. used to say Muscles move bones, and they believed strongly in balancing muscles. Muscles react to nutrients, and in his initial research Goodheart found natural vitamin E strengthened muscles. Other nutritional elements that can help support muscle national organizations. One plan that could help address this situation is having members extend personal invitations to nonmembers to join. In the movie We Are Marshall, the true story of the plane crash that killed Marshall University s entire football team, a personal request was depicted that made a significant impact on the comeback of the university s football program. The National College Athletic Association (NCAA) did not allow freshman to play their first year but freshmen were the only players available to Marshall. Marshall s president wrote a letter to the NCAA requesting that the rule be waived for his university due to their special circumstances. The request was denied. When the denial was received the new head coach encouraged the president to ask again but in a different way. The coach compared the importance of the request to that of asking someone to marry you. You would not ask by letter. The request was too important and personal to ask by letter. The coach asked the president to go to the NCAA in person and ask directly. The president traveled to the NCAA office, made his case in person and the request was granted. This example can hold true in asking for someone s commitment to Nutritional Considerations of Chiropractic Adjustments By Dr. Steve Lavitan regeneration include balanced essential amino acids. To help support the muscles, some practitioners may recommend dry dessicated muscle tissue for supplementation. However heat can destroy join and serve in an organization. Personal invitations can make a difference. Every chiropractor participating in state and national organizations should personally ask a few non-members to join. The worst thing that could happen is the doctor will say no. If that does happen, everyone should remember the doctor is still one of us. Agree to disagree in a friendly manner to prevent widening the gap between members and non-members. Finally, a good example of pulling together was witnessed by this author in September of 2012 while speaking to the Louisiana Union of Chiropractic Physicians. The group collected funds for a few chiropractors who lost their homes and businesses in the most recent hurricane to strike the Louisiana shore. Some of the doctors were not members of their organization. I hope we all support our colleagues on the east coast in a similar manner, members or not. K. Jeffrey Miller, DC, DABCO has been an author and speaker for 20 years in the chiropractic profession. He frequently writes and speaks for the ANJC. Jeff is a member of the UVCA and serves as the director of clinical operations for Tuck Chiropractic in the New River and Roanoke Valleys of Virginia. some of the most important amino acids, including methionine, in the muscle tissue. Instead, using a dessicated muscle tissue that utilizes Offers Good Thru February 28th Pricebreaking Offers on Clinical E-Stim! 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10 18 Winter Winter Accurate Mensuration Documents Spinal Ligament Injuries, Reduces Costs By Dr. Bill F. Puglisi As noted in the proposed PIP Regulation Changes by the Department of Banking and Industry, there is a major effort in cost-containment by insurance carriers. In most cases these changes are a detriment to both the treating doctor and the injured patient. However, it should be obvious that accurate diagnosis and treatment of injuries saves everyone time and money, while benefiting patients. In Worker s Compensation claims for example, insurance carriers report that a large amount of healthcare costs may be due to malingering or fraud. This also applies to Auto Personal Injury claims as well. The problem for doctors becomes deriving an actual, accurate, objective differential diagnosis for these injuries, so everyone is on the same page. Obviously the biggest cost-saving measure is in prevention. Reducing risk factors is an obvious area of focus and ergonomics at the workplace has become an industry in itself. Much attention is also placed on safety in the workplace environment. Yet the number of work-injury claims over the past 10 years has not been significantly reduced with regard to musculo-skeletal injury. Work injuries still happen at a significant rate. The incidence of auto accidents is actually increasing in many areas. When injury is confirmed, the degree of injury, and therefore the amount of treatment, is often in question. It is difficult to determine the exact extent of certain injuries, especially those classified as softtissue injuries of the neck and back, the most common of all injury claims (see W.H.O., CDC and OSHA Statistics osh2.nr0.htm). Twenty five percent of all workplace injuries are of the lower back from overexertion (Bureau of Labor and Statistics data). The cost containment efforts involved in treatment of these injuries is of concern to all parties, especially the patient and their insurance carrier. Any implemented cost-containment measures need to be evidence-based, practical, and at the same time not be a compromise to a patient s needed care. The problem is that with many of these common work-place injuries, the assessment process used by most physicians has at least some degree, if not a large degree, of subjectivity. As an example, in a study by W.S. Marras (Gregory G. Knapik and William S. Marras, Biodynamics Laboratory, the Ohio State University, Columbus, USA Ergonomics Vol. 52, No. 1, January 2009, 60 70): The disability ratings of the same patient by 65 independent medical examiners shows that the range of disability varied from 0% to 70%. The problem with such subjective assessments that lack objective criteria is apparent from the lack of convergence of the assessments. It has been estimated that a precise diagnosis is unknown in 80-90% of disabling LBDs, emphasizing the need for more quantitative measures (29). Imagine: A patient with a lumbar spine injury with an associated permanent impairment was sent to 65 medical experts for a specific impairment rating using the AMA Guidelines to the Evaluation of Permanent Impairment. The patient returned with assessments from zero to seventy percent impairment! Obviously a more quantitative assessment is necessary. CRMA (Computerized Radiographic Mensuration Analysis) is a very valuable tool in addressing these injuries, especially when it comes to spinal softtissue injuries of the neck and lower back. CRMA is the most accurate assessment available to quantify soft-tissue spinal ligament injury (severe spinal sprain) and subluxation, common in work accidents and auto accidents. CRMA is a highly advanced computerized mensuration of standard diagnostic x-rays, used mainly for assessing spinal ligament compromise. CRMA has been available for clinical use since It has been incorporated into the National Guidelines Clearing House, and established in peer-reviewed treatment guidelines. Are you being investigated by the nj Board of ChiropraCtiC examiners or audited by an insurance Company? Representing yourself could be a costly mistake. You could be subject to fines, recoupment or even the loss of your license. Protect your livelihood! Hire someone who has insider experience working with deputies and investigators as former Acting Director of Regulatory Affairs for the NJs Consumer Affairs Department. Ms. AriAns drafted many of the laws that regulate the health care community. She will aggressively defend your interest. Call today and put your mind at ease. The LAw Offices Of e. Vicki AriAns, LLc (973) The cost-containment value for use of CRMA is many-fold: 1) A more accurate quantification of spinal injury obviously leads to more accurate classification of that injury, which in turn leads to more precise application of treatment protocols. This saves all parties involved in any claim time and money in healthcare costs. Noting the fact that spinal pain (neck and/or back pain) is the number one reason for missed time from work each year, even employers can greatly benefit in reduced work time loss; something that is a key issue for workers, employers, and insurance companies, with savings in the billions. 2) Accurate diagnosis and streamlined care is a tremendous benefit to not only patients under care, but the resultant possible/ probable decrease in treatment time saves money for the party responsible for payment of the care for those injuries, usually the insurance company (seventy-five percent according to the above studies). Of course nothing is more important than the patient recovering faster and more completely from an injury. 3) Accurate diagnosis and proper classification of soft-tissue spinal injury also weeds out fraud and malingering by alleged injured patients, which according to insurance carriers, is a very significant cost to them, and a major part of their cost-containment efforts. All other criteria for spinal injury assessments have some degree of subjectivity in their evaluation. The least amount of subjectivity, and therefore the most objective diagnostic evaluation, is found in CRMA as an assessment tool. 4) After treatment is completed, a permanent impairment rating by a medical expert will determine most of the future medical/insurance costs that may be associated with an injured patient (see Marras study above). CRMA, if performed by reputable companies with a Board Certified Medical Radiologist on board, yield reports with permanent impairment image findings, greatly aiding any doctor performing an assessment of a patient for permanent injury. Again, accuracy and objectivity of CRMA helps eliminate malingering and fraud, as well as properly classifying the actual injury sustained. Everybody wins. The AMA requires evaluation of soft-tissue spinal ligament injury to be assessed only by comparison of flexion extension radiographs. There is no other accurate way (AMA Guidelines, pg 379). MRI and CT scan are of very limited value in this regard, as you can see by the Marras study above, as well as many others studies. CRMA is by far the most accurate and objective way to compare flexion extension radiographs, a consensus drawn from various peer-reviewed Treatment Guidelines, such as the CCP (Chiropractic Clinical Practice Guides) and others. CRMA is by far the most accurate and objective way to compare flexion extension radiographs, a consensus drawn from various peer-reviewed Treatment Guidelines, such as the CCP (Chiropractic Clinical Practice Guides) and others. This type of analysis is already being embraced by carriers in most states, being required as a cost-cutting measure. For example, in some states, insurance companies require accurate mensuration of the lumbar spine before they will authorize a spinal fusion surgery. Certain threshold numbers have to be met before surgery will by authorized. Most surgeons will not perform a scoliosis corrective surgery without accurate mensuration. Most will not perform a hip replacement surgery without accurate mensuration. So why would any doctor in any profession, treat a soft-tissue spinal ligament injury resulting in subluxation without proper assessment and classification of that injury by objective and accurate mensuration? The obvious conclusion from these facts is that a more objective analysis of soft tissue spinal injuries is necessary, and since CRMA is the most accurate and objective analysis available anywhere, and already established and accepted in both the medical and chiropractic community, it should be included as part of any spinal injury analysis where ligament sprain injury is suspected. Published research reports a 41-71% error rate when analyzing these improprieties by hand mensuration (Siegler and Howe, JMPT :75-80), leaving CRMA as the most accurate and reliable assessment available. CRMA should be the goldstandard of spinal soft-tissue injury analysis for all doctors, especially chiropractors, as it measures, confirms and grades subluxation, something we have all been wanting for over 100 years. Dr. Bill F. Puglisi, DC, CCWP, of Elite Wellness Center, Totowa, NJ He has been a practicing N.J. chiropractor for 29 years, and author of the book Finally, The Truth About Health. EHR Meaningful Use: To Do, or Not To Do By Dr. Jeff Brown Technological advancement enhances the success of any industry, and healthcare is no exception. It is easy to recognize technology s role in the medical world; magnetic resonance imaging and arthroscopic surgery (necessary or not) are two great examples. It s also easy to understand the reason for such improvement would you like to have a 1950s knee surgery based on a 1950s x-ray in 2012? Now let s look at clinical documentation advancements. What significant documentation change has occurred in the past 60 years that improved patient outcomes? There isn t one. Think about it. Aside from being required to write down more stuff, nothing has changed since Even if you transitioned to an EHR or EMR years ago, all you have done is increase your capacity to document more stuff by pushing a button instead of pushing a pen. In reality, there is nothing a traditional EHR can do that a doctor using pen and paper can t do. Ultimately, both doctors end up with a clinical note saved in either a paper chart or on an office computer. It is true traditional EHRs benefit the individual provider because of increased documentation efficiency, however, healthcare as a whole gains nothing. I say this because the clinical knowledge you ve amassed through your documentation, whether on paper or computer, sits idle in your office. No other provider, not even the patient him or herself, can benefit from your documentation unless you physically mail or fax this information. Even you, the provider who authored the notes, are limited to really benefiting from your own documentation; this depends entirely on how much time and effort you spend reviewing past notes. Enter the federal government. One role of government is to fulfill specific needs of its collective citizens, which an individual citizen cannot be expected to fulfill on his or her own. The perfect example of this concept at work is traffic signals. You will never go down to your local hardware store, purchase a traffic signal, rent a bucket truck, and install the light at the intersection of Main St. and Wall St. Instead, you entrust government, local in this case, to handle this activity for you and your neighbors. Just like needing traffic signals to keep transportation efficient and safe, it s a good idea to have universal clinical documentation standards in place to keep healthcare efficient and safe. The problem is individual doctors do not demand highly functional EHRs capable of doing more than fast note-taking. Therefore, the government stepped in and created the EHR Incentive Program, the intent of which is to drive technological advancement in the area of clinical documentation by putting stimulus dollars in the hands of doctors willing to do something extra. That something extra is taking clinical information, what traditionally sits idle in provider offices, and make it live through certified EHRs. The rationale is this: If health information becomes active, meaning it s not sitting in paper charts, useful only to a few people, and the information becomes easily exchanged between doctors, doctors and government, and even between doctors and patients, vast amounts of knowledge and efficiency will be gained. The end result for healthcare being increased quality, and decreased cost. (Note: The sharing of information between doctor and government is extremely limited under the EHR Incentive Program.) Chiropractic & Oncology 1998 Aug;62(1):49-55) or Stop Nausea Inhaler, which contains essential oil of peppermint (J Perianesth Nurs, 2004 Feb;19(1):29-35). Constipation may be treated with smooth move tea. Berberine may be useful in reducing the severity of diarrhea related to abdominal radiotherapy. The list is not endless as research is still being conducted to find ways to address the treatment side effects that plague this patient population. Currently, NCI and NCCAM are currently sponsoring or cosponsoring various clinical trials to study complementary and alternative treatments for patients with cancer. These studies include: Electroacupuncture for delayed chemo, nausea, CoQ10 for blood level support for women on doxorubicin, Curcumin to reduce skin reactions from radiation, Acupuncture to prevent dry mouth in head and neck cancer. As the focus on quality of life and treatment outcomes creates more options for those suffering through the diagnosis and treatment Continued from page 11 of cancer, chiropractors will hopefully find a significant role in the field of integrative oncology. To be a partner in this necessary arena, cooperation and collaboration combined with open-mindedness are essential. To quote Richard Stephenson, the founder and chairman of Cancer Treatment Centers of America, It is and always will be about the patient. Jeffrey Sklar, DC, Director of Chiropractic Services at Cancer Treatment Centers of America in Philadelphia, has been practicing chiropractic for more than 15 years. Dr. Sklar has been featured in numerous magazine articles and television interviews about chiropractic treatment and integrative care for cancer patients. He is also a member of the Cancer Fighters Thrive magazine editorial board. For more info Jeff.Sklar@ctcahope.com. For the above benefits to be realized, two things must occur simultaneously. Software vendors need to develop new capabilities within their products to become certified under government standards and providers need to actually use these new EHR capabilities in practice. The later is termed meaningful use, which literally means using a certified EHR in a meaningful way. Meaningful use is defined by CMS and is made up of 25 requirements known as measures. Essentially, if you complete each measure, then you have proven you ve used your certified EHR in a meaningful way, and are now eligible for a stimulus check. The question is, Do you want to do, or not to do meaningful use using a certified EHR? There are positives and negatives to either answer. Let s take a look. To Do: Currently, the greatest positive to participating in meaningful use is the $44,000 (per provider) in stimulus money you can receive. This amount of money far exceeds any additional costs associated with certified software. At this point the only negative is the extra work required to achieve meaningful use. Notice I didn t say ridiculous, overwhelming, or unrealistic amounts of work, I only said extra. I bet the 100K plus providers who received $18,000 in 2011 or 2012 will tell you the extra work was worth it. Especially since they are eligible for another $12,000 stimulus check their second year! And, choosing to do doesn t mean you re left to fend for yourself. Stepby-step guidance is available to make meaningful use, and the stimulus money that follows, within everyone s reach. Not To Do: The positive of doing nothing is simply doing nothing more. Easy enough. I ve also heard doctors say they don t want to be on the government s radar. But the fact is, you re already on the radar if you bill anything to Medicare. The negative to not participating is a bit more complicated. Not only would you be missing out on lots of stimulus money and facing reduced Medicare reimbursement beginning in 2015, but you d also be left to exist in the traditional documentation vacuum of yesteryear. As the rest of healthcare becomes more and more interconnected, you ll be left behind wondering why no one wants to send patients your way. To Do, Or Not To Do Meaningful Use? This is the question. Either conclusion may be wise for your practice depending on your personal practice goals and aspirations. When deciding, just know the healthcare industry is taking great strides to finally bring true advancement and technology to EHRs for the betterment of everyone. And this trend isn t going away; the benefits of meaningful use are long overdue and too great to be ignored. Jeff Brown, DC, CPC, CCPC is the founder of Meaningful Use Mentor, a low cost membership website, and author of Meaningful Use Provider Guide- Book. Dr. Brown practiced for four years in both Ohio and Michigan, after which he attained Certified Professional Coder (CPC) and Certified Chiropractic Professional Coder (CCPC) distinctions, taught numerous CE seminars, wrote articles, and traveled nationwide performing in-office provider consultations. Brown is a 2003 summa cum laude graduate of Sherman College of Chiropractic and holds a Bachelor of Science from Michigan State University. 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11 20 Winter Winter Q: For 2013 PQRS, I do not use EHR so do I have to report that measure? A: No, Measure #124, Health Information Technology (HIT): Adoption/Use of Electronic Health Records (EHR) was retired for 2013 and no longer in use. Q: What are the Measures that a chiropractor could use for PQRS? There are 3 measures: Measure #131: Pain assessment and Follow-Up Measure #182: Functional Outcome Assessment Measure #321: Participation in a Systematic Clinical Database Registry that includes Consensus Endorsed Quality* *This may not be applicable to many DC s Q: For the Pain Assessment Measure, does it have to be reported every visit or just at the time of a re-examination? A: The instructions for this Measure specifically states that this measure must be reported on each visit during the reported period. Medicare Q: Would I have to report a G-code for Pain Assessment Measure if the spinal adjustment was a maintenance visit? A: If the Medicare patient is 18 or older and you performed a 98940, or adjustment this would be considered eligible criteria for this measure whether the visit was for active care or maintenance care. The appropriate G-code for this measure may vary depending on whether the provider used a standardized tool, the result of the pain assessment and the documentation of a follow-up plan reassessing the pain. Q: For the Outcome Assessment, which G-code would I use for the visits in between the 30 days of each Outcome Assessment tool? A: G8942 would be used for reporting purposes for these visits. Q: Can I use the Visual Analog Scale to report for both the Pain Assessment and Outcome Assessment instead of doing two different ones? A: No. The use of a standardized tool assessing pain alone, like the VAS, does not meet the criteria of a functional outcome assessment standardized tool. ANJC Assists Members Affected by SUPERSTORM SANDY The member matching process began with HQ reaching out to members to see whose offices were functioning, and whose were not. We asked those that were functioning to let us know if they would be willing to donate space to doctors who were not functioning. Through this effort, almost 90 doctors volunteered office space. HQ geographically matched up the doctors who had space with those in need, and were successful in reaching and assisting doctors who needed help. HQ also asked doctors to lend or donate equipment to those members who sustained damage or loss of RTHE ROTHENBERG GROUP, LLC Continued from page 1 equipment, and once again the ANJC members answered the call in helping their colleagues. Fifty-one doctors graciously donated or lent such items as stationary tables, x-ray machines, exam tables, office furniture, massage chairs, and various PT equipment. HQ notified members in need of equipment and they reached out directly to these doctors. Despite the devastation and longterm effects from Superstorm Sandy, the member matching program was a huge success. It shows that the generosity and camaraderie of the members of ANJC is as solid as ever! PIP COLLECTION SPECIALISTS Family owned and operated for 18 years Over 75 million dollars collected Serving over 100 medical providers Minimize Arbitration delays Don t be a victim of the Arbitration System Most Chiropractic services don t require Arbitration & can be resolved quickly. Free in office seminar, teaches patient intake, treatment & billing strategies, precert, denials, appeals, carepaths, medical necessity and permanency. Our system allows the patient to receive all necessary services, under the current regulations. Learn how to continue to prosper under the new proposed regulations, when they are enacted. Call today for low tax deductible rates and references! JRAPIP@optonline.net PQRS Sheet Update What is it? PQRS is a Medicare program called Physicians Quality Reporting System. Per the Patient Protection and Affordable Care Act (aka Obamacare) participation in this program is mandatory beginning in Starting in 2013 you must participate at a satisfactory rate (50%). If you do not successfully report on 50% or more of claims between Jan. 1, 2013 and Dec. 31, 2013 then in 2015 your reimbursement from billed amounts to Medicare will be reduced by 1.5% and by 2% starting in How do I participate? There is no registration process for PQRS. You simply need to report on the two measures applicable to DCs. These measures are: Measure #131 Pain Assessment and Follow-up; Measure MEASURE # 131 PAIN ASSESSMENT and FOLLOW-UP Provider Action Pain Assessment Documented as Positive AND Follow up Plan Documented Pain Assessment Documented as negative, No follow-up plan documented Patient not Eligible for Pain Assessment for Documented Reasons Pain Assessment Documented, Follow-up plan not documented, Patient not Eligible/Appropriate Pain Assessment not Documented, Reason not Specified Pain Assessment Documented as Positive, Follow-up Plan not Documented, Reason not Specified MEASURE # 182 FUNCTIONAL OUTCOME ASSESSMENT Provider Action Current Functional Outcome Assessment and Care Plan Documented Current Functional Outcome Assessment Documented, no Functional Deficiencies Identified, Care Plan not Required Functional Outcome Assessment and Treatment Plan documented within the previous 30 days Current Functional Outcome Assessment not Documented, Patient not Eligible Current Functional Outcome Assessment not Documented, Reason not Specified Current Functional Outcome Assessment Documented, Care Plan not Documented, Reason not Specified Important LINKS Provider Action ACA Guidebook to PQRS CMS Guide to PQRS CMS PQRS Help Desk 2012 Qualified PQRS EHR Direct Vendors Access to Feedback Report NJ Medicare Administrator TIMELINE of Incentives/DISINCENTIVES Provider Action #182 Functional Outcome Assessment. To participate, you must report on BOTH measures. To report you would place the appropriate G-code on your claim form for your response to each of the Measures required. The G codes are five digit alpha-numeric codes and would be placed in box 24 of your CMS 1500 form, the section of your claim form where CPT codes are entered. You would enter the CPT codes billable to Medicare (98940, 98941, 98942) followed by the G codes then followed by any other CPT codes performed. You must report on these measures on every visit for every Medicare patient who is at least 18 years old. Code Code G8730 G8731 G8442 G8939 G8732 G8509 Code G8539 G8542 G8942 G8540 G8541 G8543 Phone: Qnetsupport@sdps.org QualifiedEHRDirectVendors.pdf community/pqri_home/212 Code % incentive bonus % incentive bonus % incentive bonus % payment decrease % payment decrease If you do not successfully report on the PQRS measures in 50% of your claims from 1/1/13 to 12/31/13 you will be penalized 1.5% on all Medicare patients beginning in 2015!!! Kinesiology Tape: Crucial in Providing Top Level Care to All Patients, Including Athletes By Dr. Kevin D. Jardine As chiropractors we are always looking for innovative and effective ways to help our patients recover and get back into action. One of the tools I have added to my skill set is the use of kinesiology tape. Kinesiology tape offers people of any age and any activity level the opportunity to naturally reduce the discomfort associated with muscle and joint aches and pains. The advancements in pain neurophysiology have revealed some of the amazing potential kinesiology taping has to offer and forms the base of modern education into the use of kinesiology tape. Current research is shedding light on the negative neuromuscular consequences of injuries on a patient s recovery following musculoskeletal injuries. This has led to an increased understanding of the importance of sensori-motor stimulation for both therapeutic and rehabilitative success. What the research has shown us is that virtually all painful conditions are associated with altered neurosensory signaling between the muscles and joints affected and the central nervous system (CNS). The clinical presentation of this is what we call neuromuscular deficits. This is ultimately where injuries result in an alteration of information coming into the central nervous system and if you have altered information coming in, you will have altered information going out. Therefore, what we are attempting to do with our treatment and rehab strategies is provide the right type of afferent stimulation in order to change the efferent output in the direction of therapeutic intent. This is exactly what we achieve with the use of kinesiology tape. A: In the special services, procedures and reports heading in the medicine section, codes provide the reporting physician with the means of identifying the completion of special reports and services that are an adjunct to the basic services rendered. These adjunct services describe patient encounters involving a special circumstance, such as a service requested and performed after scheduled office hours. These adjunct codes are never reported alone, but rather in addition to another code or codes describing the service related to that patient encounter. For example, an after office hour visit may be reported with the appropriate E/M visit code and code Services requested after office hours in addition to basic service. Code represents an "adjunct" code and is intended to be reported for office-based practices whose usual posted hours (with scheduled staff ) do not include services provided after the normal With the use of kinesiology tape, the altered signals experienced by the nervous system after an injury can be normalized due to the afferent stimulation of the tape on the skin. This process occurs through a combination of mechanotransduction and mechanodisruption leading to neuroplastic changes if prolonged. When the tape is adhered to the skin s surface, it mechanically stimulates the touch receptors. This stimulation is converted into an electrical signal through the process of mechanotransduction. The electric impulse is then sent rushing through the nervous system. Since the impulse is traveling on A-beta fibers, touch receptors, which are bigger and faster than C-fibers pain transmitting neural pathways the end result is the modulation or dampening of the sensation of pain. And in the nervous system, as the signaling of pain diminishes, the ability of effected muscles to activate properly is restored. Rigorous scientific testing is still needed, but anyone who has used kinesiology taping in practice will vouch for the benefits seen in clinical practice. The introduction of precut, ready to apply applications now make applying kinesiology taping more clinic friendly and time efficient. The sound understanding of the clinical relationship between a patient s compliance and how you apply the tape underlies the importance of an educational program. The education behind the use of kinesiology tape helps you understand the multitude of conditions taping can help with and can also help you understand the different ways the same piece of tape can be applied in order to achieve a different clinical outcome. Q&A Billing & Coding Continued from page 6 posted office hours For example, if the regularly posted office hours are Monday-Friday 9 AM-5 PM, and the physician is requested to see the patient in the office at 7 PM to evaluate administration of pain medication, then from a CPT coding perspective, the physician may report the appropriate evaluation and management service code and code to indicate that the service was requested and performed outside of the posted office hours. The medical record should reflect the medical necessity and services rendered. CPT code is reported for service(s) provided on an emergency basis out of the physician's office, which disrupts other scheduled office services. Code is reported in addition to the basic service. So in regards to the appropriate code I think you are using it, unfortunately the payers you are reporting it to don t appear to cover that type of service or have incorrectly denied it I would appeal the denial. One of the main therapeutic benefits of using kinesiology tape in practice is the ability to extend your therapeutic input to your patient beyond the walls of your office. As an example, we can look at something as common as knee pain. With the signals of discomfort actively transmitting to the CNS, the brain will be telling the muscles supporting the knee to turn off, which leads to an alteration in the timing and sequence of activation and thus a loss of function. In clinical practice, after treating the area I would apply kinesiology tape and instruct the patient to leave it on for five days. In this case kinesiology tape would be applied using a neuro-sensory technique (there are various techniques that are dependent on your clinical objectives) resulting in a reduction in discomfort for the patient, but more importantly, a restoration towards normal motor activation, which is crucial if movements and exercise are used as a part of the treatment plan. Kinesiology tape is different from traditional forms of tape because it is designed to be flexible, so it moves with you while you are active. The tape also has a very special adhesive that allows kinesiology tape to be in contact with the skin for multiple days of continuous wear without leaving any residue or skin irritation. Kinesiology tape can be worn in very vigorous physical activity as well as during everyday occupational activities. The advent of kinesiology taping provides your patients, whether athletic or not, an opportunity to wear their therapy while demanding the most out of their bodies or simply trying to get through their day. Dr. Kevin Jardine is a leading innovative health strategist and an expert in the field of athletic medicine. Dr. Jardine is the original creator of Spider- Tech and the president and owner of Collaborans, a multimedia continuing education company for healthcare and fitness professionals, which provides both online and hands-on learning opportunities for today s leading practitioners. Visit or for more information. Your Most Valuable Asset: Your Team call if you can. If you have a NP phone script, see how well it s followed. Use this to train your team. Face to face skills Consider an anonymous survey with five questions sent to your patients. Ask direct questions about your team, and whether each patient feels excellent customer service is delivered. Lack of attention to detail As errors are discovered, make a list. Look for the common areas where mistakes are made and plan training time specifically for that area of focus. Lack of knowledge Use team meetings to play fun training games and to incorporate pop quizzes. Use this to uncover areas where the team needs training. Make it fun with $10 Starbucks cards for the winners, or movie tickets. Where much is given, much is required. Expect the best from your team. Continued from page 12 Staff that is well trained in their positions and in office customer service standards are valuable assets to any chiropractic office. Listen closely to hear patient comments about your office and its improvements. Implement the change you wish to see, and you will be amazed how quickly a positive and confident environment attracts quality patients who leave feeling great and offer positive comments about your office to their friends and family! Kathy Mills Chang is a Certified Medical Compliance Specialist (MCS-P) and since 1983, has been providing chiropractors with reimbursement and compliance training, advice and tools to improve the financial performance of their practices. Kathy thanks KMC University Reimbursement Specialist Suzanne Ball for her contributions to this article. Kathy, Suzanne and all the other specialists at KMC University can be reached at (855) TEAMKMC or info@kmcuniversity.com.

12 22 Winter Winter LEGAL EASE NJ PIP Regulation Amendments Take Effect January 4, 2013 Proposal #: PRN The Department of Banking and Insurance (DOBI) has proposed new regulations relating to the personal injury protection (PIP) benefits available under the New Jersey No-Fault Act to persons injured in automobile accidents. The changes include amendments to PIP benefits, PIP dispute resolution, and PIP medical fee schedules. The DOBI published proposed regulation amendments on August 1, 2011, in the New Jersey Register. A 60 day public comment followed under which the DOBI received over 19,000 comments that prompted a substantive revision of the proposal and re-publication and comment under the Administrative Procedures Act on February 21, The new comment period expired on April 21, 2012, and the DOBI recently published its comment responses on November 5, 2012, with an effective date for the regulations of January 4, The ANJC and its members oppose these regulations because they will have a negative effect on persons who are injured in automobile accidents and a chilling effect on the medical providers who treat them. It is the ANJC s position that the proposed regulations are illegal and ultra vires on their face as the DOBI has greatly exceeded their authority under the New Jersey No- Fault statutes and has proposed regulations that directly conflict with the No-Fault statutes and New Jersey Supreme Court precedent. Further, the ANJC feels that the proposed regulations are invalid as they violate the due process and equal protection rights of patients afforded by both the United States and New Jersey constitutions. Finally, the ANJC submits that the proposed regulations are in direct conflict with the express terms as well as the legislative intent behind the New Jersey No-Fault law and the intent of the federal Patient Protection and Affordable Care Act (PPACA) as the regulations will limit access to medical care, interfere with the ability of chiropractors to treat patients, delay the prompt payment of medical bills, and will result in an actual increase in healthcare costs as opposed to cost savings mandated by these remedial laws. The following is a non-exhaustive list of the amendments that will affect chiropractors in their daily practices. REGULATION AMENDMENTS: 1. PIP HMOs PIP HMOs are not authorized under this set of regulatory amendments. The first proposal allowed established Workers Compensation Networks to qualify as a PIP Organized Delivery System (ODS) and, therefore, be able to waive co-pay and deductible responsibilities of patients as an incentive to use network providers as was first permitted by the July 2010, PIP ODS regulations. This provision was deleted in the second proposal as NJDOBI felt it warranted further study before inclusion in the regulations. 2. PIP Vendors There is extensive new language requiring PIP vendors / third party administrators, such as Concentra and Procura, to register with the DOBI and be under their regulatory oversight. This should provide some accountability for the vendors and is a positive aspect of the amendments. PIP Vendors must have a medical director licensed in the State of New Jersey. 3. Daily Reimbursement Cap Is increased from $99 to $105 per day, a $6 dollar increase. Acupuncture is included within the daily maximum cap as well as unspecified Physical Therapy codes CPT and Fee Schedule Update 1,100 additional CPT codes are being added to the fee schedule. However, DOBI removed 117 CPT codes for low-frequency, high-cost procedures performed by neurosurgeons and spinal surgeons that were initially in the first proposal, which will continue to be paid at the provider s Usual and Customary Rate. 5. Uniform Appeal Process A uniform appeal process was to be implemented using only the NJDO- BI Uniform Appeal Form but has been delayed for a year for DOBI to revisit the appeal process. The appeal provisions of the amendments, thus, will take effect on November 5, Appeals are a condition precedent to arbitration and proof of appeal and response, or if no response, a certification as to no response signed by the attorney, must accompany all arbitration demands. A provision was added that providers and their attorneys can have penalties imposed for filing arbitrations without fully exhausting the internal appeals process as provided by the Forthright Rules of Arbitration. If the carrier fails to issue an appeal determination within the proscribed deadlines, they are estopped from raising any issues raised in the appeal at arbitration. Appeals can be submitted via fax, or web portal but if the provider submits via snail mail, they must have proof of mailing. Appeals are broken down into two categories: a. For Future Treatment Appeals, the provider has 5 days to appeal medical necessity denials of precertification for future treatment. The carrier must acknowledge receipt within 3 days and must issue a decision within 10 days of receipt. The initial amendments included a provision that if the provider does not appeal within the 5 day deadline, his or her appeal would be converted to an administrative appeal was deleted and replaced with an indication the provider can resubmit a precertification request if they miss the 5 day appeal deadline and then appeal a second denial within 5 days. A provision was also added that the PIP carrier response timeframes above will be stayed if the carrier requests an IME of the patient. b. For Administrative Appeals, comprising non-medical necessity issues such as coding, reimbursement, etc., the appeal must be filed within 180 Jeffrey Randolph, Esq. ANJC General Counsel days of denial and carrier has 5 days to confirm receipt. 6. Assignment of Benefits AOBs are limited to service providers only, which precludes the factoring of PIP claims. Carriers are permitted to include the assignment of duties to the healthcare provider in the AOB, which is in direct contradiction to the Appellate Division decision in Selective v. Hudson East Pain Management, 416 N.J. Super.418 (2010), aff d A-105 (7/18/2012), affirmed by the NJ Supreme Court on appeal, which held that patient assignments of benefits to healthcare providers does not also assign a duty to cooperate. This language was included in direct response to the Selective case and will require providers to attend Examinations Under Oath and provide discovery of non-medical corporate and licensure documents that both the Appellate Division and Supreme Court held they did not have to provide. 7. Paper-Only Arbitration Hearings Are expressly permitted pursuant to the Forthright arbitration rule amendments effective 8/1/11 for claims with a fee scheduled amount due of less than $1,000. MRI fee schedule payments were reduced so that many MRI arbitrations will fall within the paper hearing provisions. 8. PIP Arbitration Attorneys Fees DRPs are directed to calculate the Lodestar fee based on reasonable rates and time spent on the case pursuant to RPC 1.5 with specific focus on fees being consonant with the amount awarded to the provider. They must also engage in specific proportionality analysis of: i) cases where the fee certification exceeds the amount awarded to the provider; and ii) fees attributable to claims or issues won as opposed to fees attributable to claims or issues lost. 9. Usual and Customary Rate (UCR) Analysis The amendments add the Fairhealth database (successor to Ingenix) and Wasserman as databases DRPs can take into account as evidence of Usual and Customary Rates. 10. Kinesiotaping There is no separate reimbursement for kinesiotaping (similar to hot/cold packs) and the surgical strapping codes (i.e. CPT 29220) may not be billed. The provider can only bill for the actual tape using a DME code (i.e. A4552 which pays $.36 per unit). Kino-Tex Gold tape costs $18.90 for a 16.4 foot roll resulting in a cost of $1.15 per Continued on Page 26 Athletic Injuries & Muscle Pulls Essential Knowledge of Myofascia and Structure By Dr. William Charschan Athletic injuries are often an athlete s greatest frustration. They may feel a pull, a stitch, a hip pointer, calf pain, foot pain or another type of pain while they compete athletically. I ve seen many people sidelined when I played softball over the years. They stretched for minutes before the game to avoid injuries, which happened anyway because their body mechanics were compromised. However, they had little understanding of why. We inherit our body style from our parents. The way we walk by the age of six is most similar to how we walk as adults, however it also determines the way our body functions and feels. This is how we all see the world from then on and the way we feel at the age of six is our normal. When we feel pain or discomfort, using our assumed normal, we consider this abnormal. While this brings into question the value of symptoms (a common chiropractic theme), such as it hurt today, and not yesterday (yet the area is likely functionally mediocre both days), from a physician s point of view, the quality of a functional assessment of a person s problem is vital to helping them resolve their problem. By trying to treat their symptoms, which have little true meaning other than they are uncomfortable, and now understanding the underlying cause of those symptoms often in a different area of the body we are failing them miserably if we do not go the extra mile and look at them functionally. Perhaps, this is why many doctors are now integrating functional evaluation techniques like the Functional Movement Screen to better understand why their patient hurts. The way a person functions mechanically and its ramifications (tightened myofascia, restricted mobility they consider normal) results in rituals like exercises, stretches, etc. an athlete or regular patient will perform because they feel worse if they don t. Then, something happens leaving them in pain. As the patient s doctor, it is your responsibility to diagnose fully; look at the macro, the big picture including their structure, balance, etc., not just the micro where it hurts, where they feel tight to arrive at the most appropriate diagnosis, which leads you to the most effective path to help them get out of pain and avoid further injury. This is one of the thought processes that separate chiropractors from allopathy, and their model of symptoms and symptom resolution. A few years ago I experienced a quadriceps pull while retrieving a ball my young son threw wildly. All I did was bend to pick it up. I was feeling great that day so why did that happen? An important clue is that I am built asymmetrically. There was a reason the injury occurred and that reason existed just prior to my injury, but unfortunately, I never saw it coming. Your patients are no different. We all have a personal bias based on what we consider normal because our normal is what we have experienced since we were six and this is how we see the world. My quadriceps tear did not just occur; there was a precursor I was not aware of, which is almost always the case when your patient was playing tennis, or basketball, came down supposedly wrong on the foot and As a doctor, looking past the obvious needs to be our mission. It is not the injury to the knee, but since the knee is just a conduit, what was going on in the hip, core and foot, the kinetic chains of the body, will yield large clues as to why the injury occurred, and why future injuries may be avoided if we diagnose and treat the patient correctly. Master looking outside the box and you will help more people with more complex problems that conventional treatment regimens fail to help. People who are most likely to hurt themselves are built asymmetrically as stated before. This means one side of their body works differently than the other. The effect of this is torsion and pain throughout the body, which is amplified through the pelvis, and reinforced by tight myofascia that surround it. For the sake of this article, normal is symmetrical, abnormal is asymmetrical. Is there a normal, a range of normal or is overall function against gravity the problem? In most cases, the symptom is the last thing that occurs with poor function, and treating it often brings little relief, or worsens the pain, or if the symptom does improve, paves the way for future symptoms from the same mechanical issues. Always look at the mechanism, with the symptom being just part of the big clinical picture. Asymmetry strains joints, causes pain, and affects how the core muscles in your mid section function. The way we are built affects the way we walk, run and move. The myofascia, which covers all the muscles and organs in our body, according to Tom Myers of Anatomy Trains fame, actually controls movement. He describes it as a sock that covers all the tissues and is molded because of the forces that we place on it. His is a static model. Luigi Stecco, PT and his children have more of an active model that has been introduced to our country by Warren Hammer DC, DACBO. There are other models but the current information has made what many of us learned in chiropractic college in anatomy lab years ago obsolete. Taking this idea one step further, if we are moving about asymmetrically, our myofascia adapts to this and will eventually further reduce the effectiveness of our core muscles, making exercises ineffective, making the fascia surrounding our muscles tight and assuring us years of misery in the form of chronic pain and misdiagnosed Fibromyalgia (a condition misunderstood by the rheumatologists who have described it). The problem is, the harder we push to overcome our body style, without having an understanding for both the physician and the patient, the more injuries we experience to our back, our knees, and our muscles and the more inflexible we become because of pelvic torsion or tortipelvis. We have five motion zones, the two hips, the two shoulders and the core (3). This may be a new concept to many people but it explains the problem simply. All the motion is powered by the stability of your core. If we have poor core function, or if it becomes distorted, as we see in people who are built asymmetrically, the rib cage also distorts, causing neck problems, the tight core also restricts shoulder motion causing shoulder pain and neck problems and even hand numbness. If you run, it will cause you to over and under stride, which is what predisposes most runners to injury. The typical chiropractic patient has functional problems that require them to visit us for relief, often due to asymmetry and core issues. If the myofascia in the core distorts (3), it will further create problems for you and your patient, with more injuries, poor flexibility and chronic pain due to torsion throughout the kinetic chains and a poor distribution of forces throughout the body. To overcome this, we have to cheat mother nature, which also happens to be the title of my new book on amazon.com, or change the rules of the way we operate against gravity. To change the way the body works, we cannot change the way a patient is built. Remember that structure is largely inherited, unless there was a fracture that altered that structure. There are three things you will need to recommend to reliably affect structure and its adaptation in your patient. For many chiropractors, this applies to you too since the physical work required of us requires a stable core and good mechanics and spinal fitness. 1. Your patient must wear sandals with good arches and wear some type of foot orthotic in their shoes. This basically cheats mother nature by making them walk differently. It improves symmetry; many doctors who I have met who have learned to live with chronic problems aggravated by our profession feel better while wearing orthotics and Foot Levelers has created a successful business around this concept. At a minimum, an off the shelf insert will help your patient stay out of pain and be functionally sound while also creating a reliable income stream for your practice. This is a win-win for your patient and your success with treating their problem. 2. Your patient must have some type of bodywork done that specifically addresses the myofascia. This can include Active Release Techniques (a style of fascial release), myofascial release (including Rolfing), or Graston technique (instrument assisted soft tissue treatment). Warren Hammer has been teaching fascial release through as well. Massage is practitioner dependent, so choose carefully who you recommend for massage. 3. Finally, your patient will need gait retraining. Once your patient has improved and can be evaluated using one of many methods of active evaluation, they will tolerate exercises. Examples of these can be found on our website These are part of a simple system devised over the years to help patients improve their core function and their tolerance to gravity and more. The problem has never been what do you stretch, but why does my patient tighten while other people are less likely to? What is different about my patient is a very important question to ask yourself. Body style and asymmetry are at the root of why people tighten and visit chiropractors. Become an expert at understanding function, the myofascia, and addressing their mechanical issues your patients present with and your reputation in your community will be outstanding. To understand these concepts more fully, read the book, Cheating Mother Nature, now available on Amazon.com. This was written for both patients and doctors to understand why people hurt. Dr. William D. Charschan has been in practice in both Scotch Plains and North Brunswick since He is the medical director for USATFNJ, specializes in running injuries and has authored many articles, is an active blogger (Diary of a NJ Chiropractor) and authored Cheating Mother Nature: what you need to know to beat chronic pain. Visit Whypeoplehurt.com.

13 24 Winter Winter Running Mechanics and Running Workshops Nutritional Considerations of Chiropractic Adjustments Continued from page 17 By Dr. Donald C. DeFabio This article is an overview of running mechanics, functional assessment of the runner, and the framework to go out and provide this information as a marketing tool, called the Running Boot Camp, to position Doctors of Chiropractic as the running specialists in the community. The focus is to run with better mechanics to enable more training miles and fewer injuries: a simple concept that has many layers of application for the DC. According to The 2012 State of the Sport Report by Running USA, running is experiencing its second largest boom in the last decade with over 28,000 runners running at least once per week. There were 14 million finishers in road races in 2011 from fun runs to raise money for a local charity to marathons. To further underscore the potential impact for chiropractic doctors in treating runners, consider that runners spent an estimated 2.46 billion dollars in 2011 in running related apparel, training aids and performance improvement technology. These patients are out there and are looking to improve and maintain their performance. Let s begin with the central theme to improve running mechanics: running is a linear activity. Any motion that is not directly moving forward or causing you to move forward is wasteful, creates overuse injuries and decreases performance. Anatomical checkpoints are used to both evaluate and improve running mechanics to ensure that no motion is lost or wasted. Specifically, the feet, knees, hips, pelvis, rib cage, shoulders, elbows, hands and head alignment are all monitored. Understanding this concept leads us to beginning the process of improving running mechanics by isolating any mechanical imbalances that need to be corrected. The best technique for this evaluation is the Overhead Squat Assessment, OSA. The OSA is quick, requires no equipment and can determine both muscle and joint imbalances. It is done in stocking feet, hip width apart and feet straight ahead where you watch the runner s anatomical checkpoints (listed above) looking for dysfunctional movement patterns. This five step assessment is easily done in the office, or on site at a local 5K race, in the following combinations: Arms extended fully overhead Arms extended fully overhead with the heels elevated 2 Hands on hips, feet level Single leg ¼ squat with hands on hips, right and left* *Tomorrow, ask your runners to stand on one foot, no shoes, feet straight ahead, and do several ¼ squats and watch their running anatomical checkpoints. Running is a fast ¼ squat, so if they fall or are unable to maintain proper mechanics with this simple test, imagine how their running looks. But maybe that s why they are in the office in the first place! As the checkpoints shift away from the midline, it indicates an imbalance that needs correction. Be sure to observe the runner from the front, side and back and remember that the heels need to be on the ground in every position except when elevated in part 2. For more information and a demonstration of the overhead squat assessment visit: Second, establish a treatment plan for your runner. An examination will reveal if there is loss of joint play in Governor Christie Surveys Chiropractors throughout NJ the feet, knees, hips, spine or shoulders requiring adjustments. Tight muscles will need myofascial release both in the office and at home with a foam roller. Weak muscles will need stabilizing exercises to strengthen before speed and power can be introduced. If foot instability is the issue, prescription orthotics are needed. Next, learn to use a foam roller and teach your runners the correct technique. Rolling over the muscles finds the myofibrotic lesions, and staying on them for seconds releases them via ischemic compression. For corrective exercise protocols it is best to foam roll before running, however, it can also be done afterward. A foam roller is required equipment for all runners. Research has documented that a dynamic warm-up is superior to static stretching prior to sports. Runners need to do dynamic warm-ups that reinforce the correct anatomical checkpoints we listed above. All dynamic exercises need to reinforce proper running alignment and form. Balance and agility exercises also need to respect these checkpoints. Finally, teach your runners to put all of this information together. Remind them to keep their feet straight, knees straight, relaxed stride, hips level, rib cage quiet, shoulders down, relaxed elbows and hands, long neck and head level. Do not let them carry anything in their hands as it only serves to tighten up the upper extremity. Arm swing needs to be along the sides of the body and even. It takes time to improve running mechanics so I recommend the following protocol for every workout: Foam roll, dynamic warm-up, run 3-5 minutes concentrating on technique, complete your scheduled workout, cool down with 3 minutes of strides with technique. Over time the correction will take effect. Clearly, teaching running mechanics is more than sending a runner off with a schematic drawing from a biomechanics text and instructions to stretch. I do it as a six step process that can be easily be performed both individually and in a group setting as a Running Boot Camp. The five parts of the Running Boot Camp include: 1. A functional assessment of each runner s mechanics 2. A targeted treatment program with corrective exercises 3. Dynamic warm-up 4. Nutritional advice for pre-, during and post-training 5. Prescription of the appropriate home support devices 6. Balance, agility and core protocols Runners, like all athletes, are willing to invest time and resources in improving their performance. Help them reach a new PR by supplying the support tools they need and by teaching them to run better so they can run more. Dr. Donald DeFabio is in private practice in Berkeley Heights, NJ and is the technique and conditioning coach for two local high school track programs. He conducts Running Boot Camps locally and also consults with doctors interested in learning to provide their own Running Boot Camp programs. He can be reached at drdefabio@aol.com. vacuum drying at low temperature keeps amino acids active, and provides more effective nutrition to the muscles. Bones are composed of protein, hydroxyapatite, and water. You need all the essential amino acids to make bone protein, and you need the proper minerals in the right ratios to be supplied to the osteoblasts. The preferred way of supplementing is supplying raw bone meal, because the proper ratio of proteins and bone salts are already present. Bone meal can be denatured by improperly processing it, particularly through too much heat. When raw activated bone meal is mixed with calcium, it can be easily made soluble and ionic. Adding in the use of botanicals can also help improve nutritional treatment. Many people often experience dramatic relief when using ANJC to Launch Separate CA Membership Continued from page 1 As a CME you can expand your patient base, increase your services to the community, and become part of a federal program. For example, if you have one CA, annual membership is $35 per quarter; for two CAs, it s $55/quarter. ANJC is also bringing on 1-2 leading national CA consultants to elevate ANJC s expertise in this area. We are also building a CA task force and if you know of any incredibly skilled NJ CAs who might want to participate have them contact ANJC HQ at As you know in 2013, ANJC will be working to introduce legislation for CA certification to be overseen by the NJBCE. Once that is in place, training to be eligible for certification along with required CEUs will be FREE as a CA member benefit. CA Member Benefits will include, in part: 1. FREE monthly webinars on topics of greatest need/interest to CAs. 2. CA members attend FREE all CA modules in conjunction with ANJC Spring and Fall Conventions. 3. ANJC experts respond to questions ed by CAs (similar to what we do for members). 4. Monthly enewsletters and articles. 5. When CA certification legislation is in place, CA members receive FREE all required training and CEUs (similar to ANJC membership). 6. Special training (chiropractic nutrition assistant) to assist doctors who want to focus on implementing nutrition in their offices. botanicals. Botanicals are often the catalysts that encourage dramatic change. With all due respect to chiropractic, herbal medicine is the most commonly used natural approach. There obviously has to be a reason for that. In my experience, Red Clover, Kudzu, Black Cohosh, and Epidemium are four herbs that have been shown to be effective in treating bone problems (Nutritional Wellness, Herbs to Strengthen Bones, by Kerry Bone, an MPA Media Publication, and on the web). This leads us to supporting the nerves with nutrition. Generally, neurological tissue responds well to vitamin B complex and groups of associated vitamins. Biochemist Casimir Funk originated the word vitale amine, which quickly changed to vitamin, while studying the B complex. At the time, fat soluble vitamins were considered vitamin A and all water soluble ones were vitamin B. The assorted diseases that have been associated with B deficiencies include beri-beri, peripheral neuropathy, pernicious anemia, and pellagra. The challenge with the B complex is that it consists of many known and unknown substances that tend to work in concert. While you can supplement one of the fractions of the B complex, you can cause a deficiency of another. That s why it is wise to always use a food source such as liver, yeast, or rice polishing, which are automatically balanced in nature. In fact with any supplement, the key is giving it in a nutritionally dense matrix so the body can make maximal use of the nutrients. I had a patient, a very famous chemist, who had terrible back and leg pains. When he started the full compliment of the B complex, he asked me if morphine and heroin were in the pills I gave him, because the pain relief was so great. When I told him it was just good whole food nutrition found in liver, yeast, or rice polishing, he laughed. Give the body a chance, and innate intelligence will take the real nutrients and put them to work in the healing process. When this is done, patients often respond in ways reminiscent of the original chiropractic patients. Dr. Lavitan has been in private practice since 1976 in Teaneck, NJ and seen thousands of patients. He is a graduate of Rutgers College, Columbia Institute in 1976, and the Eastern School of Acupuncture and Traditional Medicine. He is both a LAc, and a DC. Millions of Patients 34 Peer-Reviewed Articles No other custom orthotic is engineered quite like a Stabilizing Orthotic. Introduced 60 years ago, the intelligent design stabilizes the three arches of the foot, providing a natural balance of flexibility and stability for the whole body, not just the foot. No wonder 81.8% of chiropractors in the U.S. said they prescribe orthotics for their patients. 1 Stabilizing Orthotics improved sporting performance such as driving the ball up to 15 yards farther. 2 Clinical trial showed back pain relief by 44% and improved function by 38% in 6 weeks, 5 when wearing Stabilizing Orthotics. Proprioceptive-friendly orthotics. Allows normal ranges of motion. Supports all three arches of the foot. Unique 10.2% increase in O 2 levels Foot Levelers, Inc. Stabilizing Orthotics improved balance (eyes open) and proprioception (eyes closed). 3 Stabilizing Orthotics reduced knee injuries by 31% FootLevelers.com Choose 3 patients. They will have an improved quality of life within 6 weeks or your money back. References for the published peer-reviewed scientific research papers: 1. National Board of Chiropractic Examiners Stude DE. JMPT 23 (3) April Stude DE. JMPT 1997; 20(9): Stude DE. JMPT 2001; 24(4): NEW PMS Stabilizing 361c PMS 298c Orthotic Stabilizing Orthotics increased hip and pelvic joint ranges of motion. 4 FREE 5. Cambron, JA. JMPT May 2011 (Vol. 34, Issue 4, Pages ) 6. Zhang, J. J of Chiropractic Medicine June :2, Jensen B. J Chiro Ed 2007; 21(1):109 Stabilizing Orthotics significantly decreased blood pressure and improved Heart Rate Variability. 6 take the FootLevelers.com/3patients The World s leading authority on individually designed Stabilizing Orthotics since 1952 FLA ANJCSO.indd 1 1/2/13 2:05 PM

14 26 Winter Winter Back Pain: Where Are We in 2013? By Samuel K. Cho, M.D. ANJC Launches Webinars Continued from page 1 NJ PIP Regulation Amendments Take Effect January 4, 2013 Continued from page 26 Back pain is the second leading reason for a visit to the doctor s office following the common cold, and it costs our society billions of dollars in healthcare utilization and lost economic productivity. On a typical day in the office, there will be anywhere from 70-80% of patients who will come to see me with either back or neck pain. If there is concomitant pain that radiates down the leg or the arm, we, the so-called spine specialists, have a better grip on what to do next since radiating pain usually indicates nerve involvement. A magnetic resonance imaging (MRI) is soon ordered, and we proudly point out to the patient where the pinched nerve is. Patients will typically receive a prescription for non-steroidal antiinflammation drug (NSAID), perhaps along with a muscle relaxant and/ Welcome New Members! Dr. Courtney Ahlers Dr. Kathleen Amoroso Dr. William Bonsall Dr. Pasquale Carcaise Dr. Nicolas Chillemi Dr. Shari Collins Dr. Leonard Confalone Dr. John Dowling Dr. Keith English Dr. Ronald Federico Dr. Dana Fusco Dr. John Graziadei The New Jersey Chiropractor is a bimonthly publication of the Association of New Jersey Chiropractors. To assist with the many challenges of everyday practice, it is filled with updates and extraordinary ideas from our profession s best and brightest minds and serves as a leading information resource for the more than 3000 chiropractors located throughout the Garden State. We hope you enjoy ANJC s latest effort to keep you updated and informed. The Association of New Jersey Chiropractors - The kind of association you ve been aching for! ANJC Elected Officials Dr. Joseph D Angiolillo President Dr. Michael Kirk Vice President Dr. Tom D Elia 2nd Vice President Executive Director Dr. Sigmund Miller Central Dr. Robert Blozen Dr. Joseph D Angiolillo Dr. Kostantinos Linardakis Dr. Alfonso Manfort (Alt.) Northwest Dr. Don DeFabio Dr. Dave Graber Dr. Jerry Szych Dr. Jeannine Baer (Alt.) ANJC State Board Members ANJC Leadership ANJC Appointed Officials Dr. Richard Healy Treasurer Katherine Lusk Editorial Assistant Immediate Past President Dr. Steven Clarke Council Dr. Larry Marchese Dr. Alan Vargas Dr. Lenny Siskin (Alt.) South Dr. Barry Coniglio Dr. Dan Fuzer Dr. Michael Kirk Dr. Brett Wartenberg (Alt.) Northeast Dr. Steven Clarke Dr. Tom D Elia Dr. Joe Garolis Dr. Bob Haley (Alt.) Dr. Joe D Angiolillo Legal Advisory Dr. Robert Blozen COCSA Rep Dr. Richard Healy Medicare Consultant Dr. Steven Clarke Legislative Dr. John Cerf Hospital Protocol Dr. Mike Stewart Sports Council Dr. Mark Spratford Communications Dr. Tom D Elia Insurance Dr. Barry Coniglio Rules and Regulations Dr. Joseph Garolis NJ Board of Examiners Dr. Christopher Bump Nutrition Dr. Frank Zaccaria College Liason Dr. Mark Magos Senior Advisory ANJC VISION & Mission or an opioid in most severe cases. In addition to the medications, they will receive physical therapy (PT) and other non-operative treatments including chiropractic care. Acupunture is increasingly becoming an accepted treatment modality for low back pain. Most patients improve with these treatments and that will be the end of their care. If symptoms persist, epidural steroid injections (ESI) can be performed by either pain management anesthesiologists or physiatrists. Surgery is indicated in most severe cases when patients fail non-operative care. The compressed nerve is freed by removing the offending bone or ligament. When there is evidence of instability, fusion is also performed in the same setting. Then there is back pain without the radiation. In this situation, we scratch our heads and begin Dr. Scott Huber Dr. Carolyn B. Ilnicki Dr. Robert Kandarjian Dr. James Louro Dr. Stephen Lychock Dr. Timothy Lyons Dr. Neal Mathews Dr. Helen McWeeny-Dowling Mr. Matthew Mondoro Dr. Cynthia Pageno Dr. Garett Rosati Dr. Larry Sabel Committee Chairs Advisors Consultants Dr. Richard Healy Finance Dr. Joseph D Angiolillo Executive Committee Dr. Kostantinos Linardakis HQ Committee Dr. Mike Kirk PR Committee Dr. Richard Fellows PAC Committee Jon Bombardieri Lobbyist Lynette Contreni Insurance Consultant Dave Klein, CPC, CHC Insurance Consultant Dr. Mike Goione Insurance Consultant Anthony Rosner, PhD Research Consultant Jeffrey Randolph, Esq Legal Counsel Vision: To position Doctors of Chiropractic as providers of first choice for New Jersey families to obtain optimal health and wellness, while improving the quality of their lives. Mission: To improve the health of patients, families and communities by promoting high standards of professionalism and patient care through chiropractic methods, education, advocacy and accountability. Association of New Jersey Chiropractors 3121 Route 22 East, Suite 302 Branchburg, New Jersey fax info@anjc.info prescribing the same NSAID, PT, or perhaps refer these patients to pain specialists. The source of pain can be elusive and MRI typically does not produce useful information. Is it simply musculoskeletal? Is it discogenic? Is it psychosomatic? Will this patient who has been suffering from this pain for the past five years get better with ibuprofen and core strengthening exercise? Because of this treatment dilemma with no clear cut answers, I recently conducted a systematic review of the available medical literature on back pain to see whether others have already devised a more effective treatment algorithm for back pain patients. The results were rather discouraging. The literature is diffuse and often confusing. The level of scientific evidence is often mediocre. More importantly, there is little integration of care from different disciplines that treat the same patient. Recently, there has been much demand on healthcare providers to prove the effectiveness of treatments that they offer to patients for various ailments. The government and insurance agencies want to see NJ PIP Regulation Amendments Take Effect January 4, 2013 unit/foot. Thus, chiropractors would be required to provide this efficacious treatment modality at a loss to PIP patients for each unit of tape applied. This will result in a drastic reduction of the use of this treatment modality for auto accident patients. 11.Spinal MUA CPT may only be reported once per procedure for all spinal areas and cannot be broken down by cervical, thoracic and lumbar spines. 12.Ambulatory Surgical Center (ASC) Facility Fees The fee schedule will no longer use the Grouper system with a separate fee schedule. The standard PIP fee schedule will have a professional fee as well as an ASC facility fee listed on it for all codes. ASC facility fees are set at approximately 300% of the Medicare RBRVS. Only surgical procedures that are on the Medicare approved list for being performed Continued from page 22 that the cost of care is justified by appropriate level of improvement in patient symptoms. Back pain is no exception. Perhaps the current situation in back pain management is an opportunity for all of us involved in providing health services for such patients to come together. Research has shown that interdisciplinary approach to patient care improves quality and is cost-effective. This one-stop shop approach is currently beginning to be practiced at many places and may be a viable, I dare say, only way to cut down cost while providing excellent care. Dr. Cho is Assistant Professor of Adult and Pediatric Spinal Surgery in the Department of Orthopaedic Surgery at Mount Sinai School of Medicine in New York City. Dr. Cho s clinical practice focuses on surgical care of common degenerative conditions (e.g., disc herniation, stenosis), as well as complex spinal deformities (e.g., scoliosis, kyphosis). He currently sees patients at Montvale Health Associates, a multi-disciplinary group of healthcare providers, in Bergen County. in an ASC are reimbursable. Otherwise, they must be performed in a hospital or Hospital Outpatient Surgical Facility. If there is no fee listed in the ASC column of the fee schedule, the procedure cannot be performed in an ASC setting. 13.Award Payment Time Frame A new provision was added extending the time for payment of arbitration awards by carriers from 20 days to 45 days. If a request for modification/clarification or an appeal is filed in a Forthright arbitration or if an Order to Show Cause is filed in Superior Court to vacate the arbitration award, the payment timeframe is automatically stayed. 14. Precertification A provision was added permitting carriers to reasonably restrict who can submit Precertification (APTP) forms for Continued on Next Page Special Note: As a back-up to each live webinar presentation, technology is now in place so you can view any recorded versions and receive credit to be eligible to receive CEUs and sit for the National Registry Exam. NYCC Postgrad will issue transcripts confirming completion of live or recorded webinars making you eligible to sit for the National Registry Examination; also includes 12 CEUs. The ANJC DOT webinars will provide the nuts and bolts and ins and outs of performing these exams. Additionally, the webinars also provide review for the exam as well as a DOT business management class to help grow your DOT business. Most importantly, ANJC is launching a DOT Council to provide updates on any new rules or regulations and to assist medical examiners (MEs) with any problems or questions they may encounter. Faculty Jerry R. Szych, DC, MS, APC Involved with the NRCME since 2007; currently helping develop test questions for the upcoming exam. Performing DOT exams and drug screens for ten years. Faculty Robert Striker, DC, MBA Completed ACOEM Certified Medical Examiner DOT Training Course. Actively performing DOT examinations since 2007 and extensive experience in the development and integration of the DOT exam procedures in private practice. This training course conforms to FMCSA s training curriculum modules and topics on regulations and guidelines for conducting commercial motor vehicle (CMV) driver medical exams. FMCSA regulations and guidelines are reviewed regularly, and the training is updated as required. This course was last updated on 12/23/2012. Total Fee: $295 Complete (other DOT certification programs include fees averaging $750+). You must register online through NYCC ( then click ANJC/DOT-CME Training. Once completed you will receive follow-up s from NYCC and ANJC to register for each webinar live or recorded. Webinar Modules Include: 1. Module I / Jan 21 Background, rationale, mission goals of FMC- SA; role of medical examiner; responsibilities and work environment of commercial motor vehicle (CMV) operations. (2 CEUs) 2. Module II / Jan 28 Obtain, document, review driver medical history, includes meds. 3. Module III / Feb 11 Perform, review, document driver medical exam. 4. Module IV / Feb 25 Perform, obtain, document diagnostic tests; obtain other testing/ medical opinions. 5. Module V / Mar 11 Determine driver certification outcome and period that certification is valid; FMCSA reporting/documentation requirements. 6. Module VI / Mar 25 Certification Examination Review (2 CEUs) 7. Module VII / Apr 8 Growing Your DOT Business (No CEUs) For more information info@anjc.info or call ANJC HQ at precertification and provide for precertification via web portal. 15. Durable Medical Equipment (DME) Medicare Claims Manual is formally adopted for DME claims. TENs supplies cannot be billed separately (i.e. leads, batteries, pads) for rentals but can be billed separately if the unit is purchased. 16. CCI Edits expanded and formally apply to PIP claims including -59 billing and AMA Assistant coding opinions formally adopted. 17. New Definition of Medical Necessity DOBI has proposed to amend the rule to redefine medical necessity to evidence based clinical guidelines/practice/treatment published in peer-reviewed journals. WHAT IS BEING DONE? As was stated in the introduction to this article, it is the ANJC s position that the proposed amendments to the New Jersey No-Fault Regulations embodied in PRN are ultra vires, contrary to law, public policy and improperly impinge upon the fundamental rights of the citizens of the State of New Jersey. They must, therefore, be struck down by the judiciary as a valid exercise of checks and balances over the over-reaching of the New Jersey Department of Banking and Insurance. Two healthcare coalitions consisting of healthcare providers of various specialties have already filed a request that DOBI stay these regulations while they appeal to the Appellate Division of the New Jersey Superior Court. The ANJC has officially signed on as a member of one of those coalitions the New Jersey Coalition for Quality Healthcare which is being represented by the preeminent law firm of Wolf and Samson, and the ANJC State Board of Directors voted to contribute it pays to belong! funds to the coalition to fight these regulations through the legal process. This request to DOBI for a stay was denied by the DOBI on November 23, 2012, and DOBI s decision can be read at: nj.us/dobi/orders/a12_114.pdf. Since then, the New Jersey Association for Justice (NJAJ, formerly ATLA) has already filed a Notice of Appeal with the Appellate Division of the New Jersey Superior Court and the healthcare coalitions appeal(s) will shortly follow suit. The ANJC also intends to support the NJAJ and the other coalition of healthcare providers in their similar battle against the regulations and to provide whatever support it can to a parties fighting for the rights of all healthcare providers and, more importantly, their patients. If you have any questions on these regulatory amendments, do not hesitate to contact me at: jrandolph@ jrlaw.net. association of new Jersey chiropractors (code: Va) Help support our fundraising efforts by joining TD Bank s Affinity Membership Program. Your participation earns us an annual contribution based upon the number of members enrolled. Eligible accounts include: Checking Money Market Savings CDs IRA Existing TD Bank Customers are eligible, too! Just give them our organization s name and they ll take care of the rest. to open an account, visit your nearest td bank or call

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