Academy of Chiropractic Personal Injury & Primary Spine Care Program
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“Treatment Goals and Get Paid for Long-Term Chiropractic Care”
“Clinical Excellence = Getting Paid” Mark Studin 2018
There is currently a case working its way through the Federal Courts in the State of Washington that could have a long-reaching effect on your cases with getting future care approved and previous care paid. As this is a Federal case, it will have precedent nationally, and we should all pay attention and be prepared. Since State Farm is the defendant, the results fo this case will be felt quickly across the country and all carriers will “piggy-back” on it. Without yet having read any of the proceedings and only speaking to counsel who has been following the case, I can share with you it has to do with denying care prospectively and having the clinical “demonstrative” evidence for the necessity for both previous and additional necessary care.
It has been well-established that ligament pathology, no matter how small or large affects spinal biomechanics, with more significant damage leading to quicker spinal instability and degeneration (Wolff’s Law). The above is the arbiter to demonstratively show the progression of care and the realization of goals.
Historically, chiropractors have used pain or function as the variable for care. Pain; that is easy, but fraught with pitfalls due to both the subjectivity of pain and the FACT that ALL biomechanical failures CANNOT be addressed until AFTER the pain abates. Simply put, until the spasticity relaxes, the spine cannot return to its anatomical neutral juxtaposition relative to the adjacent vertebrae. Therefore, biomechanical correction begins when the pain goes AWAY!
Therefore, you need to “re-think” your goals, and it comes down to your documentation and training on how to manage your cases. I no longer consider pain as my “end-game” or long-term goal, only an intermediary step in treatment and I discuss that in my reports. The ultimate goal is biomechanical reintegration, and the challenge is how to document that clinical scenario so that a layperson can understand the progression when evaluating either your care or your claims for long-term care.
In the past, ranges of motion were good indicators of joint function, and they still are. However, they look at a region globally ignoring the motor units as individual segments that can compensate for adjacent hypo or hyper-mobilized segments. Therein lies the problem where compensation within the same region can give you a “false-normal,” and the spine continues to fail biomechanically.
The solution for long-term chiropractic care is to “demonstratively” document segmental biomechanical failure, also known as spinal biomechanical pathology, which fits into the carriers algorithm of reimbursement for treatment of a disease process. There is currently a large body of evidence that is snowballing to support the analysis of the failure, and the evidence of the progression of care is the visualization of the changes on a patient by patient basis of the motor unit reintegration of function. In the past, I utilized the work from Applied Spinal Biomechanical Engineering and I was able to visualize the segmental failures.
In recent years I have come to realize that Dr. Weigand’s work offers you both the analytics of determining the primary lesions in the spine vs. adjusting compensation as well as numerically quantifying the severity of the biomechanical lesion (pathology). Therefore, with a plain film, I can “demonstratively” document the progression of individual motor unit biomechanics over time verifying the continued necessity of care. This coupled with the published fact that x-ray is not cumulative, offers virtually no risk to the patient in diagnosis, with a high yield of information to correct the underlying pathology.
Dr. Owens, Dr. Weigand and I have been working with our IT team and have re-engineered the digitizing portal. We have made it an easy, “seamless,” and cost-effective process where you will have the right to utilize and bill for the analysis as often as you deem clinically necessary while diagnosing the biomechanical pathology. You will then be able to “demonstratively” document the reintegration of the individual motor units clearly showing the necessity of ongoing care until the problem has either been corrected or reached MMI.
At our symposium in October, we will be releasing the re-engineered version of the software for you to utilize in your practices. This should “open the door” to necessary, longer care being reimbursed as the clinical necessity will be demonstratively shown through numerical qualification of the individual motor units. My goal for this is not to show you how to make more money, although that is the by-product. It is to show you how to diagnose the primary lesions of the spine vs. treating compensation and being able to change your treatment plan as care progresses by managing the reintegration of the motor unit biomechanics. The inability to do so lends your patients to premature degeneration of the spine (Wolff’s Law) and permanent, irreversible biomechanical failure.
This is also why we are bringing Dr. Weigand in on Friday, October 26th from 9-5 for a full day of training at no charge for our clients (you need to email me that you are coming so we can reserve enough space). On Saturday and Sunday, October 27th-28th we will be doing a full “show and tell” on the new software with Dr. Weigand being available to discuss any ongoing issues over the entire weekend. CLICK HERE TO SIGN UP.
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
Adjunct Associate Professor of Chiropractic, University of Bridgeport, College of Chiropractic
Adjunct Post Graduate Faculty, Cleveland University-Kansas City, College of Chiropractic
Adjunct Professor, Division of Clinical Sciences, Texas Chiropractic College
Graduate Medical Educational Presenter, Accreditation Council for Continuing Medical Education Joint Partnership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences
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