Academy of Chiropractic

Quickie Podcast 1290
Compliance and Insurance CA 65 CA

From the Desk of Dr. Mark Studin
Academy of Chiropractic

Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006

Using Technology to Prevent Lawsuit

Dr. Studin: So Jas, without getting into specific names of the parties, you had alerted me to a federal lawsuit against the doctor who was a former client. And if I remember correctly, that goes about back about five years. Is that correct?

Guest: I believe so. Yes. 

Dr. Studin: And after reading through that complaint, which I've read through probably a dozen times, cause I've written an article about it, especially written a few articles about it, the doctor put it's about insurance fraud and predetermined treatment plans. And the doctors attorneys a few years after the suit put in summary judgment for dismissal, which was denied by the federal courts. And it's still ongoing with interest accruing. So, five years in federal court, I would say his legal fees are easily 300,000 or better. And whatever the complaint was with interest, it's probably close to double. So I guess that's something we don't want to get into, but in the tenants of that, court case, it clearly brought out that, one of the many issues. I mean, there are dozens of allegations against this doctor, but one of them, was about free determined treatment plans. Do you remember reading that? 

Guest: Yeah, yeah, I do. 

Dr. Studin: And they talked about was the doctor always treated the same region, but only altered the frequency, but not the location. Therefore they consider that fraud because what reasonable person would be treating the same area over and over and over and never changing that. So what would your basic feeling be about that particular allegation and the validity of your side or from the doctor's response of the carrier's allegation?

Guest: Well, I mean, I think it's a legitimate, legitimat, lawsuit. I mean, I think there was,  I can't remember, but I think there was over hundreds of cases within hundreds of 37. Yeah. Over a five-year timeframe, maybe even longer. It was actually a six year timeframe. Good memory. And if you do the math, I mean, and, hitting the same segmental level on every single one of them, there's not much of a case there. I mean, as far as defense goes, correct. So there's two things that come into play for me. One, is that, and what they said in almost every case, it was almost the same segments because the doctor listed the segments, not the regions. 

Dr. Studin: Now there were like [inaudible] so he did a right cervical, thoracic or lumbar. So one of the things that we recommend and for other than Medicare is to not list it, segmental it, because if I said to you, Dr. Walia, you adjusted C3, are you telling me C4? Didn't go with that. Also. You can't say that that's absurd. 

Guest: True.

Dr. Studin: So therefore you're always better and more compliant by just saying you adjusted the cervical spine or thoracic, and there's no regulation other than Medicare that says you have to list the exact segments. But if you look at the literature and if you've taken, which I know you have the spinal trauma pathology and the neurology of connective tissue courses and any of the primary spine care courses you'll know that once a ligament impaired, it doesn't heal collagen and elastin, once they get damaged, only gets replaced with collagen, which is internal scar tissue and the Dolan article about ligament and healing issues, injuries that came at it from the open rehabilitation journal, which is an index peer reviewed journal article that came out in 2013, said that that tissue will never, never, ever it'll remain, and pay her for the rest of the person's life. So part of the responses for me for that particular article would be, as you're going to always treat the same region on a person that's always going to be weakened, always. So, and you're going to decrease the frequency over time, but usually the same area. However, every patient can have the same area, but if you're going to cervical, thoracic and lumbar, you know, it's like if I'm a neurosurgeon and I'm treating brain tumor and every single diagnosis is brain tumor and every single treatment is tumor estimate, you know, how could you argue with that? That's what we do. 

Guest: So, you know, it's like, how do you get around that? And what do you look at?

Dr. Studin: So for me, Symverta, which is an analytical tool really resolves that issue and not so much for the, um, AOMs side of translation and angular deviation, but the spinal biomechanical component. Now, have you been using that biomechanical component showing for keyboard rotations? 

Guest: Yeah. Yeah. 

Dr. Studin: Okay. Could you explain a little bit of how that's worked for you in creating treatment plans? 

Guest: Yeah. I mean, it's a demonstrative evidence it's supports where's it going to get, 

Dr. Studin: put into words what that is, put the visual into words so that the listeners can see what you're doing and looking at, 

Guest: um, for you, you put plots on, um, on pretty much the, um, liberal body and spines processes. And it goes into the, um, computer eyes researched formula is what my understanding is. And it comes up with angles and, um, um, comparisons to ideal spines through, um, a bunch of research. And it gives you areas that are, um, it basically gives you a listings based on, based on that. And then you just confirm them with your technique, um, and get in front of, with your palpation, with your clinical examination. Yeah. And then, um, it, it allows you to kind of focus on certain segments that a, um, you weren't aware of, or that are, like you said, um, uh, compensations from biomechanical aberrations for years. So if another area of the spine is affected, that may not be symptomatic, um, it kind of lays out the whole slide for you and tells you what, which areas are the ones, um, that, um, that are pretty much, um, dysfunctions. So basically not basically you have a tool now to diagnose Hassell biomechanics.

Dr. Studin: Yes. You're not falling into the carriers understanding of a medical model that, um, there has to be pain or reflexes off or neurological dysfunction. You're looking at mechanical pathology. Yes. And you can go ahead and then you can use it to explain non-specific back pain with, with more understanding. Um, as far as, you know, the practitioners you're explaining it to, um, on, on what you're doing and, and why, well, because there is no such thing as bad, specific back pain, it's very specific. This tool actually tells you where the level of specificity, it gives you that level of specificity to tell you where the pathology is just, and it's so easy to see. I mean, here it is right here. It shows you, it gives you a graph. It gives you a bar, it gives you this. It says here's the pathology. So if you were using this, so by the way, do you re x-ray your patients and up with a follow-up exam on this?

Guest: I don't, I mean, it depends on the case, but I will, um, if they are, if they are symptomatic after, um, after reaching higher protic MMI and I am doing an evaluation for permanency, I will go and have them do an x-ray faster. Um, during that time period, um, that, that I released him from care for about four to six weeks to see how they do with stressors on their spine. And then I'll have them do an x-ray during that time. And then I will re digitize it. And then if the finding is still there, then I basically have more backing evidence for the permanency recommendation and future care. 

Dr. Studin: Okay. So I would do it a little bit and you're not wrong by the way. And there's no right or wrong answer. This is a clinical judgment issue, but I would do a baseline in the beginning of care, not for AOMs PSI, looking for translation or angular deviation, because we know you can't rate that until the patient is attained MMI with their permanent and stationary. But what I would do is I would do what to create that biomechanical pathology, um, uh, diagnosis and a look at the biomechanical pathology in conjunction with my clinical findings. Then after doing one or two re-evaluations and 30, 60, or 90 or three at 90 days, if the patient became relatively asymptomatic, then I would follow up with another x-ray because we know that that diagnostic x-ray radiation is minuscule and there is never, and I'm, I don't like talking in absolutes, but there's never been a report in the literature where that's created any average health issue, diagnostic x-ray it's all dogma. So I would follow up at that point in time with a follow-up x-ray if in fact I've seen normalized segmental function from Paso biomechanical function, and their symptoms have cleared out and their clinical findings are cleared up. I'm released MMI in them are released from care, but if there are symptoms cleared out and I still see significant biomechanical failure, I'm going to totally change my diagnosis, prognosis and treatment plan, because what's the purpose of taking, doing a test. If you're not going to change your diagnosis, prognosis or treatment plan, there isn't any, you shouldn't do it. You're not doing it to screen a patient, and you're not doing it to pander, to a lawyer to give them an impairment rating, but I would do it to create a new diagnosis, prognosis and treatment plan, which should be purely. And that I would change my treatment plan and a valve, and start adjusting that patient differently. Along with a series of home exercise programs, to support those corrections after the symptoms have cleared out. And then I have a baseline of, of this specific patient of what's there and it's demonstrative, and now the patient and the, and now the carriers can go, you know, can go, you know, father, someone else. I was going to say, screw themselves, that was inappropriate. Um, they can go bother someone else because I've created demonstrably.

The keyword is demonstrable. I now have a tool to show what I'm treating. I'm now showing it's specific. And that was the key to the carriers because what the carriers have done is they aggregate statistics. And you said that appropriately, they looked at 131. I believe patients over a six year period. And they aggregate statistics saying that 91% have the same diagnosis, 91% of the same region, 96% have the same treatment. Well, your treatment patterns, aren't going to change, but they get very customized when you're looking at a segmental rotation and deviation and what's going on. So now you could customize that for each patient, and it's no longer predetermined. You're doing another test to determine where that patient is. And then I would treat that patient for another 60 days. And then I would either look for, um, I would either re x-ray them for the third time with a spot shot, just to see what's going on. Or I would find some clinical algorithm to, uh, to avoid having to re x-ray again, even though x-rays, don't bother me, um, uh, to be able to MMI the patient at that point in time. And some patients might go on for a year or two, everyone. You're right. Everyone's different, but this is how to use that tool to avoid having any problems. And basically it takes all the guesswork away. There's no more guesswork.

Did I miss anything? Or is there anything the article that you said, I think you may have misquoted who, who wrote it was no, sorry. The, the, um, all ligaments, um, you know, don't Dolan Dolan. It wasn't the Tozer one. No, no, no, no, no. Tozer is different. Okay. This is Dolan Houser at Al et cetera, from, uh, LIGO ligament and healing injuries. Um, 2013 from the open rehabilitation journal. 

Guest: And it says, and if you'd give me a half a second to run in front of a computer, I want to make sure I'm quoting it properly. 

Dr. Studin: Yes. I like proper quotes. It says. And I quote, uh, nevertheless, these tissues that's ligaments that have torn and repaired, continued to exhibit greater stress relaxation, indicating that once ligaments have sustained injury, they remained less efficient in maintaining loads in all the ligaments that certain ligaments do not heal independently following rupture. And those that do heal do so with characteristically inferior compositional properties, meaning that collagen and elastin is only replaced for college. And as a result of that, lost its elasticity because there's no elastin in there. And that joint is forever at HES, which that joint will then have premature degeneration based upon Wolff's law and the PSO electric effect. Beautiful. You like that? I had, I had the slide. I had the teaching slide up while that was doing it a little while ago when I wrote, um, uh, something else. But, um, this is how to put all of it together. And remember these two words, legally defensible, it's got to be legally defensible based upon the literature and demonstrable, and you are in, believe it or not. You're in a hot area for, uh, lawsuits and licensure issues. I have more doctors you're in the state of Washington.

I have more doctors in the state of Washington than any state in the country that have been sued that the board has taken their license away. You're in a really aggressive state. Massachusetts is another aggressive state, Georgia and New Jersey are all aggressive States. Um, you would think New York would be, but New York, what they're looking for is they're looking for like the Russian mafia quote unquote, um, who are staging accidents. So they're real busy with that, but you're in a real aggressive state CRO. You have to really dot your I's and cross your T's. All right. Very good. Is there anything else I need to bring up?

 Guest: Thank you so much.


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