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What to look for in a Chiropractic Debt Collection Agency!

Thankfully, many chiropractors are inexperienced in dealing with chiropractic debt collection agencies because a large number have cash practices and keep costs affordable so that their patients are able to pay on time. At the same time, however, ignorance is not bliss when you discover that several patients are falling behind on their payments. If this happens to you, follow these tips to ensure that your experience is positive and financially advantageous!

Keeping an eye out for red flags

Although, in a perfect world, all chiropractic debt collection agencies are regulated, you still want to make sure that you’re dealing with a reputable agency. Do your research online and make sure that they are the type of debt collection agency that you want representing you and your practice.
  • Certifications –Your chiro debt collection agency should require that their collectors be certified, for example, through industry trade groups such as ACA International – the Association of Credit and Collection Professionals. This ensures you’re going to partner with an agency that has a vested interest in finding and training high-quality collectors.
  • Compliance – Make sure that the collection agency is fully compliant with the Fair Debt Collections Practices Act (FDCPA) and is licensed in all states where your patients live and where you run your practice.
  • Data Security – Every reputable chiropractic debt collection agency will have emergency backup systems in place and will maintain strict privacy measures so that your data is not only secure, but will be used for business related purposes only.
  • 24/7 Online Access – This is more of a convenience than a hard, fast rule. Being able to submit and access the status of your files at any time of the day is a standard in today’s Internet economy and will weed out the companies whose systems may be outdated.
Questions to ask when interviewing agencies

When seeking out your debt collection agency make sure to ask these types of questions: How many chiropractic clients do you have?

In essence, chiropractic debt management is a type of “niche” market because collections are relatively uncommon compared to the massive delinquencies accrued in the medical community. Collection agencies need to understand that your business model may be quite different than other independent practitioners. Therefore, it is imperative that they are sensitive to the specific needs of chiropractors and do not approach debt management in the same exact manner that they tackle their other clients’ debt portfolios.

What type of recovery plans do you offer?

Some agencies will charge a flat fee or rate for a certain number of accounts that they manage over a pre-determined time period. This will give you the flexibility to use their services as you need, and generally you will receive 100 percent of the money that they collect.

Do you use skip tracing?

According to LexisNexis, “Research has shown that as many as 35 percent of delinquent debtors move each year and 50 percent of all accounts received for collections require some form of skip tracing.” Instead of banging their heads against the wall and wasting time sending countless letters to unoccupied addresses, skip tracing helps debt collectors locate debtors by monitoring their credit history, cell phone usage, and employer location in an effort to track down someone who may be avoiding their financial obligations.

Am I able to personalize your approach?

Remember, the manner in which your chiropractic debt collection agency collects your debts directly reflects upon your personal character and how you run your private practice. You don’t want a company to mistreat and/or upset your patients. Make sure that you have a strong voice in the way that the collection agency approaches communicating with your patients, so that their methods are congruent with your business model.

How many credit bureaus do you report to?

When things get beyond their ability to control, your collection agency needs to use every resource available to collect your patients’ delinquencies. Make sure that they report to all four major credit bureaus to hold your patients fully accountable for their fiscal obligations.

In summary, utilizing receivables management resources are vital to ensure that your chiropractic debt collections do not get out of hand. Following the guidelines above will help ensure that you will make a wise choice in an agency and, subsequently, will receive the best possible benefit from your investment.

IC System Quick Facts
  • For more than 40 years, Chiro Collect, Powered by I.C. System, has worked with hundreds of Chiropractic Practices nationwide, collecting millions of dollars on their behalf. I.C. System is a BBB Accredited Business with an A+ Rating.
  • We are among just a few dozen agencies worldwide to be ”certified” for Best Practices through ACA International, The Association of Credit and Collection Professionals, Professional Practices Management System (PPMS) program.
  • We leverage comprehensive skip-tracing efforts to find “missing” patients.
  • We offer Chiropractor Clients Online Tools to easily submit debts, view our work effort (number of letters mailed, number of calls made, etc.) on debts, report payments, and generate reports.
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5 Ways to Get Chiro Patients Paying On-Time!

Nothing like stating the obvious, but the most effective way to keep your accounts from requiring professional chiropractor debt collection services is to prevent them from going delinquent in the first place! Easier said than done, right?

According to Life University Chiropractic Sciences Department Chair Lydia Dever, the key is to be proactive and not reactive. Owning and operating a private practice for the past decade, Dr. Dever has utilized chiropractor debt collection help only once in her career. “You need to make sure your patients pay every time they come into the office,” Dr. Dever says. “That way things don’t get out of control.”

Dr. Dever makes a good point. This is business, not charity. To keep your books up-to-date, you must assure that your patients pay their office visit fees before they leave every time. Being an industry deeply rooted in service, chiropractors are notorious for not being firm in this area. Subsequently, many doctors get taken advantage of, but this happens needlessly.

5 Steps to Ensure Payment

Of course, you can’t force anyone to do anything. When your patient attempts to laugh off their bill by saying, “Get ya next time,” simply don’t do it. Instead, employ these methods:
  1. Transparency – Be upfront with your office fees and payment policies on Day 1 before you begin care. Over-communicate so you don’t miscommunicate. This way, everyone is on the same page before care begins, and patients understand that their account will be sent to chiropractic debt collections if they fall behind.
  2. Staff support – Train your staff to be firm, but polite, in regards to settling an account before a patient leaves your office. Staff members are your gatekeepers and set the tone for your office. If they are no-nonsense about finances, your patients will respond accordingly.
  3. Do not bill – Although some patients will request for you to send them a bill, don’t do it. If they forgot their wallet and have no way to pay, then (firmly, but politely) let them know that payment remittance is expected by the time of their next visit. If they try to pull the same thing next time, nip it in the bud right away. This person could be a predatory patient, and you don’t want him or her in your practice.
  4. Be the authority – It may be easy to pawn off the “enforcer” role to your CA, but you are the doctor and it is your practice. Step up when needed and discuss with the situation with your patient next time he or she is in the office.
  5. Having “The Talk” – First of all, be non-confrontational and gracious. Remember that people are innocent until proven guilty, right? People steer away from confrontation and you may lose them as a patient if you come off too strong. Your patients will generally have good reasons for what they do, so ask them why they didn’t pay their bill. For instance, you may end up learning that they are in dire financial straights and that they are willing to sign on to a payment plan.
In summary, proper office protocol ensures that a vast majority of your accounts will never escalate to the point of requiring chiropractic debt collections services. Whether you own a cash practice or are in a managed care group, set up procedures like the ones we’ve outlined above so that your patients pay their co-pays, deductibles, and office visit fees at the time of service!

IC System Quick Facts
  • For more than 40 years, Chiro Collect, Powered by I.C. System, has worked with hundreds of Chiropractic Practices nationwide, collecting millions of dollars on their behalf. I.C. System is a BBB Accredited Business with an A+ Rating.
  • We are among just a few dozen agencies worldwide to be ”certified” for Best Practices through ACA International, The Association of Credit and Collection Professionals, Professional Practices Management System (PPMS) program.
  • We leverage comprehensive skip-tracing efforts to find “missing” patients.
  • We offer Chiropractor Clients Online Tools to easily submit debts, view our work effort (number of letters mailed, number of calls made, etc.) on debts, report payments, and generate reports.
See more at:



How to Know if You Need Chiro Debt Recovery Services

Sometimes, doctors wonder if utilizing chiropractic debt collection services are worth the time and money. Unlike other independent health care practitioners, chiropractors generally do not deal with massive delinquent debt loads because their services are traditionally affordable. Typically, the average debt chiropractic patients accrue is around $250.

You may be asking:
  • Is it worth my time and money?
  • Will this burn bridges with current patients and potential referrers?
  • What are a couple hundred bucks in the grand scheme of things?
To Collect – or Not?

To help you determine whether to work with a chiropractic debt collection agency, consider the following:
  • Due diligence – Have you given your patients a fair opportunity to respond? Typically, the best practice to collect from an unresponsive patient is to leave two voicemail messages and send one (final) written notification concerning a delinquent account. After two weeks with no response, the assumption is that your patient is avoiding the situation and you are best served by utilizing a chiropractic debt collection agency.
  • Count the cost – The debt has to be worth your investment. Discuss your situation with a certified chiropractic debt recovery professional to see if utilizing their services makes sense for your bottom line.
  • Is this a new or perpetual problem? – If this is a first-time offense with a long-standing patient, then think twice about sending him or her to a chiropractic debt collection company prematurely. People usually have a good reason for falling behind, and this is especially true with patients who have proven their loyalty and timely payment ability in the past. On the other hand, if this is a new patient and you suspect that he or she may be predatory, then having a no-nonsense approach will probably serve you well.
  • Was it your fault? If you didn’t set the tone, neglected to deliver proper expectations up front or were lackadaisical in your fee-for-service procedures, then can you really fault your patient for falling behind? In this situation, to save your reputation and credibility, use chiropractic debt collection help only after fully addressing the situation with your patient and giving him or her ample time to respond.
A True Story

Chiropractor examining a charming woman's backDepartment Chair at Life University Lydia Dever tells the story of a situation in which a patient fell behind on a considerable amount of money and then just disappeared. Giving her the benefit of the doubt because this patient was a loyal patient in the past and didn’t seem too malicious in her actions, Dr. Dever forgave the debt and forgot all about it. Two years later, completely out of the blue, the patient came into the office and handed her a check for $300. She thanked Dr. Dever for her understanding and told her a touching story as to why she wasn’t able to pay. Evidently, the patient was so embarrassed that her bill got behind that she avoided the office, but after her account got current she resumed care. Does this sound like a referral source or what?

When All Else Fails

Of course, not every story ends with such a happy feeling, and you will be required to utilize chiropractor debt collection services at one point or another. This is particularly true for doctors who specialize in personal injury and high profile insurance claims. Thankfully, chiropractor debt recovery options are readily available to help in these situations so that you can focus on what you do best.

IC System Quick Facts

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10 Tips for Dealing With Late-Paying Chiropractic Patients

When your staff has been unsuccessful in reaching a patient who is past due on his or her account, the pressure is on you to have “The Talk” before you send them to chiropractic debt collection help. As much as it pains you to do it, you must. However, your interaction doesn’t have to be miserable. In fact, if done correctly, it may even prove to be quite fruitful!

Here are 10 Key “Do’s” and “Don’ts” to familiarize yourself with before you approach your patients:
  1. Do be a soft place to land – Most people are embarrassed in discussing financial troubles, so it is vital to provide a welcoming situation where they will discuss the situation with you. When approaching a patient who has a delinquent account, try phrasing your initial question something like this: “[Patient Name], I noticed that you’ve gotten behind on your bill, and was just curious – is everything okay? Is there some way I can help you?”
  2. Do be genuine – A facade can be spotted a mile away. If you come across as only wanting their money and don’t show that you still care about them as a person and as a patient, then they will tune you out immediately. From a patient’s point of view, if you don’t care about me, why should I care about you and pay my debt?
  3. Do give them the benefit of the doubt – This is vital! Be intentional in believing that your patient will pay his or her bill. It has been proven that your beliefs do_dont2will determine your actions, especially unconscious facial expressions and mannerisms. If you believe that the patient is never going to pay up no matter what you say or do, then it will inevitably slip out in one way or another.
  4. Do be upfront and clear – If your patient is unmoved by your attempts to reach a financial agreement, ensure (verbally) that he or she knows the bill will be sent to chiropractic debt recovery as part of the process.
  5. Do have them sign a letter of advice. To confirm what you have stated above, have your patient sign a document affirming that you advised him or her that the account will be handled by chiropractic debt collection help if he or she is unable to pay. Remember to give your patient a copy.
  6. Don’t make it personal – Since this is your business, you may have the tendency to take things personally when people fall behind on their financial obligations. Don’t! Business is business, and those that survive the emotional turmoil and refuse to get personally attached to these types of situations will always come out on top.
  7. Don’t take a knee-jerk approach – Remember that people generally have good reasons for letting their account fall behind. Find out why they are not paying their bill – You may be surprised by what you learn!
  8. Don’t scare anyone away – Being non-confrontational is key. Most people avoid uncomfortable situations like the plague, and certainly you don’t want to create a rift in your doctor-patient relationship. If people get spooked, they won’t come back.
  9. Don’t forget that this person is still your patient. The person you’re dealing with has a history with you and is still a potential source for referrals. The way that you handle this situation can determine if he or she lambasts you on Facebook or refers all his/her friends and family to you instead!
  10. Don’t lose hope – Not only can a delinquent account easily – and quickly – become a current account, but there’s still a good chance you’ll get your money even if patients don’t respond to your efforts. Send the account to your chiropractic debt collection agency and let them worry about it!

IC System Quick Facts
  • For more than 40 years, Chiro Collect, Powered by I.C. System, has worked with hundreds of Chiropractic Practices nationwide, collecting millions of dollars on their behalf. I.C. System is a BBB Accredited Business with an A+ Rating.
  • We are among just a few dozen agencies worldwide to be ”certified” for Best Practices through ACA International, The Association of Credit and Collection Professionals, Professional Practices Management System (PPMS) program.
  • We leverage comprehensive skip-tracing efforts to find “missing” patients.
  • We offer Chiropractor Clients Online Tools to easily submit debts, view our work effort (number of letters mailed, number of calls made, etc.) on debts, report payments, and generate reports.
See more at:



Nonverbal Interpersonal Interactions in Clinical Encounters and Patient Perceptions of Empathy

Summary: Objective: The relationship between nonverbal behaviors and patient perceptions of clinicians has been underexplored. The aim of this study was to understand the relationship between nonverbal communication behaviors (eye contact and social touch) to patient assessments of clinician (empathy, connectedness, and liking). Methods: Hypotheses were tested including clinician and patient nonverbal behaviors (eye contact, social touch) were coded temporally in 110 videotaped clinical encounters. Patient participants completed questionnaires to measure their perception of clinician empathy, connectedness with clinician, and how much they liked their clinician. Results: Length of visit and eye contact between clinician and patient were positively related to the patient’s assessment of the clinician’s empathy. Eye contact was significantly related to patient perceptions of clinician attributes, such as connectedness and liking. Conclusion: Eye contact and social touch were significantly related to patient perceptions of clinician empathy. Future research in this area is warranted, particular with regards to health information technology and clinical system design. Practice Implications: Clinical environments designed for patient and clinician interaction should be designed to facilitate positive nonverbal interactions such as eye contact and social touch. Specifically, health information technology should not restrict clinicians’ ability to make eye contact with their patients.

Keywords: Clinician-patient interaction, communication, relationship, empathy, nonverbal behavior.

Citation: Montague E, Chen P, Xu J, Chewning B, Barrett B. Nonverbal interpersonal interactions in clinical encounters and patient perceptions of empathy. J Participat Med. 2013 Aug 14; 5:e33.

Published: August 14, 2013.

Competing Interests: The authors have declared that no competing interests exist.



HIPAA - Protecting Patient Privacy

The Health Insurance Portability and Accountability Act (HIPAA) is comprised of two overarching parts--the Privacy Rule and Security Rule. The HIPAA Privacy Rule provides federal protections for personal health information and provides patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes. The Security Rule specifies a series of administrative, physical, and technical safeguards for covered entities to use to assure the confidentiality, integrity, and availability of electronic protected health information.


On January 25, 2013, The U.S. Department of Health and Human Services (HHS) published it’s long awaited Final Rule entitled “Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules under the Health Information Technology for Economic and Clinical Health Act and the Genetic Information Nondiscrimination Act; Other Modifications to the HIPAA Rules” (Omnibus Rule).  There are three (3) specific areas that physicians will need to focus on to comply with the new Omnibus Rule:
  1. Privacy, Security, and Breach Notification policies and procedures;
  2. Notice of Privacy Practices (NPP); and
  3. Business Associate (BA) Agreements.
The Omnibus Rule became effective on March 26, 2013, with a compliance period of 180 days, requiring all providers to be compliant with the new regulations by September 23, 2013.

Below you will find information and resources to help you understand and comply with HIPAA regulations. 

PLEASE NOTE: The sample forms linked to below do not constitute legal advice and are for educational purposes only. These forms are based on current federal law and subject to change based on changes in federal law and the content may need to be modified to adhere to state law or subsequent guidance or advisories. Doctors are advised to consult with their state licensing Board or legal counsel.
For more information visit the HHS Health Information Privacy website.


October 1st Deadline: Employers Must Provide Notice to Employees of Health Insurance Exchange Options

While there has been much publicity about the delays in implementing certain features of the new Patient Protection and Affordable Care Act (ACA), there is one rapidly approaching deadline that no employer should ignore. Employers must provide their current employees with a health insurance exchange notice no later than October 1, 2013. This applies to all employers engaged in interstate commerce or with at least $500,000 of sales per year, regardless of whether or not an employer offers its employees health care coverage. (If your practice accepts credit cards or insurance, you probably engage in interstate commerce.)

Model employee notices can be accessed at (updated link)
Read more about this deadline and what is required of you as an employer at and



Doctors' Diagnostic Errors Are Often Not Mentioned But Can Take A Serious Toll

This KHN story was produced in collaboration with The Washington Post

Until it happened to him, Itzhak Brook, a pediatric infectious disease specialist at Georgetown University School of Medicine, didn't think much about the problem of misdiagnosis.

That was before doctors at a Maryland hospital repeatedly told Brook his throat pain was the result of acid reflux, not cancer. The correct diagnosis was made by an astute resident who found the tumor -- the size of a peach pit -- using a simple procedure that the experienced head and neck surgeons who regularly examined Brook never tried. Because the cancer had grown undetected for seven months, Brook was forced to undergo surgery to remove his voice box, a procedure that has left him speaking in a whisper. He believes that might not have been necessary had the cancer been found earlier.

"I consider myself lucky to be alive," said Brook, now 72, of the 2006 ordeal, which he described at a recent international conference on diagnostic mistakes held in Baltimore. A physician for 40 years, Brook said he was "really shocked" by his misdiagnosis.

But patient safety experts say Brook's experience is far from rare. Diagnoses that are missed, incorrect or delayed are believed to affect 10 to 20 percent of cases, far exceeding drug errors and surgery on the wrong patient or body part, both of which have received considerably more attention.

Recent studies underscore the extent and potential impact of such errors. A 2009 report funded by the federal Agency for Healthcare Research and Quality found that 28 percent of 583 diagnostic mistakes reported anonymously by doctors were life-threatening or had resulted in death or permanent disability. A meta-analysis published last year in the journal BMJ Quality & Safety found that fatal diagnostic errors in U.S. intensive care units appear to equal the 40,500 deaths that result each year from breast cancer. And a new study of 190 errors at a VA hospital system in Texas found that many errors involved common diseases such as pneumonia and urinary tract infections; 87 percent had the potential for "considerable to severe harm" including "inevitable death."

Misdiagnosis "happens all the time," said David Newman-Toker, who studies diagnostic errors and helped organize the recent international conference. "This is an enormous problem, the hidden part of the iceberg of medical errors that dwarfs" other kinds of mistakes, said Newman-Toker, an associate professor of neurology and otolaryngology at the Johns Hopkins School of Medicine. Studies repeatedly have found that diagnostic errors, which are more common in primary-care settings, typically result from flawed ways of thinking, sometimes coupled with negligence, and not because a disease is rare or exotic.

The problem is not new: In 1991, the Harvard Medical Practice Study found that misdiagnosis accounted for 14 percent of adverse events and that 75 percent of these errors involved negligence, such as a failure by doctors to follow up on test results.

Despite their prevalence and impact, such mistakes have been largely ignored, Newman-Toker and others say. They were mentioned only twice in the Institute of Medicine's landmark 1999 report on medical errors, an omission some patient safety experts attribute to difficulties measuring such mistakes, the lack of obvious solutions and generalized resistance to addressing the problem.

"You need data to start doing anything," said internist Mark L. Graber, founding president of the Society to Improve Diagnosis in Medicine and a leading errors researcher. Despite dozens of quality measures, Graber said, he is unaware of "a single hospital in this country trying to count diagnostic errors."

In the past few years, a confluence of factors has elevated the long-overlooked issue. In his 2007 bestseller, "How Doctors Think," Boston hematologist-oncologist Jerome Groopman vividly deconstructed the flawed thought processes that underlie many diagnostic errors, including several he made during his long career.

More recently, an influential cadre of medical leaders has been pushing for greater attention to the problem. They cite concerns about the growing complexity of medicine and increasing fragmentation of the health-care system, as well as relentless time pressures squeezing doctors and the overuse of expensive, high-tech tests that have supplanted traditional hands-on skills of physical diagnosis.

Publicity about the death last year of 12-year-old Rory Staunton, sent home from an emergency room in New York after doctors missed the raging systemic infection that quickly killed him, have put a human face on the problem. At the same time, new digital databases such as IBM's Watson and Isabel promise to boost doctors' accuracy, although their usefulness remains a matter of debate.

"One of the reasons it's time to begin looking at it is that so many of the quality measures we use now assume that the diagnosis is the right one in the first place," said Christine Cassel. A member of the panel that wrote the 1999 IOM report, she is now president and chief executive officer of the American Board of Internal Medicine.

But what if it's not?

In a much-cited essay, Robert Wachter, associate chair of the Department of Medicine at the University of California at San Francisco, wrote that a hospital could earn "performance incentives for giving all of its patients diagnosed with heart failure, pneumonia and heart attack the correct, evidence-based and prompt care -- even if every one of the diagnoses was wrong."

Discovered Late -- Or Never

Unlike drug errors and wrong-site surgery -- mistakes that patient safety experts consider to be "low-hanging fruit" amenable to solutions such as color-coded labels and preoperative timeouts by the surgical team -- there is no easy or obvious fix for diagnostic errors. Many are complex and multifaceted, and may not be discovered for years if ever, said Graber, a senior fellow at RTI International, a research firm based in Research Triangle Park, N.C.

"There is probably nothing more cognitively complicated" than a diagnosis, he said, "and the fact that we get it right as often as we do is amazing."

But doctors often don't know when they've gotten it wrong. Some patients affected by misdiagnosis simply find a new doctor. Unless the mistake results in a lawsuit, the original physician is unlikely to learn that he blew it -- particularly if the discovery is delayed. While diagnostic errors are a leading cause of malpractice litigation, the vast majority do not result in legal action.

Some environments are more susceptible to error than others. Graber calls the emergency room "a petri dish" for diagnostic mistakes: The doctor doesn't know the patient, the patient doesn't trust the doctor, and time pressures and frequent interruptions are the rule.

Misdiagnosis is not limited to hospitals; a recent commentary on the Texas VA study by Newman-Toker and Martin Makary estimates that "with more than half a billion primary care visits annually in the United States . . . at least 500,000 missed diagnostic opportunities occur each year at U.S. primary care visits, most resulting in considerable harm."

There is another reason such mistakes have been long ignored: They are regarded as an unusually personal failure in a profession where diagnostic acumen is considered the gold standard.

"This really gets to who we are as clinicians," said internist Robert Trowbridge, who directs the medicine clerkship program for Tufts University medical students at Maine Medical Center in Portland.

"Overconfidence in our abilities is a major part of the problem," said Graber, who believes doctors have gotten a pass for too long when it comes to diagnostic accuracy. "Physicians don't know how error-prone they are."

Many, he noted, wrongly believe that the problem is "the other guy" and that they don't make mistakes. A 2011 survey of more than 6,000 physicians found that 96 percent felt that diagnostic errors are preventable; nearly half said they encountered them at least once a month.

In the Texas VA study, more than 80 percent of cases lacked a differential diagnosis, in which a doctor not only declares what he believes is ailing the patient but also lists other potential causes of the problem based on symptoms, test results and a physical exam.

"A differential helps people to cognitively focus," said Hardeep Singh, director of the Houston VA Patient Safety Center of Inquiry. Failure to ask "What else could this be?" can cause premature fixation on the incorrect diagnosis, said Singh, the study's lead author.

At Maine Medical Center, Trowbridge spearheaded a pilot program launched in 2010 to persuade doctors to anonymously report diagnostic errors, which would then undergo comprehensive analysis. He said he had to "hound" his colleagues to report mistakes. During the first six months, 36 errors that would otherwise have gone unreported were identified; most were deemed to have caused moderate to severe harm.

Trowbridge said the program has changed how he practices. "I'm much more reflective, much more attuned to the errors I'm prone to make. I work with checklists more."

It Wasn't Fibromyalgia

While second opinions are one strategy believed to reduce misdiagnosis, the original error may be the basis of a cascade of mistakes.

For nearly three years, beginning in February 2008, financial executive Karen Holliman logged more than 50 visits with various doctors in Durham, N.C., trying to get help for the increasingly severe fatigue that had plagued her for several years as well as back pain so excruciating that she wound up in a wheelchair.

Doctors variously told her she had fibromyalgia, chronic fatigue syndrome or a psychiatric problem. The real reason for her symptoms was metastatic breast cancer, which had riddled her spine, fracturing her back. Signs of cancer had been found on an MRI scan performed in February 2008. But a bone scan performed a few weeks later did not indicate cancer; her internist told her she did not have cancer, and doctors repeatedly failed to investigate the discrepancy.

To make matters worse, Holliman was taking hormone replacement pills prescribed by her internist to combat hot flashes; the drug fed her breast cancer.

"I'm terminal," she said. In December 2010, when she was told she had Stage IV breast cancer, an oncologist estimated her life expectancy at about three years. "I could have been diagnosed in 2008," she said, adding that she believes timely diagnosis and treatment might have extended her life expectancy to 10 years.

Holliman has regrets: that she never got a second opinion from an internist or orthopedist, that she didn't question the radiologists who performed her scans and that she failed to obtain her medical records earlier.

During meetings last year attended by her family, including a relative who is a prominent physician, as well as by her doctors and the hospital system for which they worked, Holliman said, a hospital lawyer called her case "a series of unfortunate events" but denied that the hospital was liable for the delayed diagnosis.

"I spent a lot of time being angry," said Holliman, who is 52. She said she has not filed a malpractice suit because she was advised she was unlikely to win. "Now I'm just trying to live a really great life in the time I have left."


National Government Services Upcoming Webinars on Chiropractic Services

National Government Services Upcoming Webinars on Chiropractic Services

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Physiotherapists In The United Kingdom Gain New Power

This past month in the United Kingdom, physical therapists gained the right to prescribe medications independently.

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Medical Inc. The Movie in Final Production

Filmmaker and NCLC guest speaker Jeff Hayes is in the process of putting the finishing touches on his latest documentary, "Medical Inc." The film examines the history surrounding the American Medical Association's conspiracy against the chiropractic profession--which ultimately led to the Wilk vs. AMA trial--and dissects the current medical monopoly  and its efforts to suppress complementary and alternative care. With more than 80 interviews conducted and first-hand accounts from people of various backgrounds and professions, this film is certain to shed new light on how important chiropractic services are to the health and well-being of the public. To see a sneak preview of the film and learn how you can play an active role in the anticipated September release of this documentary.

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ACA Mourns Loss of Board Chairman Dr. Robert Mastronardi

The American Chiropractic Association (ACA) mourns the loss of its Chairman of the Board of Governors (BOG) Robert Mastronardi, DC, 60, who passed away yesterday following a battle with cancer.

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ACA Awards 2010 Alternate Delegate of the Year Award

The American Chiropractic Association (ACA) hosted its annual meeting in Newport, RI September 30-October 2, 2010.  The 2010 ACA Alternate Delegate of the Year was awarded to Louis Lupinacci, DC, FICC.  Dr. Lupinacci is the ACA NY Downstate Alternate Delegate and current NYSCA Vice President.  Accepting the award on behalf of Dr. Lupinacci was Dr. H. William Wolfson ACA NY Downstate Delegate.  Dr. Wolfson acknowledged Dr. Lupinacci’s service to the ACA, “Mild mannered, bright, even tempered, kind, professional, gentleman are only a few of the words you can use to describe this respected, admired and loved doctor … He is deserving of this prestigious ACA award and honor”.  Dr. Wolfson added how appropriate it was for Dr. Lupinacci to receive this award in Rhode Island, as Dr. Lupinacci was born here!  NYSCA extends our best wishes to Dr. Lupinacci on this well deserved award and the ACA by recognizing Dr. Lupinacci for his service to the profession, its doctors and patients!

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The Power of Facebook for Expanding Your Chiropractic Practice

"We ain't one-at-a-timin' here. We're MASS communicating!'" - Pappy O'Daniel

If you think of Facebook as a place for high schoolers and soccer moms, think again. Facebook has quickly earned a following of over 500,000,000 fanatical users who tune in early and often every day. Moreover, as of March 2010, Facebook surpassed Google in daily pageviews. However, that alone is not the reason to make Facebook a part of your chiropractic online advertising strategy.


Until now, when a new patient found you via Google, Yahoo, Bing, Dogpile, or, how many friends could you assume they'd tell about your site. Answer: zero. They might make it a bookmark or favorite but probably did not tell anyone else about your site at least not until after their first appointment. THIS IS WHERE FACEBOOK CHANGES THE MARKETING GAME.

HOW does Facebook spread the word virally?

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B vitamins slow brain atrophy in people with memory problems

The two-year randomised clinical trial is the largest to study the effect of B vitamins on mild cognitive impairment, and one of the first disease-modifying trials in the Alzheimer’s field to show positive results in people.

Around 1 in 6 elderly people over the age of 70 has mild cognitive impairment, experiencing problems with memory, language, or other mental functions, but not to a degree that interferes with daily life. Around half of people with mild cognitive impairment go on to develop dementia – mainly Alzheimer’s disease – within five years of diagnosis.

Certain B vitamins – folic acid, vitamin B6 and vitamin B12 – are known to control levels of the amino acid homocysteine in the blood, and high levels of homocysteine are associated with an increased risk of Alzheimer’s.

So the Oxford team set out to see whether supplements of the B vitamins that lower homocysteine could slow the higher rate of brain shrinkage, or atrophy, observed in mild cognitive impairment or Alzheimer’s.

The study followed 168 volunteers aged 70 or over with mild memory problems, half of whom took high dose B vitamin tablets for two years and the other half a placebo tablet. The researchers assessed disease progression in this group by using MRI scans to measure the brain atrophy rate over a two-year period. The findings are published in the journal

The team found that on average the brains of those taking the folic acid, vitamin B6 and B12 treatment shrank at a rate of 0.76% a year, while those in the placebo group had a mean brain shrinkage rate of 1.08%. People with the highest levels of homocysteine benefited most, showing atrophy rates on treatment that were half of those on placebo.

Along with rate of brain shrinkage, the team from the Oxford Project to Investigate Memory and Ageing (OPTIMA) also monitored cognitive test scores, revealing that those with the slowest rate of shrinkage scored more strongly.

The team suggests that, since the rate of brain atrophy is known to be more rapid in those with mild cognitive impairment who go on to develop Alzheimer’s, it is possible that the vitamin treatment could slow down the development of the disease. Clinical trials to test this should now be carried out, they add.

‘It is our hope that this simple and safe treatment will delay the development of Alzheimer’s disease in many people who suffer from mild memory problems,’ said Professor David Smith of the Department of Pharmacology at Oxford University, a co-leader of the trial. ‘Today there are about 1.5 million elderly in UK, 5 million in USA and 14 million in Europe with such memory problems.

‘These are immensely promising results but we do need to do more trials to conclude whether these particular B vitamins can slow or prevent development of Alzheimer’s. So I wouldn’t yet recommend that anyone getting a bit older and beginning to be worried about memory lapses should rush out and buy vitamin B supplements without seeing a doctor,’ he said.

Rebecca Wood, Chief Executive of the Alzheimer’s Research Trust, which co-funded the study, said: ‘These are very important results, with B vitamins now showing a prospect of protecting some people from Alzheimer’s in old age. The strong findings must inspire an expanded trial to follow people expected to develop Alzheimer’s, and we hope for further success.

‘We desperately need to support research into dementia, to help avoid the massive increases of people living with the condition as the population ages. Research is the only answer to what remains the greatest medical challenge of our time.’

Professor Chris Kennard, chair of the Medical Research Council’s Neurosciences and Mental Health Board which co-funded the study, said: ‘This MRC-funded trial brings us a step closer to unravelling the complex neurobiology of ageing and cognitive decline, which holds the key to the development of future treatments for conditions like Alzheimer’s disease. The findings are very encouraging and we look forward to further research that is needed in order to test whether B vitamins can be recommended as a suitable treatment.’

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Red Flags Rule

On Friday, the FTC issued a notice indicating that the Red Flags Rule would not be enforced until January 1, 2011.  Over the past few months Congress has been debating whether this regulation should apply to healthcare providers.  The AMA has also filed a lawsuit against the FTC because they believe that the FTC has overstepped its bounds by attempting to apply this regulation to healthcare providers.  In the next few months I believe we will see a bill passed which would exempt healthcare providers from this regulation.

For more information on the Red Flags Rule visit:  Read the FTC’s release here

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NBCE Staff Publishes Article on Performance-Based Testing

Greeley, Colo.— Paul D. Townsend, D.C., the NBCE Director of Practical Testing Research and Development , is the lead author on an article published in the January 2010 issue of the journal Teaching and Learning in Medicine.  NBCE Director of Testing and Executive Vice President Mark G. Christensen also contributed to the article.

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Red Yeast Rice for Dyslipidemia in Statin-Intolerant Patients (A Randomized Trial)

ABSTRACT Background: Red yeast rice is an herbal supplement that decreases low-density lipoprotein (LDL) cholesterol level. Objective: To evaluate the effectiveness and tolerability of red yeast rice and therapeutic lifestyle change to treat dyslipidemia in patients who cannot tolerate statin therapy. Design: Randomized, controlled trial. Setting: Community-based cardiology practice. Patients: 62 patients with dyslipidemia and history of discontinuation of statin therapy due to myalgias. Intervention: Patients were assigned by random allocation software to receive red yeast rice, 1800 mg (31 patients), or placebo (31 patients) twice daily for 24 weeks. All patients were concomitantly enrolled in a 12-week therapeutic lifestyle change program. Measurements: Primary outcome was LDL cholesterol level, measured at baseline, week 12, and week 24. Secondary outcomes included total cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride, liver enzyme, and creatinine phosphokinase (CPK) levels; weight; and Brief Pain Inventory score. Results: In the red yeast rice group, LDL cholesterol decreased by 1.11 mmol/L (43 mg/dL) from baseline at week 12 and by 0.90 mmol/L (35 mg/dL) at week 24. In the placebo group, LDL cholesterol decreased by 0.28 mmol/L (11 mg/dL) at week 12 and by 0.39 mmol/L (15 mg/dL) at week 24. Low-density lipoprotein cholesterol level was significantly lower in the red yeast rice group than in the placebo group at both weeks 12 (P < 0.001) and 24 (P = 0.011). Significant treatment effects were also observed for total cholesterol level at weeks 12 (P < 0.001) and 24 (P = 0.016). Levels of HDL cholesterol, triglyceride, liver enzyme, or CPK; weight loss; and pain severity scores did not significantly differ between groups at either week 12 or week 24. Limitation: The study was small, was single-site, was of short duration, and focused on laboratory measures. Conclusion: Red yeast rice and therapeutic lifestyle change decrease LDL cholesterol level without increasing CPK or pain levels and may be a treatment option for dyslipidemic patients who cannot tolerate statin therapy. Annals of Internal Medicine 16 June 2009 Volume 150 Issue 12 Pages 830-839

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Effects of prenatal multimicronutrient supplementation on pregnancy outcomes: a meta-analysis

Abstract Background: Reduced intake of micronutrients during pregnancy exposes women to nutritional deficiencies and may affect fetal growth. We conducted a systematic review to examine the efficacy of prenatal supplementation with multimicronutrients on pregnancy outcomes. Methods: We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library for relevant articles published in English up to December 2008. We also searched the bibliographies of selected articles as well as clinical trial registries. The primary outcome was low birth weight; secondary outcomes were preterm birth, small-for-gestational-age infants, birth weight and gestational age. Results: We observed a significant reduction in the risk of low birth weight among infants born to women who received multimicronutrients during pregnancy compared with placebo (relative risk [RR] 0.81, 95% confidence interval [CI] 0.73–0.91) or iron–folic acid supplementation (RR 0.83, 95% CI 0.74–0.93). Birth weight was significantly higher among infants whose mothers were in the multimicronutrient group than among those whose mothers received iron–folic acid supplementation (weighted mean difference 54 g, 95% CI 36 g–72 g). There was no significant differences in the risk of preterm birth or small-for-gestational-age infants between the 3 study groups. Interpretation: Prenatal multimicronutrient supplementation was associated with a significantly reduced risk of low birth weight and with improved birth weight when compared with iron–folic acid supplementation. There was no significant effect of multimicronutrient supplementation on the risk of preterm birth or small-for-gestational-age infants. CMAJ • June 9, 2009; 180 (12). doi:10.1503/cmaj.081777.

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The time is now for ChiroVoice!

The New York State Chiropractic Association asks members to support the ACA chiropractic advocacy network, (ChiroVoice). Through this chiropractic advocacy network, patients and chiropractic supporters can stay informed about important health care issues and contact their legislators in Washington. Chiropractic supporters will be able to educate policymakers about the value of chiropractic and work to positively impact any legislative efforts to reform the current national health care system. ChiroVoice will also enable the NYSCA to mobilize patient support at the state level for legislative action when necessary. Ask your patients to sign up now! (Please be sure to adhere to all HIPAA regulations if signing patients up in your office.) The time is now for ChiroVoice! The opportunity to challenge some of the long standing issues beleaguering our profession. Prevention... Wellness... Fee Parity....Anti Discrimination Statutes, Full Scope Medicare, etc. These are just a few of our issues to be debated in DC. Historically, when given the chance to compete on a level playing field our profession shines. Along the same lines, historically the way we get there is through grass roots activities. The ACA has iniated ChiroVoice. Yet, many docs have not asked patients and staff to sign up. Please take time today to get your patients and staff involved. The Senate is marking up legislation this week and the House in a few weeks. President Obama wants a bill on his desk by the fall if not sooner. We can shape our future. It is said "Inaction has as significant of an impact as action," please don't let inaction cause us to fail. It's up to all of us to get involved, be involved, stay involved and be triumphant...we all benefit! Thanks for your help! Louis Lupinacci, DC, FICC NYSCA Vice President H. William Wolfson, DC, FICC NYS Downstate Delegate

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