The American Medical Association (AMA) has announced that it will issue a correction to all purchasers of its Guides to the Evaluation of Permanent Impairment, Sixth Edition, after ACA’s legal team questioned the legality of restrictive language related to evaluations by doctors of chiropractic and accused the AMA of violating the permanent Wilk injunction. In a Feb. 20 letter to ACA, AMA’s legal counsel writes that the text in question "is incorrect and warrants immediate correction."

New York Chiropractic College was recognized by the Commission on Independent Colleges and Universities (CICU) for its leadership role in New York’s independent academic sector. CICU’s winter 2008 publication highlighting private education’s favorable impact on New York residents’ health care, referenced NYCC’s Acupuncture and Oriental Medicine program and acupuncture’s reputation as a safe, cost effective, and efficacious alternative to western medicine. NYCC’s chiropractic program, long recognized for its academic excellence, was lauded for its study involving vertebral anatomy, rehabilitation and relief of neuromusculoskeletal disorders. CICU concluded with: “New York’s independent campuses draw talent, research dollars, and patients looking for promising new treatments while also reaching deep into the state’s most intractable health problems, probing for solutions – and delivering”.

Database Company Ingenix – Used by Dozens of Insurers – at Center of Scheme Cuomo Notifies Ingenix and its Parent, UnitedHealth Group, of Intent to File Suit; Subpoenas 16 Other Companies NEW YORK, NY (February 13, 2008) – Attorney General Andrew M. Cuomo today announced that he is conducting an industry-wide investigation into a scheme by health insurers to defraud consumers by manipulating reimbursement rates. At the center of the scheme is Ingenix, Inc., the nation’s largest provider of healthcare billing information, which serves as a conduit for rigged data to the largest insurers in the country. Cuomo also announced that he has issued 16 subpoenas to the nation’s largest health insurance companies including Aetna (NYSE: AET), CIGNA (NYSE: CI), and Empire BlueCross BlueShield (NYSE: WLP), and that he intends to file suit against Ingenix, Inc, its parent UnitedHealth Group (NYSE: UNH), and three additional subsidiaries. The six-month investigation found that Ingenix operates a defective and manipulated database that most major health insurance companies use to set reimbursement rates for out-of-network medical expenses. Further, the investigation found that two subsidiaries of United (the “United insurers”) dramatically under-reimbursed their members for out-of-network medical expenses by using data provided by Ingenix. Under the United insurers’ health plans, members pay a higher premium for the right to use out-of-network doctors. In exchange, the insurers promise to cover up to 80% of either the doctor’s full bill or of the “reasonable and customary” rate depending upon which is cheaper. The Attorney General’s investigation found that by distorting the “reasonable and customary” rate, the United insurers were able to keep their reimbursements artificially low and force patients to absorb a higher share of the costs. “Getting insurance companies to keep their promises and cover medical costs can be hard enough as it is,” said Attorney General Andrew Cuomo. “But when insurers like United create convoluted and dishonest systems for determining the rate of reimbursement, real people get stuck with excessive bills and are less likely to seek the care they need.” Cuomo’s investigation also found a clear example of the scheme: United insurers knew most simple doctor visits cost $200, but claimed to their members the typical rate was only $77. The insurers then applied the contractual reimbursement rate of 80%, covering only $62 for a $200 bill, and leaving the patient to cover the $138 balance. The United insurers and many other health insurance companies relied on the Ingenix database to determine their “reasonable and customary” rates. The Ingenix database used the insurers’ billing information to calculate a “reasonable and customary” rate for individual claims by assessing how much a similar type of medical service would typically cost, generally taking into account the type of service, physician, and geographical location. However, the investigation showed that the “reasonable and customary” rates produced by Ingenix were remarkably lower than the actual cost of typical medical expenses. The United insurers and Ingenix are owned by the same parent corporation, United HealthGroup. When members complained their medical costs were unfairly high, the United insurers hid their connection to Ingenix by claiming the rate was the product of “independent research.” The Attorney General’s notice to United expressed concern that the company’s ownership of Ingenix created a clear conflict of interest because their relationship gave Ingenix an incentive to set rates that benefited United and its subsidiaries. Cuomo’s notice of intent to sue names the following potential defendants: UnitedHealth Group and its subsidiaries, United HealthCare Insurance Company of New York, Inc., United Healthcare of New York, Inc., United Healthcare Services, Inc. and Ingenix. The subpoenas served today request documents showing how the insurer computes reasonable and customary rates, copies of member complaints and appeals, and communications with members and between Ingenix and the insurer on the issue. Cuomo continued, “The lack of accuracy, transparency, and independence surrounding United’s process for setting a ‘reasonable and customary rate’ is astounding. United’s ownership of Ingenix coupled with the inherent problems with the data it is using clearly demonstrate a broken reimbursement system designed to rip off patients and steer them towards in-network-doctors that cost the insurer less money.” Consumers Union Programs Director Chuck Bell said, "Based on the findings in this investigation, it appears that United Health failed to fulfill the promises it made to cover a fair portion of medical expenses, and consumers were stuck with the bill. The current process for establishing ‘reasonable and customary’ rates is riddled with conflicts of interest and manipulations that consistently lead to patients paying more, and insurers paying less. We applaud Attorney General Cuomo for taking on this issue which is vitally important for consumers everywhere.” Cancer Care’s Associate Executive Director Ellen Coleman said, “Cancer patients and others faced with life-threatening illnesses need to know that a fair portion of the often overwhelming medical expenses will be covered by their insurance company. Insurers should fulfill their promises and not leave patients forced to choose between the medical care they need and the medical care they can afford. Cancer Care thanks Attorney General Cuomo for taking action on this issue and for continuing to protect the rights of patients.” “The litigation initiated by the Attorney General is critically important for two reasons,” said Ron Pollack, Executive Director of the health consumer organization Families USA. “First, it is essential that health services obtained outside of a network be compensated fairly and adequately. Eighteen million Americans under the age of 65 will spend more than a quarter of their family income on health care this year, and healthcare debt is the number one cause of individual bankruptcy. Second, there needs to be transparency in these payment arrangements. For these reasons, we support the efforts of the Attorney General.” The American Medical Association's President-elect Nancy Nielsen M.D. said, “The investigation launched today by New York Attorney General Andrew Cuomo calls into question the validity of a system that health insurers have used for years to reimburse physicians and their enrolled members. Patients have a right to expect fair and accurate payment for services promised by health insurers. The AMA greatly appreciates the Attorney General’s interest and leadership in protecting consumers, and we offer our full cooperation in any effort to hold UnitedHealth accountable to New York state laws.” The Medical Society of the State of New York President Dr. Robert Goldberg said, “The Medical Society of the State of New York applauds Attorney General Cuomo and his hard-working staff for their diligent efforts in moving forward in an investigation that we believe will have long term benefits to healthcare in New York. MSSNY also applauds the Attorney General for acting on the complaints of our patients and our physician members.” The Attorney General’s industry-wide investigation is being handled by Acting Deputy Chief of the Healthcare Bureau James Dering as well as members of the Healthcare Industry Taskforce, Assistant Attorneys General Brant Campbell and Sandra Rodriguez, under the direction of the head of the Attorney General’s Healthcare Industry Taskforce, Linda Lacewell. Audio Attachments:

Davenport, IA – After an illustrious 20-year legacy as chairman of the Palmer College of Chiropractic Board of Trustees, Ms. Vickie Palmer announced to Board members on Jan. 15, 2008, that she would officially conclude her tenure as chairman at the Feb. 1-2, 2008, Board meeting in San Jose, Calif. Ms. Palmer continues serving on the Board as a Board officer and member of the executive committee. “I began considering this nearly seven years ago and consulted with many advisors, including my two sisters, during that time,” explained Ms. Palmer. “For many reasons, I’m confident that this is the right time to make a smooth transition. We’ve successfully completed our capital campaign and opened the Academic Health Center. I’m also very comfortable with the strength of the Board and the College administration. More importantly, the time is right for a practicing chiropractor to lead this College as it has become a true participant in the mainstream healthcare delivery system.” As part of her announcement, Ms. Palmer submitted the nomination of Vice Chairman Trevor Ireland, D.C., as her successor. At the Board meeting, Dr. Ireland received unanimous support and approval from all members and officially assumed chairman responsibilities on Feb. 2. “I appreciate that the Board of Trustees agreed with my nomination of Dr. Ireland as chairman,” Ms. Palmer added. “He is an incredible individual and I’m certain he will do an excellent job. Dr. Ireland possesses all of the characteristics necessary to lead us on this journey.” “I’ve trained my entire life to assume this position,” Dr. Ireland said of his election to Board chairman. “It has been a privilege to have served with Vickie for all these years. As we enter this new era of chiropractic, I shall do my utmost to benefit Palmer College, pursue its mission, and protect and perpetuate its philosophy, science and art, and continue to honor the historic connection between Vickie Palmer and the College.” Dr. Ireland, a 1970 magna cum laude graduate of Palmer’s Davenport Campus and a Board member since 1988, is founder of the Ireland Clinic of Chiropractic in Anchorage, Alaska, one of the largest chiropractic healthcare facilities in that state. During his distinguished 38-year career in chiropractic, he has been honored as a fellow of the International Chiropractors Association, the Palmer Academy of Chiropractic, the Palmer West Campus Academy of Chiropractic, and the International College of Chiropractors. Dr. Ireland was the youngest doctor ever to receive all four Chiropractic fellowship honors. In addition, he co-founded the Alaska Chiropractic Society and is a past president of that organization. With Dr. Ireland assuming the Board chairman position, Mr. Kent Forney was elected vice chairman. Mr. Forney, a prominent attorney in Des Moines, Iowa, has served on the Board since 1982, most recently as the Board secretary. “Having been a Board member for more than 25 years, I have had the pleasure of serving the College with Vickie Palmer,” said Mr. Forney. “I have always been impressed with her unselfish devotion to the College and the profession. Her tireless efforts as chairman will be sorely missed. Fortunately, she will remain a member of the Board, so as we move forward, her talents will not be lost to the College.” Ms. Palmer was named to the Palmer Board in 1978 and served as vice chairman from 1985 until her election to chairman in 1987. During that tenure, she has been instrumental in many significant accomplishments for the College. Those include opening of the Palmer Academic Health Center on the Davenport Campus; the growth, development and stabilization of Palmer’s West Campus; the establishment of the Florida Campus in 2002; the creation of the Palmer Center for Business Development and the Palmer Center for Chiropractic Research, and the unification of the three Palmer campuses as one College. “Having literally grown up on the Davenport Campus, my entire life has been centered around Palmer College,” said Ms. Palmer. “It has been my pleasure to serve this wonderful College in so many ways, including my time working in various areas such as Student Affairs, Academics and, for the past 20 years, as chairman of the Board. “I have reached a time in my life – and in the life of Palmer College – when I wish to serve the Board in a new role; one that allows me to be more interactive with our students and alumni. I am excited about contributing in different ways to help Palmer College of Chiropractic move forward.” “Over the years, Vickie has quietly contributed her time, resources and talents to the College as she has honorably carried on the Palmer family legacy,” said Larry Patten, chancellor of Palmer College. “She’s been an exceptional leader and I personally want to thank her for all she has done.”

Abstract of Study Study Design: Population-based, case-control and case-crossover study. Objective: To investigate associations between chiropractic visits and vertebrobasilar artery (VBA) stroke and to compare this with visits to primary care physicians (PCP) and the occurrence of VBA stroke. Summary of Background Data: VBA stroke is a rare occurrence. Neck pain and headache are common symptoms of VBA dissection and typically precede VBA stroke. Chiropractic care is popular for neck pain and headache, but has been associated with an increased risk for VBA dissection and stroke. People experiencing headache and neck pain may also choose to consult a primary care physician. Methodology: The cases studied comprise eligible incidents of VBA stroke admitted to Ontario hospitals over a nine year period from April 1993 to March 2002. Four controls were age and gender matched to each case. Visits to chiropractors and primary care physicians during the year before the stroke date were determined from Ontario Health Insurance Plan (OHIP) billing records. In the case cross-over analysis, cases acted as their own controls. Results: Over the nine year study period, there were 818 cases of VBA stroke admitted to Ontario hospitals in a population of more than 100 million person-years. Among those under 45 years of age, cases were about three times more likely to visit a primary care physician or a chiropractor prior to their stroke compared to controls. A strong association was found between primary care physician visits and VBA strokes in all age groups. There was no increased association between chiropractic visits and VBA stroke in those older than 45 years. Conclusions: VBA stroke is a very rare event in the population. The risk of VBA stroke associated with a visit to a chiropractor’s office appears to be no different from the risk of VBA stroke following a visit to an MD’s office. The incidence of VBA stroke associated with chiropractic and primary care physician visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. The study found no evidence of excess risk of VBA stroke associated with chiropractic care compared to primary physician care. J David Cassidy, DC, PhD, et al. Spine. Vol. 33, No. 4S, pp. S176-S183.

(Arlington, Va.) -- Following an unprecedented profession-wide campaign led by the ACA, UnitedHealthcare (UHC) has announced it will rescind its recent policy declaring chiropractic manipulative treatment for headaches and pediatric patients as unproven, and therefore, not a covered service. “We are pleased that UHC has decided not to implement this policy,” said ACA President Glenn Manceaux, DC. “We strongly believe that through the actions of ACA, along with the other chiropractic organizations, the profession made a compelling argument as to why this policy should have been rescinded. We feel that our members, the profession and our patients will be well served by UHC’s recent decision.” Since September 2007, ACA has maintained a line of communication with UHC to emphasize its members’ concerns over the proposed policy change. Furthermore, ACA joined forces with ACC, CCGPP, COCSA, FCER and ICA to issue a joint letter opposing the "flawed" and "unconscionable" policy and supporting a detailed CCGPP analysis and critique of UHC's stance. The ACA Council on Chiropractic Pediatrics also submitted a separate response to UHC. In October, UHC delayed implementation of its flawed policy pending additional review of research and information provided by the ACN Chiropractic Professional Advisory Committee (CPAC) and other chiropractic organizations. “The ACA is proud to have led this effort, which serves as a very important reminder that there is strength in numbers. When all corners of the profession work together with a single vision and a single voice, there is no limit to what we can accomplish. It also underscores the critical role research and evidence play in the reimbursement world and the need for insurers to consult with the chiropractic profession before implementing changes that negatively affect our patients,” said Dr. Manceaux. Click below for the full text of UHC’s policy update.

Increasingly the New York State Board for Chiropractic has been receiving questions and concerns about certain types of advertising. The information provided in this brief article may help clarify some of the responsibilities we have as practitioners when we advertise. Beyond those rules and regulations we have that are specific to our profession in New York, we must also comply with the general Rules of the Board of Regents which are applicable to all licensed professionals in the state of New York. If you do not have a copy of these regulations you can view them online at www.op.nysed.gov or call the New York State Board for Chiropractic at 1-518-474-3817 ext. 190. The specifics of advertising are discussed in Part 29 "Unprofessional Conduct". As described in Part 29 Advertising or soliciting not in the public interest shall include, but not be limited to, advertising or soliciting that: 1. "is false, fraudulent, deceptive or misleading" 2. "guarantees any service" 3. "makes any claim relating to professional services or products or the cost or price therefore which cannot be substantiated by the licensee, who shall have the burden of proof" 4. "makes claims of professional superiority which cannot be substantiated by the licensee, who shall have the burden of proof" 5. "offers bonuses or inducements in any form other than a discount or reduction in an established fee or price for a professional service or product". This list is for the most part pretty self explanatory. However, item number three may deserve a little more attention. If in the course of your advertising you state that your technique is effective a certain percentage of the time, it is up to you to be able to prove it. If some of the information in your advertising program is being provided to you from an outside source, then please verify that it is true and accurate because you, the practitioner, are ultimately held accountable for the accuracy of your advertising. If you have any questions on these rules and regulations or any other questions you may have, please contact the New York State Board for Chiropractic office at: NY State Education Department Office of the Professions State Board for Chiropractic 89 Washington Ave. Albany, NY 12234-1000 1-518-474-3817 ext.190 NYSBC Information Committee

Dear NYSCA Members, An urgent appeal from COCSA is requesting the support of all state associations. The Congress of Chiropractic State Associations embraces two ACA initiatives. The first is a data collection project where each doctor sends the ACA 5 example charts showing managed care abuse that has hindered patient care; the second initiative is an effort to encourage all DC’s to appeal every restriction of care. This “en masse” effort is intended to push back insurers’ efforts to withhold benefits that patients are entitled to. The NYSCA is wholly behind these ACA initiatives. COCSA has set goals for the state associations in procuring un-sanitized case files of inappropriate denial of care. Details of their plan are found on their homepage www.cocsa.org. You help is needed now! The ACA General Counsel states the window is now open for the real possibility of legal action against the shameless practices of Managed Care groups. The cornerstone of any legal action will be patient files that can be used as direct evidence. These files must bear the scrutiny of the court, therefore we urge you to review the instructions below and join the effort for your future as well as that of patients in your state. Data Collection initiative at www.acatoday.org/datacollection (also below) DOI Appeals initiative at www.acatoday.org/appeals (toolkit for offices) To do your part and assist ACA, we ask that you take the following steps. 1. Read and sign the HIPAA Business Associate Agreement (found here) so that patient information may be provided directly to the ACA Insurance Relations Department. Note that all patient records will be kept in a locked room in locked cabinets pursuant to HIPAA requirements. 2. Identify patients whose care or benefits have been compromised by coverage decisions made by managed care networks and speak with them to ascertain if they are interested in allowing their medical file to be shared with the ACA and regulatory authorities. A patient information sheet is provided here for your convenience. No information regarding patients or their doctors will be shared with managed care companies. Specifically, we need copies of the following items from your patients’ files: a) Completed patient intake forms b) Completed diagnostic testing reports c) Chart notes d) All forms that show a complete chronology of the interaction with the managed care organization 3. Obtain HIPAA Authorization: Explain HIPAA rights to the patient – (a brochure can be found here just in case you are unsure if your office documentation is up to date.) Once you are sure the patient clearly understands the reason for this initiative, and they indicate they would like to participate, have them sign the HIPAA Authorization, found here which has been pre-completed for your convenience. 4. Mail the following to the ACA: copies of your five complete un-sanitized patient files with the associated HIPAA Authorization and your signed Business Associate Agreement to the following address: Documents Needed to Assist Business Associate Agreement Cover Letter to Doctors Four Steps to Help Patient Information Sheet HIPAA Authorization Questions? Contact @ ACA Daniel Lyons at [email protected] or call - 703-812-0225.

(Arlington, Va.) -- The Department of Health and Human Services Office of the Inspector General (OIG), the agency responsible for identifying and reporting inefficiency in Medicare, Medicaid and other related HHS programs, announced in its 2008 Work Plan that it would again seek records from doctors of chiropractic as a follow-up to its 2005 report on chiropractic documentation. "ACA strongly urges all doctors of chiropractic who receive an OIG record request to contact the association for assistance on how to fully comply with the request,” said ACA President Glenn Manceaux, DC. “Timely response to an OIG record request is mandatory, and ACA representatives are available to help you navigate the OIG request process.” ** Official OIG record requests will be sent on letterhead that clearly states “Office of the Inspector General.” Upon receipt of an OIG request, it is critical that doctors of chiropractic include all necessary information and complete the request by the date specified by the OIG, noted John Falardeau, ACA’s vice president of government relations. In addition to those doctors who recently received an OIG record request, ACA would also like to hear from providers who have already submitted their information to the agency. The 2005 OIG Report, which was based on a random sampling of claims data from 2001, concluded that 67 percent of the claims examined as part of the study contained documentation errors or omissions that led to what the OIG considered to be inappropriate reimbursement under Medicare. The report also extrapolated that U.S. taxpayers could save more than $280 million per year if improperly documented claims filed by chiropractors were not paid by Medicare. To contact ACA regarding an OIG record request, send an e-mail to [email protected] or [email protected] . **ACA’s assistance is designed to provide authoritative information to help doctors of chiropractic fully and accurately comply with the OIG request. This assistance is provided with the understanding that ACA is not engaged in rendering legal or other professional services. If legal advice or other expert professional assistance is required, the services of a competent professional person should be sought.

ABSTRACT Background—Vitamin D receptors have a broad tissue distribution that includes vascular smooth muscle, endothelium, and cardiomyocytes. A growing body of evidence suggests that vitamin D deficiency may adversely affect the cardiovascular system, but data from longitudinal studies are lacking. Methods and Results—We studied 1739 Framingham Offspring Study participants (mean age 59 years; 55% women; all white) without prior cardiovascular disease. Vitamin D status was assessed by measuring 25-dihydroxyvitamin D (25-OH D) levels. Prespecified thresholds were used to characterize varying degrees of 25-OH D deficiency (Conclusions—Vitamin D deficiency is associated with incident cardiovascular disease. Further clinical and experimental studies may be warranted to determine whether correction of vitamin D deficiency could contribute to the prevention of cardiovascular disease. From the Framingham Heart Study, Framingham, Mass (T.J.W., M.J.P., E.I., K.L., E.J.B., R.B.D., R.S.V.); Cardiology Division (T.J.W.) and Renal Division (M.W.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Statistics and Consulting Unit, Department of Mathematics (M.J.P., R.B.D.), Boston University, Boston, Mass; Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging (S.L.B., P.F.J.), Tufts University, Boston, Mass; and Sections of Cardiology and Preventive Medicine (E.J.B., R.S.V.), Boston Medical Center, Boston University School of Medicine, Boston, Mass. Circulation. 2008 10.1161/CIRCULATIONAHA.107.706127 FOR FULL TEXT PDF click on the link below:

(Arlington, Va.) -- The American Chiropractic Association (ACA) today announced that well-known political strategist and media personality James Carville will deliver the keynote address during the 2008 National Chiropractic Legislative Conference (NCLC) scheduled for Feb. 28-29 in Washington, D.C.

Citing the “great work” for the chiropractic profession by the Foundation for Chiropractic Education and Research (FCER), a state association council that wishes to remain anonymous has given FCER a $20,000 donation. The unrestricted donation may be used for FCER’s major new initiatives such as the continuing development of the DCConsultSM Evidence-Based Resource Center (EB-RC) and the State of Research program, both announced in 2007. “FCER is very grateful for this impressive donation, especially since it came from a state association council with a relatively small membership,” Charles R. Herring, DC, FCER President, said. “For a state association council to make this large of a donation to FCER highlights the perceived trust that chiropractic organizations have in the value of FCER’s programs and importance of these initiatives to the future of the profession,” he added. FCER’s EB-RC includes an online resource center that the day-to-day practitioner can access for patient care information, discussion on the latest research and how it translates into practice, a pathway to more detailed research articles and commentaries and active links to other databases that have a related theme such as in the areas of nutrition, herbs, exercise and fitness and so on. The site will be available during the first quarter 2008. The State of Research initiative involves FCER working with state association research committees to identify needed state-specific research, especially for reimbursement, and assisting practitioners in utilizing research in daily patient care. To date, 22 states have appointed research committees as part of this program. FCER is the chiropractic profession’s oldest not-for-profit foundation, serving the profession since 1944. Based in Norwalk, Iowa, FCER has as its mission to “Translate Research into Practice” by granting funds for research and in producing practitioner and patient education materials including teleconferences, CDs, books and pamphlets. FCER is developing the DCConsult web site as part of its Evidence-Based Resource Center, an online source for customized clinical and patient education information.

Opinion Several decades ago, medical researcher Jack Wennberg studied health care services in Vermont and found that "Vermonters who lived in towns with more aggressive care weren't healthier," but rather they "were just getting more health care," columnist David Leonhardt writes in the New York Times. Wennberg's results have held true in studies conducted at the national level, and they offer "the key to health reform -- how to spend less on health care while not making the population any less healthy," according to Leonhardt. He writes that Wennberg's story "forms the backbone of 'Overtreated,' by Shannon Brownlee," a senior fellow at the New America Foundation. Leonhardt says Brownlee's work is his "choice for the economics book of the year." He continues that health care spending "simply can't continue to rise at its current pace," adding, "Fortunately -- if that's the right word -- there is an obvious candidate for cost-cutting: all that care that brings no health benefit." In her book, Brownlee "lays out an agenda for reform that is usually confined to academic journals," Leonhardt says, adding, "It includes some steps that should be widely popular, like giving doctors incentives to explain the risks and benefits of procedures more clearly than they do now." He continues, "Other solutions would be more difficult," but "models for reform are out there." Leonhardt notes that since "the 1950s, doctors have made incredible progress against diseases that were once inevitably fatal" and that such progress "is probably the finest human achievement of the last half century." Leonhardt concludes, "If we weren't wasting so much money on overtreatment, it would be a lot easier to repeat the achievement over the next half century" (Leonhardt, New York Times, 12/19). The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. (c) 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Kaiser Daily Health Policy Report: Opinion - Dec 20, 2007. You can view the entire Kaiser Daily Health Policy Report by clicking on the link below:

(Arlington, Va.) -- Congress, in one of its final acts of the session, passed legislation that temporarily halts a 10 percent across-the-board cut to the Medicare Physician Fee Schedule (MPFS). Instead, the bill will provide for a slight overall increase of 0.5 percent.

Seneca Falls, NY: New York Chiropractic College conferred the Doctor of Chiropractic degree upon 89 graduates on Saturday, December 1, 2007, during a commencement ceremony held in the Athletic Center Gymnasium of the college’s Seneca Falls campus. Frank J. Nicchi, DC, MS, president of NYCC. The commencement address was delivered New York State Senator Michael F. Nozzolio, a native of Seneca Falls and longstanding supporter of the College’s regional healthcare efforts. Christopher Lynch, valedictorian, had the honor of addressing his classmates. Amanda Louise Laytham was salutatorian. For information on New York Chiropractic College’s degree programs please visit the college’s Web site at:

CLINICAL GUIDELINES Recommendation 1: Clinicians should conduct a focused history and physical examination to help place patients with low back pain into 1 of 3 broad categories: nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause. The history should include assessment of psychosocial risk factors, which predict risk for chronic disabling back pain (strong recommendation, moderate-quality evidence). Recommendation 2: Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain (strong recommendation, moderate-quality evidence). Recommendation 3: Clinicians should perform diagnostic imaging and testing for patients with low back pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination (strong recommendation, moderate-quality evidence). Recommendation 4: Clinicians should evaluate patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis with magnetic resonance imaging (preferred) or computed tomography only if they are potential candidates for surgery or epidural steroid injection (for suspected radiculopathy) (strong recommendation, moderate-quality evidence). Recommendation 5: Clinicians should provide patients with evidence-based information on low back pain with regard to their expected course, advise patients to remain active, and provide information about effective self-care options (strong recommendation, moderate-quality evidence). Recommendation 6: For patients with low back pain, clinicians should consider the use of medications with proven benefits in conjunction with back care information and self-care. Clinicians should assess severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy (strong recommendation, moderate-quality evidence). For most patients, first-line medication options are acetaminophen or nonsteroidal anti-inflammatory drugs. Recommendation 7: For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits—for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation (weak recommendation, moderate-quality evidence). Annals of Internal Medicine 2 October 2007 | Volume 147 Issue 7 | Pages 478-491 Related articles in Annals: Clinical Guidelines Nonpharmacologic Therapies for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline Roger Chou AND Laurie Hoyt Huffman Annals 2007 147: 492-504. [Full Text] Clinical Guidelines Medications for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline Roger Chou AND Laurie Hoyt Huffman Annals 2007 147: 505-514. [Full Text] Summaries for Patients Diagnosis and Treatment of Low Back Pain: Recommendations from the American College of Physicians/American Pain Society Annals 2007 147: I-45. [Full Text]

(Arlington, Va.) -- Through the leadership of the American Chiropractic Association (ACA), doctors of chiropractic will soon be eligible to participate in Medicare’s quality reporting program, known as the Physician Quality Reporting Initiative (PQRI). In 2008, the program will include 119 quality measures, including two applicable to chiropractic. The Centers for Medicare and Medicaid Services (CMS) finalized the 2008 measures in mid-November. Beginning Jan. 1, doctors of chiropractic can report on measures related to “pain assessment prior to initiation of patient treatment,” and “adoption/use of health information technology.” “The inclusion of quality measures applicable to chiropractic care in the 2008 PQRI affords our profession an opportunity to strengthen its involvement in the promotion of quality patient care,” said ACA President Glenn Manceaux, DC. “The ACA urges doctors of chiropractic to participate in PQRI. To assist doctors in this endeavor, the association will soon release chiropractic-specific information and practical tips to help educate clinic staff on the reporting process and to ensure proper documentation.” The PQRI program has established a financial incentive for doctors of chiropractic and other health care providers to participate. Chiropractors who successfully report on a designated set of quality measures on claims for dates of service from Jan. 1 to Dec. 31, 2008, may earn a bonus payment estimated to be between 1.5 and 2.0 percent of submitted claims. For the past two years, CMS sponsored a voluntary program for physicians to report codes to the government regarding “quality” protocols and services performed in their practices. Under the 2008 program, eligible providers who choose to participate will help capture data about the quality of care provided to Medicare beneficiaries. Participating providers will also help government officials identify the most effective ways to use quality measures in daily practice. “Proper documentation will be the lynchpin for full chiropractic parity in Medicare. With the profession eagerly awaiting analysis of the Medicare chiropractic demonstration project, I urge chiropractic offices to become fully acclimated in reporting quality measures,” Dr. Manceaux added. While physicians are not required to register prior to participation in PQRI, they must be enrolled in Medicare and have a National Provider Identifier (NPI). In early 2007, recognizing the importance of improving quality patient care in the chiropractic setting, ACA established an internal Performance Measurement Workgroup to address quality measures development, endorsement, and implementation issues specific to the care provided by doctors of chiropractic. Under the guidance of an ACA hired consultant, the Workgroup has been successful in providing chiropractors an opportunity to report on quality measures specific to the Chiropractic Manipulative Treatment (CMT) codes recognized by Medicare. The detailed specifications for all final PQRI measures, along with other information about the PQRI program, can be found at http://www.cms.hhs.gov/pqri. Information regarding practical tips for doctors of chiropractic who plan to participate in the 2008 PQRI will soon be posted on ACA’s Web site at:

The American Chiropractic Association (ACA) has pledged its support for the State of Research initiative launched by the Foundation for Chiropractic Education and Research (FCER), during the recent meeting of the Congress of Chiropractic State Associations (COCSA) in Nashville, Tennessee. The State of Research initiative was announced earlier this year as a project where FCER works with state chiropractic associations to identify practitioners’ research-related needs, assists in getting the research conducted, and helps the practitioner to use the research in evidence-based practices. To date, 22 state associations have appointed state research committee chairpersons to work with FCER’s State of Research Committee on this initiative. “The American Chiropractic Association supports FCER’s State of Research project as an aggressive way to help identify the research needs of our clinicians, especially in the area of reimbursement,” Glenn D. Manceaux, DC, ACA President, said. “We encourage the state associations to get firmly behind this project, which will offer additional research- and education-related opportunities for the profession,” he added. Charles R. Herring, DC, FCER President, said, “We greatly appreciate ACA’s support in this initiative, which is an important component of FCER’s new mission. This project, along with the development of FCER’s Evidence-Based Resource Center, adds to the profession’s body of knowledge, which in the long run will make us better practitioners for our patients,” he added. Associations in the following states have appointed committee chairpersons: Alabama, Arizona, Colorado, Georgia, Idaho, Iowa, Louisiana, Michigan, Missouri, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Dakota, Rhode Island, South Carolina, South Dakota, Vermont, Virginia, Washington and Wisconsin. FCER’s State of Research Committee members are Reeve Askew, DC, chair; Charles Herring, DC; Jeffrey Fedorko, DC; Mark Kruse, DC, and Robert Hayden, DC. The ACA, based in Arlington, Virginia, is the largest professional association in the world representing doctors of chiropractic. The ACA provides lobbying, public relations, professional and educational opportunities for doctors of chiropractic, funds research regarding chiropractic and health issues, and offers leadership for the advancement of the profession. FCER is the chiropractic profession’s oldest not-for-profit foundation, serving the profession since 1944. Based in Norwalk, Iowa, FCER has as its mission to “Translate Research into Practice” by granting funds for research and producing practitioner and patient educational materials including teleconferences, CDs, books and pamphlets. FCER is developing the DCConsultSM web site as part of its Evidence-Based Resource Center, an online source for clinical and patient education information.

Five Insurers in Three Weeks Adopt Model Created Together with National Medical and Consumer Groups NEW YORK, NY (November 20, 2007) – Attorney General Andrew M. Cuomo today announced an agreement on doctor ranking programs with Group Health Incorporated (GHI) and Health Insurance Plan of Greater New York (HIP). With this agreement, a total of five insurers have adopted the Attorney General’s doctor ranking model. The others are CIGNA Healthcare, Aetna, Empire Blue Cross Blue Shield, and UnitedHealthcare. CIGNA, Aetna, and Empire’s parent, WellPoint, will also apply the principles of the Attorney General’s doctor ranking model nationwide. GHI and HIP provide health benefits to over four million people in the tri-state area. This model was created in consultation with the American Medical Association and the Medical Society of the State of New York, along with a host of consumer advocacy groups including the Consumers Union and the National Partnership for Women & Families. The North Shore Physician Organization also provided key assistance to the Attorney General’s doctor rankings initiative. “Major insurers are lining up to embrace our national model for doctor rankings. This model is supported by both doctors and consumers and has become the industry standard,” said Cuomo. “I applaud GHI and HIP for being the first insurers to preemptively accept our model before having any plans to design a program. As their commitment shows, insurers considering a program for rating doctors can and should use the national model as their foundation.” “GHI and HIP believe that consumers must have access to accurate and useful information about their physicians,” said Dr. Dan Dragalin, Executive Vice President and Chief Medical Officer of HIP. “A standard of measurement that is transparent and accurate and open to review by physicians and accrediting organizations is a solid foundation for any programs in the future. For this reason, even though we do not have a physician ranking program, we signed this agreement.” said Dr. Aran Ron, President of GHI. “The American Medical Association applauds GHI and HIP for joining the growing number of insurers who are adopting this model,” said the American Medical Association's President-Elect, Dr. Nancy Nielsen. “Patients and physicians need to be sure that any system for ranking doctors is accurate and fair. We are very pleased that Attorney General Cuomo has made accountability to physicians and patients in doctor ranking programs a widely accepted standard within the insurance industry.” “Consumers and insurance members stand to benefit greatly from today’s agreement,” said Debra Ness, President of the National Partnership for Women & Families. “Consumers deserve to know what factors go into ranking their doctors, and should be able to easily choose the doctor that is best for them. The more insurers that adopt this model, the more consumers will be able to do just that.” "Thanks to the leadership of Attorney General Cuomo more and more insurers are adopting doctor ranking programs that provide patients with clear and comprehensive information, and that accurately reflect the quality of health care provided by doctors," said Dr. Robert Goldberg, President of the Medical Society of the State of New York. "This model provides transparency in the way ratings are created and ensures a level of independence by the inclusion of an oversight examiner reporting to the Attorney General. Doctors are well served by having major insurers in New York and nationwide adopting this model." The model reforms doctor ranking programs by compelling insurers to fully disclose to consumers and physicians all aspects of their ranking system. Additionally, under this model, the insurer must retain an oversight monitor, known as a Ratings Examiner (“Rx”), who will oversee compliance with all aspects of the agreement and report to the Attorney General every six months. Under the national model, insurers will: • Ensure that rankings for doctors are not based solely on cost and clearly identify the degree to which any ranking is based on cost; • Use established national standards to measure quality and cost efficiency, including measures endorsed by the National Quality Forum (NQF) and other generally accepted national standards; • Employ several measures to foster more accurate physician comparisons, including risk adjustment and valid sampling; • Disclose to consumers how the program is designed and how doctors are ranked, and provide a process for consumers to register complaints about the system; • Disclose to physicians how rankings are designed, and provide a process to appeal disputed ratings; • Nominate and pay for the Ratings Examiner, subject to the approval of the Attorney General, who will oversee compliance with all aspects of the new ranking model and report to the Attorney General’s office every six months; the Ratings Examiner must be a “national standard setting organization” and will be national in scope, independent, and an Internal Revenue Code § 501(c)(3) organization. Doctor ranking programs are a rapidly growing practice within the healthcare industry. Major insurers nationwide either operate or are in the process of developing these programs. Today’s agreement with GHI and HIP covers the following related companies: GHI, GHI HMO Select, Inc., Health Insurance Plan of Greater New York (HIP), HIP Insurance Company of New York, Inc., The PerfectHealth Insurance Company, ConnectiCare of New York, Inc., ConnectiCare Insurance Company, Inc., ConnectiCare of Massachusetts, Inc., and ConnectiCare, Inc. The Attorney General’s industry-wide investigation of doctor ranking programs is ongoing and is being handled by Linda Lacewell, the head of the Attorney General’s Healthcare Industry Taskforce. Attachment: