Abstract Objective: To estimate the effect of adding exercise classes, spinal manipulation delivered in NHS or private premises, or manipulation followed by exercise to "best care" in general practice for patients consulting with back pain. Design: Pragmatic randomised trial with factorial design. Setting: 181 general practices in Medical Research Council General Practice Research Framework; 63 community settings around 14 centres across the United Kingdom. Participants: 1334 patients consulting their general practices about low back pain. Main outcome measures: Scores on the Roland Morris disability questionnaire at three and 12 months, adjusted for centre and baseline scores. Results: All groups improved over time. Exercise improved mean disability questionnaire scores at three months by 1.4 (95% confidence interval 0.6 to 2.1) more than "best care." For manipulation the additional improvement was 1.6 (0.8 to 2.3) at three months and 1.0 (0.2 to 1.8) at 12 months. For manipulation followed by exercise the additional improvement was 1.9 (1.2 to 2.6) at three months and 1.3 (0.5 to 2.1) at 12 months. No significant differences in outcome occurred between manipulation in NHS premises and in private premises. No serious adverse events occurred. Conclusions: Relative to "best care" in general practice, manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months; and exercise achieved a small benefit at three months but not 12 months. BMJ 2004;329:1377 (published 19 November 2004)

Southern Association of Colleges and Schools has removed the Life University’s probation status at its Commission on Colleges December, 2004 Annual Meeting in Atlanta Georgia. Next Reaffirmation of Life University by SACS-COC will be in 2011.

The American Chiropractic Association (ACA) is applauding a new study from the Medical Research Council (MRC) that shows that spinal manipulation – the primary form of care performed by doctors of chiropractic – combined with an exercise program offers effective treatment for those suffering from back pain. The study, published in the Nov. 19 issue of the British Medical Journal [see abstract below], found that a collective approach to back pain treatment provided “significant relief of symptoms and improvements in general health.” Specifically, the study found that the greatest reduction of pain and the greatest improvement in back function was experienced by patients who received a treatment approach consisting of spinal manipulation and exercise in addition to care from their general practitioner. The MRC is based in the United Kingdom where its research is funded by the country’s taxpayers. The council promotes medical and related science research with the aims of improving the health and quality of life of the general public. The MRC is independent in its choice of which research to support. “The costs of back pain and other musculoskeletal conditions on the country's economy and workforce productivity are staggering - conservatively estimated at about $50 billion per year,” commented ACA President Donald J. Krippendorf, DC. “The ACA is pleased that research such as this is being conducted and brought to the attention of the public through journals such as the British Medical Journal. With reports such as these, we can offer our patients the best care possible.” The MRC trial included more than 1,300 patients from across the United Kingdom, whose back pain had not improved after receiving care from a general practitioner. Treatment options were: • A physical exercise program • Spinal manipulation alone • A combined package of spinal manipulation followed by a exercise regimen The results showed that patients in all treatment groups reported improved back function and reduced pain over time, but to varying degrees. However, the greatest improvement was found in the patients assigned to combined manipulation and exercise. According to the ACA, the MRC study is one of a number of recent studies regarding chiropractic’s effectiveness for back pain over traditional medical care. A March 2004 study in the Journal of Manipulative and Physiological Therapeutics found that chiropractic care is more effective than medical care at treating chronic low-back pain in patients' first year of symptoms. And a study published in the July 15, 2003, edition of the medical journal Spine found that manual manipulation provides better short-term relief of chronic spinal pain than does a variety of medications. ACA Press Release. November 29, 2004. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care ABSTRACT Objective: To assess the cost effectiveness of adding spinal manipulation, exercise classes, or manipulation followed by exercise ("combined treatment") to "best care" in general practice for patients consulting with low back pain. Design: Stochastic cost utility analysis alongside pragmatic randomised trial with factorial design. Setting: 181 general practices and 63 community settings for physical treatments around 14 centres across the United Kingdom. Participants: 1287 (96%) of 1334 trial participants. Main Outcome Measures: Healthcare costs, quality adjusted life years (QALYs), and cost per QALY over 12 months. Results: Over one year, mean treatment costs relative to "best care" were £195 ($360; 279 euro; 95% credibility interval £85 to £308) for manipulation, £140 (£3 to £278) for exercise, and £125 (£21 to £228) for combined treatment. All three active treatments increased participants' average QALYs compared with best care alone. Each extra QALY that combined treatment yielded relative to best care cost £3800; in economic terms it had an "incremental cost effectiveness ratio" of £3800. Manipulation alone had a ratio of £8700 relative to combined treatment. If the NHS was prepared to pay at least £10 000 for each extra QALY (lower than previous recommendations in the United Kingdom), manipulation alone would probably be the best strategy. If manipulation was not available, exercise would have an incremental cost effectiveness ratio of £8300 relative to best care. Conclusions: Spinal manipulation is a cost effective addition to "best care" for back pain in general practice. Manipulation alone probably gives better value for money than manipulation followed by exercise. UK BEAM Trial Team. British Medical Journal.

▪ Other forms available online for completion Overview/Features Workers’ Compensation (WC) allows parties of interest, including health care providers to complete claims forms, like a C-4*, and submit it online to the Workers' Compensation Board. Other Adobe Acrobat PDF versions of WC forms may be filled out online first, saved to the doctor’s computer locally, then printed and mailed to WC, or the online form may be saved to the doctor’s computer locally first, then printed out, completed and mailed to WC. For a list of forms available online, please refer to the "List of Available Forms" below. Click on the link and go to the members only section. Not a member? Click on the application on the left and join today!

NYSCA invites you, your family and friends to the GRAND OPENING of our BRAND NEW NYSCA Mall on the web were you can enjoy savings at nearly 800 quality on-line merchants while supporting the New York State Chiropractic Association! Nothing to join, no personal information to provide and if you have an existing account with any of the merchants, you can use that account — there is no need to re-register. It really is that simple. For each purchase you make at a participating merchant, a percentage goes to NYSCA. THIS HOLIDAY SEASON your online shopping can translate into dollars for NYSCA. Now you can shop online at Target, Omaha Steaks, Macy's, Expedia, Dell and nearly 800 other quality merchants. Your purchases in the NYSCA mall will generate income to the New York State Chiropractic Association which will be used to keep the membership dues low. To start your on-line shopping to ensure your purchases are properly credited to the NYSCA, Go to NYSCA Mall locate your desired merchant in the directory shop and save! That's it! Just the satisfaction of saving time and money while supporting us! It really is that simple. START YOUR HOLIDAYS SHOPPING TODAY Thank You and Happy Shopping!

ASHINGTON, D.C.—The brief respite from faster-growing health care costs sputtered in the first half of 2004 as health costs per privately insured American grew 7.5 percent—virtually the same rate as in 2003, according to a study released jointly today by the Center for Studying Health System Change (HSC) and the Employee Benefit Research Institute (EBRI). Health care spending growth slowed in both 2002 and 2003—after peaking at 10 percent in 2001—but outpaced growth in the U.S. economy by a considerable margin. That trend continued in the first half of 2004 with health care costs still growing at a faster rate (7.5%) than the unusually high 5.9 percent increase in per capita gross domestic product (GDP) during the same period. "Health care costs are likely to continue growing faster than workers' income for the foreseeable future, leading to more uninsured Americans and raising the stakes for policy makers to initiate cost-containment policies or accept the current trend of rapidly growing health costs and shrinking health coverage," said Paul B. Ginsburg, Ph.D., coauthor of the study and president of HSC, a nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation. Research has shown that if health care costs rise at a significantly faster rate than incomes, more people become uninsured. In fact, the gap between trends in health care costs and incomes is the most important factor behind the long-term trend toward a smaller proportion of Americans with private insurance. "Even though health care cost increases have moderated compared to recent years, as long as they are increasing faster than wages and overall inflation, both public- and private-sector employers will continue to try to control those costs," said Dallas Salisbury, CEO of the Employee Benefit Research Institute, which underwrote the study. "That includes examining ways to shift costs to workers, and probably a movement toward account-based health plans." The study analyzes per capita spending on health care services—inpatient and outpatient hospital care, physician services and prescription drugs—commonly covered by private insurance. Per capita health care spending trends—also often referred to as cost trends—are important because they largely determine future health insurance premium trends. The study's findings are published jointly as an HSC Issue Brief and EBRI Notes titled Tracking Health Care Costs: Spending Growth Slowdown Stalls in First Half of 2004. The study is available online on both HSC’s and EBRI’s Web site. Growth in spending on hospital inpatient care slowed to 5.1 percent in the first half of 2004, down from 6.4 percent in the second half of 2003. While spending on outpatient hospital care held steady at 11.4 percent, outpatient care, nonetheless, remained the fastest growing category of health spending. Hospital utilization—inpatient and outpatient combined—continued to grow at a slow rate (0.8%) for the second year in a row, but hospital prices rose sharply—7.7 percent in the first half of 2004—and accounted for much of the hospital spending increase. The large jump in hospital prices is due in part to strong growth in wage rates for hospital workers, which have been driven up by a persistent worker shortage, particularly for nurses. Nonetheless, the most recent increase in hospital wage rates—4.5 percent in the first half of 2004—was considerably smaller than recent hospital price increases and has declined significantly from the peak wage rate increase of 6.3 percent in the second half of 2001. "Additional factors appear to be driving up hospital prices," said Bradley C. Strunk, an HSC health researcher and study coauthor. "One possibility is a sharp decline since 2001 in hospital Medicare margins—a situation that creates a strong incentive for hospitals to shift costs to private payers." The slowdown in hospital utilization growth may reflect an increase in health plans' utilization management activities as they selectively reinstate such tools as prior authorization requirements for some hospital services. The slow utilization growth in 2004 also may reflect continuing increases in patient cost sharing for hospital care. While prescription drugs receive much of the blame for rising health care costs, the reality is that the spending trend for prescription drugs has slowed markedly from the high growth rates in the late 1990s. During the first half of 2004, spending on prescription drugs per privately insured person grew 8.8 percent, slightly lower than the 9.6 percent increase in the second half of 2003. By comparison, spending on prescription drugs peaked at 19.5 percent in the second half of 1999—a time when drug spending accounted for a much larger share of the overall spending increase. During the first half of 2004, drug prices increased by 3.1 percent, largely unchanged from the 2.7 percent increase in the second half of 2003. The trend for prescription drug utilization also held steady, with drug utilization per person increasing 5.5 percent in the first half of 2004. By comparison, drug utilization grew by as much as 12.9 percent in the late 1990s. During the first half of 2004, spending on physician care grew by 5.7 percent—only slightly higher than the 5.4 percent increase in the second half of 2003. Roughly equal growth in price and utilization accounted for the increase. The price trend for physician care has not increased much in recent years—in stark contrast to the hospital price trend. ### ### The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation's changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc. *** *** Established in 1978, the Employee Benefit Research Institute (EBRI) is the only nonprofit, nonpartisan organization committed exclusively to data dissemination, policy research, and education on economic security and employee benefits. The Institute's mission is to advance the public's, the media's and policy makers' knowledge and understanding of employee benefits and their importance to our nation's economy. FURTHER INFORMATION, CONTACT: Alwyn Cassil, HSC: (202) 264-3484 Steve Blakely, EBRI: (202) 775-6341

ABSTRACT Background: A recent prospective study of children with asthma employing a within subject, over time analysis using dynamic logistic regression showed that severely negative life events significantly increased the risk of an acute exacerbation during the subsequent 6 week period. The timing of the maximum risk depended on the degree of chronic psychosocial stress also present. A hierarchical Cox regression analysis was undertaken to examine whether there were any immediate effects of negative life events in children without a background of high chronic stress. Methods: Sixty children with verified chronic asthma were followed prospectively for 18 months with continuous monitoring of asthma by daily symptom diaries and peak flow measurements, accompanied by repeated interview assessments of life events. The key outcome measures were asthma exacerbations and severely negative life events. Results: An immediate effect evident within the first 2 days following a severely negative life event increased the risk of a new asthma attack by a factor of 4.69 (p = 0.00). In the period 3–10 days after a severe event there was no increased risk of an asthma attack (p = 0.5). In addition to the immediate effect, an increased risk of 1.81 was found 5–7 weeks after a severe event (p = 0.002). This is consistent with earlier findings. There was a statistically significant variation due to unobserved factors in the incidence of asthma attacks between the children. Conclusion: The use of statistical methods capable of investigating short time lags showed that stressful life events significantly increase the risk of a new asthma attack immediately after the event; a more delayed increase in risk was also evident 5–7 weeks later. Thorax 2004;59:1046-1051 © 2004 BMJ Publishing Group Ltd & British Thoracic Society

Abstract With health care costs, and insurance premiums in particular, escalating rapidly, we may see the reintroduction of utilization management strategies associated with managed care, which seemed destined for oblivion only a short time ago. Results from a survey to assess Americans’ views of managed care cost containment strategies indicate mixed support: Despite an overall lack of confidence in managed care, Americans appear to be receptive to specific managed care practices. Those designing cost containment strategies must find a balance between imposing restrictions that moderate use and hold down costs and allowing consumers to retain some control over their own health care. Health Affairs, 10.1377/hlthaff.w4.516 Copyright © 2004 by Project HOPE Claudia Schur is a principal research scientist at NORC at the University of Chicago in Bethesda, Maryland. Marc Berk is vice president and senior fellow at NORC at the University of Chicago in Bethesda, Maryland. Jill Yegian is director of the Health Insurance Program at the California HealthCare Foundation in Oakland.

Berberine, a Chinese herb lowers LDL ("bad") cholesterol in anew way from drugs like Lipitor or Zocor, a new study shows. The herb has a history of medicinal use in both Ayurvedic and Chinese medicine. Click on the link below for more:

ABSTRACT Objectives: To determine how the risk of a fall in an older adult varies in relation to style of footwear worn. Design: Nested case-control study. Setting: Group Health Cooperative, a large health maintenance organization in Washington state. Participants: A total of 1,371 adults aged 65 and older were monitored for falls over a 2-year period; 327 qualifying fall cases were compared with 327 controls matched on age and sex. Measurements: Standardized in-person examinations before fall occurrence, interviews about fall risk factors after the fall occurred, and direct examination of footwear were conducted. Questions for controls referred to the last time they engaged in an activity broadly similar to what the case was doing at the time of the fall. Results: Athletic and canvas shoes (sneakers) were the styles of footwear associated with lowest risk of a fall. Going barefoot or in stocking feet was associated with sharply increased risk, even after controlling for measures of health status (adjusted odds ratio=11.2, 95% confidence interval (CI)=2.4-51.8). Relative to athletic/canvas shoes, other footwear was associated with a 1.3-fold increase in the risk of a fall (95% CI=0.9-1.9), varying somewhat by style. Conclusion: Contrary to findings from gait-laboratory studies, athletic shoes were associated with relatively low risk of a fall in older adults during everyday activities. Fall risk was markedly increased when participants were not wearing shoes. Journal of the American Geriatrics Society Volume 52 Issue 9 Page 1495 - September 2004

ABSTRACT Background: Race and sex differences in the effect of diet on bone mineral density (BMD) at the hip in the elderly are unknown. Objectives: This study related cross-sectional nutrient and dairy product consumption to hip BMD in white and black men and women aged >60 y and evaluated the influence of nutrient and dairy product consumption on changes in BMD in a white cohort participating in a calcium, vitamin D, or placebo trial. Design: The Health Habits and History Questionnaire was used in 289 white women and 116 white men who participated in the trial and in 265 black women and 75 black men to predict total hip and femoral neck BMD or changes in BMD. Results: Blacks had higher calcium intakes than did whites (700 and 654 mg/d, respectively; P = 0.0094), and men had higher calcium intakes than did women (735 and 655 mg/d, respectively; P = 0.0007). For men, the correlation between total hip BMD and dairy calcium intake after adjustment for age, race, and weight was 0.23 (P < 0.005); this relation was not significant in women (r = 0.02, P = 0.12). Similar results were found for femoral neck BMD. In the longitudinal study, calcium supplementation reduced bone loss from the total hip and femoral neck in those who consumed Conclusions: Cross-sectional results indicated that higher dairy product consumption is associated with greater hip BMD in men, but not in women. Calcium supplementation protected both men and women from bone loss in the longitudinal study of whites. American Journal of Clinical Nutrition, Vol. 80, No. 4, 1066-1074, October 2004

ABSTRACT Context Reduction of gastric acid secretion by acid-suppressive therapy allows pathogen colonization from the upper gastrointestinal tract. The bacteria and viruses in the contaminated stomach have been identified as species from the oral cavity. Objective To examine the association between the use of acid-suppressive drugs and occurrence of community-acquired pneumonia. Design, Setting, and Participants Incident acid-suppressive drug users with at least 1 year of valid database history were identified from the Integrated Primary Care Information database between January 1, 1995, and December 31, 2002. Incidence rates for pneumonia were calculated for unexposed and exposed individuals. To reduce confounding by indication, a case-control analysis was conducted nested in a cohort of incident users of acid-suppressive drugs. Cases were all individuals with incident pneumonia during or after stopping use of acid-suppressive drugs. Up to 10 controls were matched to each case for practice, year of birth, sex, and index date. Conditional logistic regression was used to compare the risk of community-acquired pneumonia between use of proton pump inhibitors (PPIs) and H2-receptor antagonists. Main Outcome Measure Community-acquired pneumonia defined as certain (proven by radiography or sputum culture) or probable (clinical symptoms consistent with pneumonia). Results The study population comprised 364 683 individuals who developed 5551 first occurrences of pneumonia during follow-up. The incidence rates of pneumonia in non–acid-suppressive drug users and acid-suppressive drug users were 0.6 and 2.45 per 100 person-years, respectively. The adjusted relative risk for pneumonia among persons currently using PPIs compared with those who stopped using PPIs was 1.89 (95% confidence interval, 1.36-2.62). Current users of H2-receptor antagonists had a 1.63-fold increased risk of pneumonia (95% confidence interval, 1.07-2.48) compared with those who stopped use. For current PPI users, a significant positive dose-response relationship was observed. For H2-receptor antagonist users, the variation in dose was restricted. Conclusion Current use of gastric acid–suppressive therapy was associated with an increased risk of community-acquired pneumonia. Author Affiliations: Department of Gastroenterology, University Medical Center St. Radboud, Nijmegen, the Netherlands (Drs Laheij and Jansen); and Department of Medical Informatics (Drs Laheij, Sturkenboom, Dieleman, and Stricker and Mr Hassing), Pharmacoepidemiology Unit, Department of Epidemiology and Biostatistics (Drs Sturkenboom and Stricker), and Internal Medicine (Dr Dieleman), Erasmus MC University, Medical Center Rotterdam, Rotterdam, the Netherlands. JAMA. 2004;292:2012-2013.

Eight NYSCA members have been selected by the New York State Department of Health to serve on the Department’s Medical Record Access Review Committee. Five members were selected to serve on a Downstate Committee and three (3) members were assigned to an Upstate Committee. The Committee members chosen by the Department are the following: ▪ Downstate Committee Members • Gary L. Haber, DC of Manhattan • Lloyd Kupferman, DC of Greenvale • Malcolm L. Levitin, DC, FACC of Rockville Centre • Donald Littlejohn, DC, of Chester and • Richard W. Scher, DC of Wantagh. ▪ Upstate Committee Members • Brian D. Justice, DC, DABCO of Rochester • Lynn B. Pownall, DC, DACNB of Jamestown, and • Richard J. Tesoriero, DC, DABCO of Oswego. The members of these committee will be convened by the Department when required to resolve disputed between chiropractic professionals and persons qualified to receive medical records. "Qualified person" pursuant to New York Public Health Law, Article I, Title II, § 18 Access to patient information, (1) Definitions means “any properly identified subject, or a guardian appointed pursuant to article eighty-one of the mental hygiene law, or a parent of an infant, or a guardian of an infant appointed pursuant to article seventeen of the surrogate’s court procedure act or other legally appointed guardian of an infant who may be entitled to request access to a clinical record pursuant to paragraph (c) of subdivision two of this section, or an attorney representing or acting on behalf of the subject or the subject’s estate.” Under Subsection (4) Medical record access review committees, the law provides, "The commissioner shall appoint medical record access review committees to hear appeals of the denial of access to patient information as provided in paragraph (e) of subdivision three of this section. Members of such committees shall be appointed by the commissioner from a list of nominees submitted by statewide associations of providers in the particular licensed profession involved; . . . . Such medical record access review committees shall consist of no less than three nor more than five licensed professionals. The commissioner shall promulgate rules and regulations necessary to effectuate the provisions of this subdivision." Under subsection (3) of the Public Health Law, providers may limit a qualified persons access to patient information for certain itemized reasons. The Committee members above will assist the Department resolve disputes between DCs and qualified persons requesting access to patients records.

New York’s Medicare Carriers have reported that they will be sending the 2005 Medicare Physician Fee Schedule (MPFS) on a CD-ROM this month to all those providers who usually receive the Fee Schedule in booklet format. Watch for additional information on your carrier’s website. This change comes as a result of a successful pilot project conducted a year earlier.

The Centers for Medicare and Medicaid Services (CMS) released yesterday, four sites CMS will use for a chiropractic demonstration projected required under section 651 of the Medicare Prescription Drug, Improvement, and Modernization Act. Making the announcement, CMS Administrator, Mark B. McClellan, M.D., Ph.D., announced that Medicare will conduct a demonstration project in Maine, New Mexico, Illinois and Virginia expanding coverage of chiropractic services for neuromusculoskeletal conditions. “We recognize that many Medicare beneficiaries seek the services of chiropractors for back pain and other conditions,” McClellan said. “This demonstration provides the opportunity to evaluate whether expanding coverage of chiropractic services reduces overall Medicare expenditures for neuromusculoskeletal conditions.” Beginning in April 2005, chiropractors that are located in the demonstration areas will be able to provide services to any beneficiary enrolled under Medicare Part B. The demonstration will expand coverage for the services that chiropractors provide for the care of neuromusculoskeletal conditions, including diagnostic and other services such as the provision of x-rays and therapy services. Current Medicare coverage for chiropractic care is limited to manual manipulation of the spine to correct a subluxation, which is defined as a malfunction of the spine. Treatment may only be provided for the active correction of a documented subluxation, and not for prevention or health maintenance. Treatment for the subluxation must be related in terms of a neuromusculoskeletal condition where there is a reasonable expectation of recovery or functional improvement. The goal of the demonstration is to evaluate the feasibility and desirability of covering additional chiropractic services under Medicare beyond the current coverage. CMS has scheduled an Open Door Forum on November 18 to solicit input from interested groups regarding benefits of this demonstration and implementation of its budget neutrality requirements. The demonstration will be conducted in the entire states of Maine and New Mexico, and in the Chicago Metropolitan Statistical Area (MSA) and 17 central counties in Virginia. The statue specified that the demonstration must include four sites, two urban and two rural, and one site of each must be in a health professional shortage area (HPSA). The statute requires an evaluation of the demonstration to assess cost effectiveness, cost benefit, beneficiary satisfaction, and other issues as the Secretary of Health and Human Services determines to be appropriate. ▪ ACA Concerns After fighting hard to have the demonstration project language included in the language of the Medicare Prescription Drug, Improvement, and Modernization Act, the ACA notes with some chagrin that is has some concerns with how the proposed demonstration project may be carried out. ACA staff met with CMS officials last Friday, November 6, to receive information on the status of planning for the demonstration. Subsequently, the ACA has identified several areas of concern with regard to the design, including possible infringements on full scope of practice under existing Medicare program benefits. ACA is preparing a formal and detailed response to CMS that will be available prior to CMS's November 18th, Open Door Forum on the chiropractic demonstration project. More on the project will be forthcoming in the not too distant future.

The Centers for Medicare and Medicaid Services (CMS) released yesterday, four sites CMS will use for a chiropractic demonstration projected required under section 651 of the Medicare Prescription Drug, Improvement, and Modernization Act. Making the announcement, CMS Administrator, Mark B. McClellan, M.D., Ph.D., announced that Medicare will conduct a demonstration project in Maine, New Mexico, Illinois and Virginia expanding coverage of chiropractic services for neuromusculoskeletal conditions. “We recognize that many Medicare beneficiaries seek the services of chiropractors for back pain and other conditions,” McClellan said. “This demonstration provides the opportunity to evaluate whether expanding coverage of chiropractic services reduces overall Medicare expenditures for neuromusculoskeletal conditions.” Beginning in April 2005, chiropractors that are located in the demonstration areas will be able to provide services to any beneficiary enrolled under Medicare Part B.

Arlington, Va. (Oct. 19, 2004) — The American Chiropractic Association (ACA) has vowed to appeal a recent decision by a U.S. District Court judge to dismiss its lawsuit against the Department of Health and Human Services (HHS), a lawsuit that protects the very heart of the chiropractic profession’s services under Medicare – manual manipulation of the spine to correct a subluxation. ACA officials said they would continue the battle until doctors of chiropractic are the only providers who can offer the profession’s core service. “While we are understandably disappointed in the judge’s decision, we take pride in the fact that our lawsuit has already put an end to years of discrimination against doctors of chiropractic and their patients,” said ACA President Dr. Donald J. Krippendorf. “Before we filed our lawsuit, Medicare HMOs were given the green light to misappropriate taxpayer dollars to pay non-physician physical therapists to deliver the chiropractic physician service of 'manual manipulation of the spine to correct a subluxation’ under Medicare – or to deny the service to beneficiaries altogether. That unfair and illegal practice has ended as a direct result of our lawsuit. We strongly believe that we owe it to our patients – and have a strong legal basis – to continue our battle in an effort to prohibit medical doctors and osteopaths from correcting subluxations, a service that is uniquely chiropractic.” Dr. Krippendorf also noted the “monumental victories for Medicare patients” already achieved through the lawsuit, including: • Compelling the government to prepare and release a study showing the virtual elimination of chiropractic services to Medicare beneficiaries entering the Medicare Managed Care system; • Prohibiting federal payments to physical therapists providing manual manipulation of the spine to correct a subluxation to Medicare patients; • And, mandating that all Medicare Managed Care plans must make available and pay for manual manipulation of the spine to correct a subluxation. In his Oct. 14 decision, U.S. District Judge John Garrett Penn granted HHS a motion for summary judgment, stating that Congress did not intend for only chiropractors to provide “manual manipulation of the spine to correct a subluxation” when it established the Medicare program in 1972, and that the Medicare statute is “neither silent nor ambiguous” in this regard. According to ACA officials, the judge’s rationale is “perplexing,” given the fact that even the U.S. government itself admitted ambiguity in the 32-year-old language governing the Medicare program – and, according to the government’s own position with the court, that “Congress has not directly spoken to the precise issue of who may provide manual manipulation of the spine to correct a subluxation to Medicare beneficiaries.” “We have a responsibility to our Medicare patients to continue this fight. They deserve to have chiropractic services delivered by doctors of chiropractic,” added Dr. Krippendorf. “We believe the use of the term ‘subluxation’ at the time it was inserted in the Medicare statute was meant to assign the correction of the subluxation exclusively to doctors of chiropractic.” The ACA first filed its lawsuit in November 1998, claiming that HHS guidelines unlawfully allowed Medicare Managed Care plans to substitute the services of other health care providers for services that should legally be performed by doctors of chiropractic and that chiropractic services were not being provided under Medicare Managed Care programs. Specifically challenged in ACA's lawsuit was a 1994 “Operational Policy Letter” stating: “Managed care plans contracting with Medicare are not required, however, to offer services of chiropractors, but may use other physicians to perform this service. In addition, managed care plans may offer manual manipulation of the spine as performed by non-physician practitioners, such as physical therapists, if allowed under applicable state law.” In January 2002, as a direct result of the ACA lawsuit, HHS issued a new policy directive that, under Medicare, physical therapists could not be reimbursed for providing manual manipulation of the spine to correct a subluxation, and also added that manual manipulation to correct a subluxation must be provided by Medicare managed care plans. In a revision to the 1994 Operational Policy Letter, Medicare's Center for Beneficiary Choices wrote: “The (Medicare) statute specifically references manual manipulation of the spine to correct a subluxation as a physician service. Thus, Medicare+Choice organizations must use physicians, which include chiropractors, to perform this service. They may not use non-physician physical therapists for manual manipulation of the spine to correct a subluxation.” (emphasis added) In addition, the new policy provides: “As a standard of Medicare Part B benefit, manual manipulation of the spine to correct a subluxation must be made available to enrollees in Medicare+Choice plans.” (Updated OPL#23, Jan. 15, 2002 emphasis added.) The ACA has 30 days to file a notice of appeal to the U.S. Court of Appeals for the District of Columbia – a court that has been coined “the second highest court in the land” because many of its judges are ultimately appointed to the U.S. Supreme Court. From there, the court will issue a briefing schedule. Typically, the U.S. Court of Appeals for the District of Columbia makes a decision on cases within 12 months. “We thank the thousands of supporters and contributors within the chiropractic profession who continue to stand with us through this monumental legal battle,” Dr. Krippendorf said. “Because of your commitment to the cause, we will continue to ensure that Medicare beneficiaries receive the safe and effective chiropractic care they need and deserve, and that they receive it only from health care providers appropriately trained and skilled to provide manual manipulation of the spine to correct a subluxation – doctors of chiropractic.” FOR MORE INFORMATION: Angela Kargus or Felicity Feather Clancy 800.986.4636 | [email protected] Copy of the opinion can be found at:

The New York State Chiropractic Association's Fall Conference at the Fort William Henry Resort in Lake George, New York was a resounding success! The conference convened Friday afternoon, October 1 through mid-day Sunday, October 3 and offered doctors a Practice Enhancement Program (PEP) and roughly 33 credits of continuing education from a list of outstanding speakers, including a class on the HIPAA Security Rule, the next evolution in the HIPAA compliance series (enforcement of the Security Rule begins April 20, 2005). Saturday evening ended with an awards dinner cruise and social sponsored by McCarthy, Chechanover & Rosado, LLP Law Firm, aboard the Adirondac, a new cruise ship on scenic Lake George. The NYSCA extends is sincere appreciation to McCarthy, Chechanover & Rosado, LLP and the many other vendors who helped make the conference such a success including: OUM Chiropractor Program, American Specialty Health Networks, Harvey Professional Supply, Tri-State Diagnostics, Meditek, Inc., PMR Products, New York Chiropractic College, Islandia MRI/East Manhattan Diagnostic, Dale Professional Supply, Jack S. Beige & Associates, LLP, Scheine, Furey & Associates, LLP, NCMIC Chiropractic Solutions, McCarthy, Chechanover & Rosado, PRI Physicians’ Reciprocal Insurers, Bee Sure Distributors, Open MRI of DeWitt, D’Youville College, HUM Division of MLMIC, Harlan Health Products, and Empire Medicare Services. The next NYSCA convocation is scheduled for January 28, 29 and 30, 2005 at the fabulous Mohegan Sun Casino and Resort in Uncasville, Connecticut. We look forward to seeing you there! As the April 20, 2005 enforcement deadline approaches, doctors should start taking the necessary steps now to come into compliance with the HIPAA Security Rule. Plan on attending the January Mohegan Sun Conference now!

Beginning October 11, interns at the Depew Health Center will be providing chiropractic services to students at the State University of New York at Buffalo (UB). This affiliation is the culmination of a two-year undertaking originally born as a result of a presentation on chiropractic made to the doctors and staff of the UB Student Health Center. Dr. Frank Carnevale, the Director of the Center, is excited about the new program and expects it will quickly become a success. The UB Student Health Center satellite clinic will expose NYCC student interns to an additional patient population that will enhance their clinical education. Hours of operation will be Mondays from 1:00 to 7:00 PM and Wednesdays from 1:00 to 5:00 PM, and appointments will be booked through the UB Student Health Center. Integrating chiropractic services with the UB Student Health Center’s medical and social services will be yet another example of NYCC’s multidisciplinary efforts aimed at benefiting patients. A byproduct of this affiliation will be the education of medical counterparts and U.B. students who come in for care. The University of Buffalo is the largest and most comprehensive university in the SUNY system. The large UB student body – more than 27,000! – will mean a busy schedule for student interns at the satellite clinic.