Health Care Crisis
The Health Care Crisis – Does Anyone Really Know What It Is About Or Care?
Author: Linda K. Christy, D.C.
A recent visit to a medical clinic elicited such a visceral response within me, that it started me thinking about the subject of the health care crisis. After all, at least once a week we hear something on the news regarding the health care crisis, yet rarely are there ever any details exposed.
First, let me share a recent experience I had when seeking medical services for my husband, who had recently experienced what I would describe as a moderate-to-severe persistent flu-like condition.
We do not have a primary physician as we are new to the area, so I got the Yellow Pages out, and proceeded to contact a health care group. It took several calls before I could find anyone with an available office-call opening. The medical office we went to had no openings either, however the receptionist informed me that they accepted walk-in patients. I questioned the length of time we would be waiting in the office, and the receptionist informed me that if we came in after 1 P.M. it should not be that long before we could be seen between scheduled patient appointments.
We arrived at the clinic about 1:05 P.M. and walked directly to the walk-in window to sign in. The young lady ( I would like to say the young lady was the receptionist, however she had no name tag on, nor did she introduce herself to us) that was at the window greeted us with, “What type of insurance do you have?” My husband replied, “ I am a cash patient.”The young lady ask if we had an appointment. My husband replied, “No, I am a walk-in, and a new patient.” We were instructed to be seated until she finished handling the paper work from the previous walk-in.
As we sat there waiting I could not help but observe the number of elderly patients seeking care. A young woman in scrubs came out of the door that lead back to the patient exam rooms, and called “Maude.” I watched this elderly woman who’s age I would guess to be late 70s early 80s, rise from the chair, grabbing her belongings, and head toward the woman in the scrubs. I had two thoughts run from my head as I watched this situation occur: (1) what was the position of the young woman in the scrubs, and (2) why did she not address “Maude” by “Mrs.” instead of by her first name, which would have been more respectful to this elderly patient.
A lady at the walk-in window then called my husband’s name, and he went to the window to obtain the paper work with instructions on completing the forms. We were rather amazed at that lack of paper work requested considering he was a new patient. He had to write the reason for the office visit which was only a quarter of a page, then the second page requested the usual information such as name, address, Social Security, emergency contact person, phone numbers, employer, and insurance information. He returned the paper work, and was told to be seated, which we were for approximately 2 ½ hours.
At one point, a woman in scrubs came out and called for “William.” My husband proceeded to stand and walk toward the woman as another man also stood and proceeded in the same direction. Then she announced a last name, and my husband realized it was not his turn.
As we sat there my husband leaned over to me, and asked, “Have you notice all the girls behind the front desk are not wearing any identification tags, so how do we know who they are and what they do?” I responded, “Maybe it is a game, and we are supposed to guess who they are / what they do.”
As we sat there patiently waiting and watching the other health care consumers a few elderly women obviously familiar with one another happen to meet up, and began engaging in conversation. They spoke rather loudly so I did not feel as if I was eaves dropping.
They began sharing what their scheduled appointments were about. One of the elderly ladies announced loudly she was there for a mammogram, and I could not help but think what could her medical history be that at her age she would still have to endure that procedure. Another woman spoke of the change in three of her four prescriptions, then seemed to lose interest in any of the conversation going on around her as she stared out through the glass windows.
Finally, my husband was called by a young woman in scrubs, and we proceeded back to an exam room after they weighed him. In the exam room the young woman took his temperature, blood pressure, and a very brief past medical history requesting, “Are you on any prescription drugs or have you had any surgeries I should know about?” My husband responded to her questions, then she proceeded to walk out informing us that the doctor would be there shortly.
We sat in the exam room for about 20 minutes waiting for the doctor. He enter the room, shook our hands, and proceeded to ask my husband questions. Luckily, his name was on the lab coat so we knew how to address him. The doctor did a brief exam then informed my husband that there was a flu going around that was of a gastroenteritis in nature, and the symptoms lasted from 5 to 7 days. He wrote two prescriptions one an anti diarrheal, the other an anti nausea (which nausea was not a symptom), and stated,
“Keep hydrated with sports drinks / water, and if the symptoms persist over the next couple of days to return to the clinic for lab work.”
As we proceeded to the car we both looked at one another, and stated, “If we had known the flu lasted 5 to 7 days, we would have just continued what we were doing, and ridden it out.”
It seems as though many medical facilities these days are owned by conglomerates, and the physicians / staff have no vested interest. Unfortunately, this lack of interest tends to be interpreted by health care consumers as revenue generating facilities, as opposed to health care facilities. It makes me wonder, what if the 42 million citizens who don’t have health care coverage suddenly did.
Then there is the issue with insurance carriers utilizing a variety of tactics to deny reimbursing claims, making it more difficult on the health care providers to sustain an independent practice. It appears that most medical providers are groups of doctors. It is rare to find an independent practitioner these days, much less if a practitioner wanted a private practice could they sustain themselves in this present-day climate of health care.
Health care providers are not exempt from contributing to the health care crisis when they order expensive medically unnecessary diagnostic testing or perform questionable surgical procedures negating the oath they took to above all “First,do no harm.”
As health care consumers, we all need to play an active role in our health. After all, we only get this one body, and we should be masters of our own ship. Do not be intimidated to question a procedure or course of treatment. The more you understand what your treatment plan is intended to do, the more you can be aware of what is occurring within your body, and can prevent further crises if the course of treatment initiated is not effective.
In conclusion, there are many good medical facilities, health care providers, and insurance carriers out there. I truly believe there is a solution to the health care crisis. I just think we need to be clear about what the actual issues are that are creating the crisis, and clearly define the issues so that we can initiate the steps to resolving this crisis.
Does Compliance Cost?
Compliance Programs: Do They
Cost or Pay?
You Be The Judge!
Author: Linda K. Christy, D.C.
An extremely important Decision was handed down by the 5th Circuit Court of Appeals September 20th, 2007. This Decision is of vital importance to health care providers throughout the Country, and provides a stellar example of the role an effective compliance program played in advancing the Chiropractic profession. Unfortunately, very little press was provided regarding this Decision.
The Decision was handed down in the Allstate et al. v. Accident & Injury Chiropractic et al. Relevant parts of that Decision are provided below:
United States Court of Appeals Fifth Circuit
F I L E D
September 20, 2007
Charles R. Fulbruge III Clerk
IN THE UNITED STATES COURT OF APPEALS FOR THE FIFTH CIRCUIT
No. 05-10265
ALLSTATE INSURANCE CO; ET AL
Plaintiffs
ALLSTATE INSURANCE CO; ALLSTATE INDEMNITY CO; ALLSTATE
PROPERTY & CASUALTY INSURANCE CO; BOSTON OLD COLONY
INSURANCE CO; GLENS FALLS INSURANCE CO
Plaintiffs – Appellees
v.
RECEIVABLE FINANCE COMPANY LLC; ET AL
Defendants
ACCIDENT & INJURY PAIN CENTERS INC, doing business as
Accident & Injury Chiropractic; RECEIVABLE FINANCE COMPANY LLC;
ROBERT SMITH; LONE STAR RADIOLOGY MANAGEMENT LLC; WHITE ROCK OPEN
AIR MRI LLC, doing business as White Rock Open MRI; NORTH TEXAS
OPEN AIR MRI LLC, doing business as North Texas Open MRI, doing
business as Harris County MRI, doing business as Bexar County
MRI; REHAB 2112 LLC; METROPLEX PAIN CENTER INC, doing business
as Lone Star Radiology; LACIDEM MANAGEMENT; STEVEN SMITH; TINA
CHESHIRE; JAMES LAUGHLIN, DO; DEE L MARTINEZ, MD; THOMAS RHUDY,
DC; LOUIS SAUCEDO, DC; KENNETH LUSTIK, DC; MARK RAYSHELL, DC;
LARRY PARENT, DC; CHRISTOPHER HOLOWISKI, DC; CAREY FABACHER, DC;
PATRICIA JOHNSON, DC; GHOLAMREZA ASSADOLAHI, DC; KYLE CAMPBELL,
DC; CHAD BLACKMON, DC; RAMESH SANGHANI, DC; MARLON D PADILLA, MD
PA; MARLON PADILLA, MD
Defendants – Appellants
Appeals from the United States District Court
* * *
Because we find the evidence insufficient to support either the jury verdict on fraud or the damages award, we reverse and render judgment for the defendants–appellants. * * *
On the evidence that was introduced at trial, a reasonable jury could not have found that Allstate actually relied on any misrepresentation by A&I. As such, the district court should not have submitted the Texas common law fraud claim to the jury. * * *
We reverse and render judgment for the defendants–appellants.
REVERSED.
The intent of insurance carriers is often to destroy providers’ reputations in the Press and bankrupt them to put the providers out of business. Providers confronting a multi-billion dollar insurance carrier and/or industry often have little choice but to “fold up their tents” and steal away into the night.
Many providers are either defenseless when confronted by spurious allegations of health care fraud and abuse, or feel as though it is merely a cost of doing business with insurance carriers to accept denials, paying little attention what the bases of those denials are. This, my dear colleague, is a huge mistake!
Accident & Injury Chiropractic (“A&I”) survived Allstate’s barrage of 5+ years of litigation and millions of dollars in legal fees for two, and only two, reasons:
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Robert M. Smith, A&I’s President/CEO, was fully committed to the implementation of a bona fide Compliance Program to ensure that: (a) patients were given the best care possible under the circumstances; (b) services performed were medically necessary; (c) fees were usual and customary; and (d) referrals were based on medical necessity; and
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There was no fraud there!
How do I know? Robert M. Smith retained Dan Osborne and me to work with A&I staff (e.g., Dr. Tom Rhudy, Dr. Lou Saucedo et al.) to create what Texas State Legislators called the “Premiere Health Care Compliance Program.” In fact, prior to the Allstate litigation, we were identified as the model to be co-opted by providers, irrespective of discipline, throughout the State.
The Spanish proverb, “Lo baroto sale caro” (i.e, “Cheap things turn out to be expensive”), is important in selecting a Compliance Program. This is, without a doubt, an area in which it is better to buy something of high quality that to buy something cheap that could result in your ruin. As Albert Einstein is reported to have said, “Sometimes one pays more for the things one gets for nothing.”
The problem is that most, the vast majority of, providers are honest hardworking professionals, consumed with a passion for helping patients who present seeking help, oblivious to the pitfalls confronting them by that palpable crime scene – the patient record!
Many providers, either out of desperation or lacking sufficient knowledge, have retained the services of convicted felons for Compliance assistance. Many of these so-called “Compliance Gurus” have neither developed nor implemented a compliance program. Furthermore, they have never observed the impact on practices of implementing such procedures.
Healthcare providers across the country are being targeted for healthcare fraud investigations. Many of those providers are clueless of this fact!
Reimbursement Denials May Be Your First Clue That Your Files Have Been Flagged!
If Your Files Have Been Flagged, Brace Yourself –A Storm Is Brewing!
Are your own actions causing you to be targeted?
Do you engage in one or more of the following?
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You accept what the insurance carrier offers, without question.
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You work with 3rd- party liability carriers and accept what your patients give you once they receive settlement, and accept your patient’s account of settlement negotiations.
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Your patient retains an attorney to handle a 3rd-party liability claim, and you accept the attorney’s offer of settlement without question.
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You work consistently with a limited number of external providers (e.g., physicians, surgeons, neurologists, etc.).
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You don’t bother to read the Explanations of Benefits (“EOBs”) in which the insurance carrier identifies the reasons for denial.
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You don’t bother to read peer reviewers’ reports.
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You don’t bother to respond to the peer reviewers’ reports, considering them merely a nuisance and cost of doing business with insurance carriers.
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You either don’t bother to read, or don’t receive, Controverting Affidavits in which both reasons for denial are reported and aberrant practices are alleged.
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You don’t bother to respond to the Controverting Affidavits in which reasons for denial are reported, considering them merely a nuisance and cost of doing business.
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You don’t bother to respond to Controverting Affidavits in which aberrant practices (e.g., unbundling of services, medically unnecessary services, medically unnecessary referrals, etc.) are alleged, because you either consider such allegations harmless or you have neither the time nor ability to provide a response challenging such allegations.
If the answer is yes, then you need to consider a quality compliance program!
While you can rationalize to yourself that these issues are just the cost of doing business, a nuisance and can be ignored, the consequences can be
disastrous.
By not sticking up for yourself you are looking an awful lot like someone who is afraid to challenge the system…maybe because of guilt…at least that is what the carriers want to believe.
What can I do?
What are some of the ways in which you may salvage your practice, license, and freedom if you have become the target of a healthcare fraud investigation? Here are a few examples:
- Develop a healthcare compliance program. Do not make the mistake of believing that a sham compliance program will suffice. You are better off having no compliance program than merely using one for window-dressing. The false sense-of-security often proves disastrous!
- Develop an audit-response program that effectively addresses deficiencies, both noted and alleged.
- Develop a policy for refunds of monies paid in error, when such errors are noted during internal audits.
- Develop an effective auditing process, assessing medical necessity and billing issues.
- Meet with SIU agents who may have “flagged” your files to identify specific areas of concern.
- Develop a Hotline to address issues of concern coming from employees, patients, insurance adjusters, etc.
- It may be possible to enter into a Corporate Integrity Agreement between the targeted-provider and investigators.
- Retain a compliance team knowledgeable in healthcare law. Do not trust your fate to an attorney inexperienced in this arena. Rest assured, the insurance carriers will not!
I am very familiar with insurance companies’ strengths and weaknesses, and I want to help you either avoid becoming a target or minimize your liability if you are already the target of a healthcare fraud investigation.
I’ve spent decades in practice, and worked closely with insurance carriers, defense attorneys, personal injury attorneys, law enforcement, and others, I understand your fears and concerns. More importantly, I know how to help you gain the knowledge you need to identify the insurance carriers’ weaknesses and practice in an ethical manner.
I have seen the exodus of hordes of providers due the insurance industry’s stranglehold on the healthcare industry, and I have taught many providers to fight back. When investigators come knocking on your office-door, will you be prepared?
An effective Compliance Program, properly implemented and managed, could make the difference between losing your practice, losing millions of dollars, losing your freedom, and being in a position to proudly announce to the investigators, “Come on in. I would be proud to show you our program.”
Do Compliance Programs cost or pay? You be the judge!
What should you do now?
Invest in a reputable compliance program. Sham programs create more problems for you than you even want to contemplate. Believe me, if, for whatever reason, you become the target of a health care fraud investigation, you do not want to be forced to justify your selection of an unqualified compliance “guru” for your tutelage in this process.
Feel free to contact me for a free Quick-Start Compliance Guide. You may do so here:
|
Linda K. Christy, D.C. Dr. Christy has 20 years of experience in Chiropractic, and has spent those years perfecting her skills as a Chiropractic Physician, clinician, diagnostician, teacher, and mentor. Dr. Christy is recognized nationally as the most knowledgeable Provider-Auditor of health care records.Dr. Christy has conducted exhaustive audits on more than 10,000 chiropractic files. She has conducted one-on-one audits on services performed by more than 100 chiropractors, MDs, and DOs.In addition to being thorough, Dr. Christy’s audits are frequently described as the most beneficial educational experience those providers audited have ever received. She leaves no-stone-unturned. In fact, due to her thoroughness, she has been referred to as “a colonoscopy in high-heels.” You may contact Dr. Christy here: doctorchristy@complianceinformationnetwork.com |
Active Rehabilitation
“REHAB BY UNLICENSED PROVIDERS, A GROWING AREA OF INVESTIGATIVE CONCERN” RAISES ADDITIONAL QUESTIONS
-Linda K. Christy, D.C.-
Daniel J. Osborne, M.S. has expressed concerns regarding perceived current trends/practices in which chiropractors permit unlicensed individuals to perform therapeutic procedures in a manner violative of the Physicians’ Current Procedural Terminology CPT guidelines (“CPT guides”). Mr. Osborne states:
In working with health care providers throughout the country on compliance related matters I find that one of the more confusing areas, and potentially volatile practice activities for today’s chiropractor, is the billing for Therapeutic Procedures rendered by unlicensed staff. (Emphasis in the original.)
Mr. Osborne proceeds to reference several cases in which chiropractors are either sentenced, indicted, convicted, or sued for ill-defined practices, the suggestion of which is that the activities to which Mr. Osborne refers may result in similar consequences. Mr. Osborne goes on to state:
So what is the answer? Can a chiropractor train their unlicensed staff on “rehab,” or the administration of therapeutic procedures? Can a chiropractor have their unlicensed staff provide therapeutic procedures to patients while the chiropractor is in the clinic treating other patients? Can the chiropractor then bill for the procedures rendered by their unlicensed staff as if he/she personally performed them?
The foregoing are good questions. Unfortunately, many chiropractors fall prey to spurious interpretations of the actual services the codes represent. Too often, regulatory agencies (e.g., chiropractic licensing boards), law enforcement agencies, and insurance carriers rely on rather myopic applications of these codes, the result of which may be catastrophic for the unwary provider caught up in investigations undertaken by one or more of the aforementioned entities.
To ensure that there is no confusion regarding this issue, we would draw your attention to CPT guides 2004, i.e.,
Therapeutic Procedures
A manner of effecting change through the application clinical skills and/or services that attempt to improve function.
Physician or therapist required to have direct (one-on-one) patient contact.
97110 Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility
AMA’s CPT Information Services (“CPT-IS”) states that to satisfy the “one-on-one@ requirement, the provider or therapist must remain in contact with the patient via sight, sound or touch.
In the AMA’s The CPT Companion: Frequently Asked Questions About CPT Coding (1998, p. 133), we find the following:
The term “provider,” as found in the Physical Medicine section of CPT, is a general term used to define the individual performing the service described in the code. The provider does not have to be a physician but can be, and in most case (sic) is, a physical or occupational therapist. Therefore, when the CPT manual refers to provider, it is referring to the individual, such as a physician, chiropractor, therapist, etc., who will be rendering the service described in the code.
In addition to the foregoing, as explained in the AMA’s CPT Assistant Volume 8, Issue 12 – Winter 1998, page 2,
[N]o distinction is made concerning the licensure or credentials of the “provider,” and that those codes containing the term “provider” can be used by anyone qualified to perform the service represented by the specific code. CPT is not a regulatory entity, nor does it become involved in third-party payer issues. As such, appropriate state and institutional entities should be consulted regarding the appropriate requirements of . . . services rendered by health-care professionals. (Emphasis added.)
The Texas Board of Chiropractic Examiners (“TBCE”) Board Rules, § 80.1 provides the following guidance:
(a) Except as provided in this section, a licensee shall not allow or direct a person who is not licensed by the board to perform procedures or tasks that are within the scope of chiropractic, including:
(1) rendering a diagnosis and prescribing a treatment plan; or
(2) performing a chiropractic adjustment or manipulation.
(c) “Qualified and properly trained” as used in this subsection means that the person, in addition to the requisite training and skill, has any license or certification required by law in order to perform a specific task or procedure. A licensee may allow or direct a qualified and properly trained person, who is acting under the licensee’s supervision, to perform a task or procedure that assists the chiropractor in making a diagnosis, prescribing a treatment plan or treating the patient if the performance of the task or procedure does not require the training of a chiropractor in order to protect the health or safety of a patient, such as: * * *
(5) performing prescribed physical therapy modalities;
(6) demonstrating prescribed exercises or stretches for a patient; or
(7) demonstrating proper uses of dispensed supports and devices.
CPT-IS, in response to an inquiry regarding the issues discussed herein, dated 09-19-02, responded, in part, as follows:
The term “provider” as stated in the guidelines for the Physical Medicine and Rehabilitation section of the CPT coding system is intended to encompass both physicians and therapists. To answer your specific question, the term “provider” is interchangeable with both terms “physician” and “therapist” in the Therapeutic Modality and Therapeutic Procedure subsections of the CPT coding system.
It is important to recognize that the listing of a service and its code number in a specific section of the CPT 2002 book does not restrict its use to a specific specialty group. (Emphasis added.)
Mr. Osborne concludes by stating:
When all is said and done, the provider must determine for themselves, via use of suitable legal and compliance resources, the appropriateness of billing for therapeutic procedures by unlicensed staff. The answer here could be that if the [respective regulatory] board allows for the delegation of these procedures to non-licensed staff, and the involved third-party payer is aware of this activity and has approved it, then I suspect that the provider would have minimal problems, if any. However, providers who do not take the necessary steps to ensure compliance may find themselves in the midst of a nightmare should this activity become the next big area of focus for health care fraud investigators and prosecutors.
We would caution providers not to abandon reason. As we are often told, “When all else fails, read the instructions!”
If we adopt the position Mr. Osborne appears to suggest, absent the imprimatur of both regulatory agencies and insurance carriers, we are left with the conclusion that licensed providers are the only individuals who can administer both therapeutic procedures (e.g., CPT-97110) and therapeutic modalities (e.g., CPT-97039). In lieu of approaching the issue with preconceived notions, read the information provided herein carefully. In doing so, I suspect providers will reach conclusions contrary to Mr. Osborne’s.
Once again, CPT-IS, in response to an inquiry regarding the issues discussed herein, dated 09-19-02, responded as follows:
The term “provider” as stated in the guidelines for the Physical Medicine and Rehabilitation section of the CPT coding system is intended to encompass both physicians and therapists. To answer your specific question, the term “provider” is interchangeable with both terms “physician” and “therapist” in the Therapeutic Modality and Therapeutic Procedure subsections of the CPT coding system. (Emphasis added.)
The Physical Medicine and Rehabilitation section to which the foregoing refers encompasses the following: (1) therapeutic modalities, both “supervised” (e.g., hot/cold packs) and “constant attendance” (e.g., ultrasound); (2) therapeutic procedures; (3) active wound care management; (4) tests and measurements; and (5) other procedures. “Constant attendance” modalities include CPT-97032 through CPT-97039.
Therefore, if the terms provider, therapist, and physician are interchangeable, and if Mr. Osborne is correct in his concern (i.e., the performance of “rehab by unlicensed individuals . . . [will] become the next big area of focus for health care fraud investigators and prosecutors”), and therapeutic procedures must be performed by licensed individuals, sans the requisite imprimatur to which Mr. Osborne refers (i.e., “the board allows for the delegation of these procedures to non-licensed staff, and the involved third-party payer is aware of this activity and has approved it”), it would be logical to conclude the following:
Provider = Therapist = Physician;
Constant attendance modalities require direct (one-on-one) patient contact by the provider/therapist/ physician;
Ultrasound (i.e., CPT-97035) is a modality requiring “constant attendance”;
Therefore, the application of ultrasound requires direct (one-on-one) contact by a licensed provider.
The foregoing is merely a logical extension of Mr. Osborne’s argument. However, we have not encountered any insurance carriers that assert that only licensed individuals may administer ultrasound, assuming a licensed and qualified individual has prescribed the modality.
Contrariwise, if one were to argue that properly trained and otherwise qualified unlicensed individuals may administer duly-prescribed ultrasound, and “the term ‘provider’ is interchangeable with both terms ‘physician’ and ‘therapist’ in the Therapeutic Modality and Therapeutic Procedure subsections of the CPT coding system,” one must inexorably conclude that properly trained and otherwise qualified unlicensed individuals may also administer the duly-prescribed therapeutic procedures to which Mr. Osborne refers.
Although we agree with Mr. Osborne that the issue he raises is worthy of discussion, we respectfully disagree with Mr. Osborne’s conclusions. We certainly encourage providers to review billing practices carefully and to be judicious with respect to the eisigetic (i.e. reading one’s own interpretation into an issue) use of CPT codes. However, we would also caution providers against allowing other individuals, albeit well-meaning, to pigeonhole them into adopting billing practices that are inconsistent with the very guidelines in which the codes are contained.
Grow Your Practice
Grow Your Chiropractic Practice
How to Grow Your Chiropractic Practice-Affordably
Chiropractors – Grow Your Healthcare Practice Affordably
by: Andrea Benoit
Spend too much time on marketing chores instead of treating patients?
Learn how to grow your practice by using proven marketing strategies to generate new clients every month. Tactics that are affordable and effective, and once organized — mostly hands-off.
Independent Healthcare practitioners, like Chiropractors, Massage therapists, Nutritionists, Opticians and other independent office treatment specialists, are like any other business — they need a constant flow of new customers. Too often, healthcare providers spend more time on marketing chores instead of on treating patients, in order to assure the survival of the office. It’s not unusual to see such clinicians spend 10 to 15 hours and many hundreds of dollars weekly in the quest to obtain new patients. Utilizing traditional marketing and advertising methods, like mailers, print ads, radio/TV, and flyers, they spend a lot of time and money, but only gain marginal results for their efforts.
But – it doesn’t have to be that way.
If you are an independent healthcare provider, such as a Chiropractor, Acupuncturist, or alternative medicine specialist, and you are looking to increase your client base — new research conducted by major search engines like YAHOO! and Google reveal some surprising statistics. In cities and towns across the United States, finding local and regional treatment specialists via internet web search engines is rapidly becoming the method of choice for people looking to select reliable healthcare providers. Thumbing through the yellow pages has been replaced by typing on keypads and searching cyberspace.
For example, in last thirty days over 7000 consumers typed in the phrase: “Chicago Chiropractor,” as they searched to find a Chiropractor in their area of the Windy City. That’s a lot of client prospects! And, in that same time frame, over 2000 patients typed in the words “Seattle Chiropractic,” 1900 people in Denver sought out “Denver Chiropractors,” over 22,000 looked for “Houston dentists,” and so on and so on and over and over, city by city, totaling millions of patients seeking healthcare providers via the Internet in any given week. Including patients in your area of the USA looking for your specialty. All you have to do is reach out to them. Make yourself easy to find.
The prime strategy — identify the specific keyword phrases that patients use for the exact type of healthcare services or products being provided, and for the exact city, region, county or other geographic designation identified with the provider. Then, include those key phrases within the text of web pages and other related postings, so those web pages and postings come up in the search engine results when that key phrase is used. It’s a simple, reliable process that has been proven to deliver results for up to four years, if maintained with annual updates.
This strategy of using the web to generate clients is not a new one. Many healthcare providers already subscribe to expensive pay-per-click and keyword-bid programs that deliver inconsistent results, as verified by Google, whose keyword system is one of the major keyword bid brokers. No, this is a very different approach to keyword use, which accesses the larger group of people (82%) who use simple — but geographically specific — keyword searches on top search engines like Lycos, MSN, Google and others to find their local source for treatment or products.
It’s not a difficult strategy to implement yourself, if you know how to edit web pages and can understand the fundamentals of keyword use in a search engine environment. We offer interested office operators a FREE tutorial on keyword choice. It’s a toll free phone call in which you will learn how to pick the most productive and least competitive keywords to fit your particular private practice. Often, in certain regions, especially if they are not in major cities, there is little competition for productive clinical keyword phrases, because in those areas the clinicians still use the old methods to market. In such cases, some simple html coding changes to existing web site pages suffice to send a stream of interested patient prospects to a provider’s web site or office phone, or very often, directly to the physical office itself.
While the “search engine keyword” campaign remains one of the most effective of the new web based healthcare provider marketing tactics, there are other excellent web methods that funnel interested patients to a specific provider. As a result, “search engine keywords” should be included only as a part of a larger Search Engine Marketing (SEM) plan, whereby other web based client referral processes are used to increase the total monthly number of new consumers who sign up for treatment. Those other web based efforts include use of focused email campaigns — whereby patients request providers to contact them by email with details on services or products; and use of web based referral posting systems that elicit direct response from patients and other professionals who refer consumers for treatment, like coaches, school nurses, employers, and other clinicians.
| About The Author
Andrea Benoit – Skilled “Search Engine Marketing” consultant, currently manages ongoing “new client” web campaigns for various healthcare providers, as well as “new customer” programs for other businesses, GUARANTEED to deliver pre-qualified client prospects and sales. For details: info@innernetsales.com Get a FREE tutorial on how to analyze your own best provider keywords, using the freshest data by calling toll free: 888-245-2582 x704 and learn how the web can help you get new paying clients every month. For details: http://www.innernetsales.com/ |
Physical Therapy For Back Pain
Physical Therapy for the Lower Back
Relief of lower back pain with physical therapy
Physical Therapy for the Lower Back: How to Prevent and Treat Lower Back Pain
by: Nishanth Reddy
Lower back pain is one of the most common causes of job-related disability and why some people miss work. It is also the second most common neurological ailment in the United States, second only to headache. In fact, approximately 80% of adults in Western countries have, at some point, experienced lower back pain.
For some fortunate people, pain in the lower back may be resolved by itself or with the aid of medication within two to four weeks. However, there are some cases of lower back pain that may last for more than a few weeks, during which case the condition is termed as “chronic” and “progressive,” meaning it can only grow worse over time.
Moreover, 60-80% of those patients who suffer their first episode of lower back pain may experience recurring pain within one year.
According to current research, there are certain muscles in the back that work to stabilize the spine. When the spine or the back suffers an injury, these muscles are reflexively inhibited or shutdown. Worse still, these muscles do not spontaneously recover, and this is true even if patients do not feel pain and are able to return to normal activity levels.
As a result of the inhibition of these muscles, called lumbar multifidi and the transversus abdominus, lower back pain occurs. However, there are steps you can take to prevent the same thing from happening to you.
Lower Back Pain and Physical Therapy
One way to prevent the inhibition of the lumbar multifidi and transversus abdominus is through a series of physical therapy exercises.
Designed to strengthen the muscles of the lower back and keep the spine healthy, these physical therapy exercises may range from back stabilization exercises to muscle strength development and several wide variety of techniques.
In addition, a physical therapist may also recommend such methods as heat therapy, ultrasound, massage, mobilization, and education about posture and body mechanics in order to prevent lower back pain from recurring.
Some of these methods will be discussed later on. You will also find some practical self-help tips provided by experts to help you avoid lower back pain or prevent the condition from worsening.
However, before we head on to learning how lower back pain is treated through physical therapy, it is important that we first understand what causes lower back pain.
Lower Back Pain: CAUSES
There are actually many types of back pain, but the most common is pain in the lower back. Why? You might ask. The reason is simple: you carry most of your weight in the lower back. Thus, it is highly likely that a person would suffer pain in that area.
There is no definitive cause of lower back pain. Sometimes, the causes of the condition are so complex that it is difficult to pinpoint just a single one.
However, physical therapists and other healthcare professionals have observed that lower back pain is often a result of strained back muscles and ligaments due to any of the following activities:
• Improper posture
• Heavy lifting
• Sudden awkward movement
• Muscle spasm
• Stress
We could all be guilty of the above activities. We may not suffer any back pains now, but it is likely that as we get older and the degree of inhibition of the back muscles as a result of these activities increases, back pain becomes a very distinct possibility.
In addition to these common activities, lower back pain may also result from specific conditions, such as:
• Herniated disk (when the disk material presses on a nerve)
• Sciatica (when a herniated disk presses on the sciatic nerve. The condition causes sharp, shooting pain through the buttocks and the back of the leg.)
• Spinal stenosis (when the space around the spinal cord and nerve roots becomes narrow. This is caused by arthritis and bone overgrowth, the pain resulting from when a nerve gets pinched in the narrow space.)
• Spondylosis (a type of arthritis affecting the spine due to degenerative changes brought on by aging)
• Spondylolisthesis (when one vertebra in the spinal column slips forward over another)
Lower Back Pain: TREATMENT
The treatment of lower back pain depends on several factors, including the specific type of lower back pain (whether it is chronic or acute) and the purported cause.
For instance, acute lower back pain is commonly treated with pain relieving drugs, such as analgesics, or some forms of exercises that can help relax the muscles.
On the other hand, chronic back pain – or one that lasts for more than two weeks and is progressive – may be caused by some underlying condition, during which case the treatment plan may consist of resolving the underlying condition to treat the back pain.
Lower Back Pain and Physical Therapy Exercise
Physical therapy exercise is one of the most common methods of treating lower back pain. In fact, many home remedies for lower back pain consist of exercise, because the general theory is that if you remain active, you remain healthy. This is true in most cases.
However, for purposes of this article, the exercises featured here will be those that are practiced by physical therapists to treat patients with lower back pain.
Generally, in physical therapy exercises, the exercise program for back pain should encompass a set of stretching exercises, strengthening exercises, and low impact aerobics. Read below for more on these exercises:
-Stretching
The back of a person is composed of the spinal column and contiguous muscles, ligaments and tendons. All these are designed to move in consonance with each other so that any limitation in the range of motion in any of these components of the back result in back pain.
Stretching for lower back pain specifically targets soft tissues, such as muscles, ligaments and tendons, found in the back and around the spine. By stretching, the spine and soft tissues are mobilized, increasing motion and thus, relieving pain.
There are many kinds of stretching exercises employed by physical therapists. One is the Hamstring Stretching Exercise which works to relax tight hamstrings, a common symptom of lower back pain. This exercise is said to help decrease the intensity of lower back pain among sufferers.
-Strengthening
Physical therapists generally use two forms of strengthening and back pain relief exercises, usually depending on the specific condition of the patient. These are the McKenzie exercises and dynamic lumbar stabilization exercises. However, the two forms of strengthening exercises may also be combined should the therapist find it appropriate to do so.
-McKenzie Exercises
Named after a physical therapist in New Zealand, McKenzie exercises are primarily extension exercises that could help reduce pain generated from the disc space and also may help reduce the symptoms of herniated disc by reducing pressure on a nerve root.
For acute pain, the McKenzie exercises should be done frequently, at least once every two hours. In addition, patients are advised to avoid flexing their spine when exercising.
-Dynamic Lumbar Stabilization Exercises
Using this back exercise technique, the first thing that a physical therapist does is to look for the patient’s “neutral” spine. This refers to the position that allows the patient to feel the most comfortable.
Afterwards, when the patient is in that position, the back muscles are then exercised in order to “teach” the spine how to stay in this position.
Performing these exercises on a regular basis can help strengthen the back muscles and keep the spine well-positioned.
Low Impact Aerobic Exercises
The purpose of low impact aerobic exercise is to recondition the back. Patients who undergo reconditioning of the back through low impact aerobic exercise will have fewer episodes of lower back pain.
In addition, whenever an episode of lower back pain does occur, the pain is less intense and lasts only for a short period.
Another benefit of low impact aerobic exercise is that patients tend to stay functional – that is, they can continue with their regular work and carry on with recreational activities. In contrast, patients who do not undergo low impact aerobic exercises typically experience the gradual loss of their functional abilities.
For low impact aerobic exercises to achieve their desired results, they should be continuous. This will increase the heart rate and keep it elevated as well as increase the production of endorphins, which are pain fighting hormones released by the body.
Here are some examples of low impact aerobic exercises that you may want to try in order to lessen or reduce lower back pain:
-Walking
One of the simplest forms of aerobic exercises, walking is generally considered as very gentle on the back. To get the maximum benefit from walking as a form of low impact aerobic exercise, walk two to three miles three times per week.
-Stationary Bicycling
This form of aerobic exercise is less painful on the back since there is lower impact produced. This is beneficial for patients with lower back pain who may find walking too painful.
-Water Therapy
Sometimes referred to as aquatherapy, water therapy is simply doing exercise in the water. The buoyancy works to provide effective conditioning at the same time stress on the back is reduced.
Summary:
Lower back pain is one of the most common causes of job-related disability and why some people miss work. In this article you will find some practical self-help tips provided by experts to help you avoid lower back pain or prevent the condition from worsening.
| About The Author
Nishanth Reddy is an author and publisher of many health related websites. Visit his website for more information about lower back pain relief and treatment methods. Learn different treatment methods used for back pain relief. |
Root Cause of Back Pain
Root Cause of Back Pain
Discover causes of back pain.
Identify The Root Cause Of Your Back Pain Before Fixing It!
by: Michael Saros
If you feel that back pain is completely overwhelming your life, you are not alone. So many people live with debilitating, even crippling back pain everyday seemingly with no end in sight.
It is a daily ritual for them to reach into the medicine cabinet and pop a pill of their favorite over-the-counter pain reliever or doctor prescribed medication.
Despite the publicized health risks for taking these drugs on a continuous basis, back pain sufferers continue to swallow pills even if the relief only lasts temporarily and is miniscule at best. A cycle of doctor visits, pick-ups at the local pharmacy and popping pills becomes a way of life.
But does it have to be this way? Are we truly limited to just a bottle of medication with potential side effects and the one-sided advice from a doctor?
ABSOLUTELY AND POSITIVELY NO WAY!!!
AND YES…YOU AND YOU ALONE CAN DEFEAT YOUR OWN BACK PAIN!
First, you must understand that everyone for the most part has access to a huge arsenal of tools for combating, eliminating and managing back pain. But not everyone has the same degree and cause of back pain.
It is so important to find and effectively use the right set of tools for your own particular situation.
For example, too much rest or relaxation (a tool for getting rid of back pain) has the potential to be detrimental to your health if weak and underdeveloped muscles are the underlying cause of your back pain.
On the other hand, if you suffer a herniated disk from playing a sport, rest and relaxation may play a larger role in a quick recovery.
So essentially, effectively treating your back pain first depends on identifying the primary cause(s) or origin(s) of your back pain.
The better you are at identifying the cause of back pain for your own particular situation, the more specific and exact your arsenal of tools will become to effectively eliminate your back pain for good.
So after all that, you must identify the cause(s) of your back pain. Let’s look at some common causes of back pain.
Common Causes Of Back Pain
-Poor Posture
-Injury (Sports, Car Accident, Fall, etc.)
-Poor Genetics Or Congenital Disorder (Scoliosis, Spinal Stenosis, Degenerative Disk, etc.)
-Using Improper Lifting Techniques
-Obesity
-Frail Bone Structure/Osteoporosis/Osteoarthritis
-Muscle Weakness/Imbalances
-Lack Of Exercise/Sedentary Lifestyle
-Poor Nutrition
-Stress/Anxiety
-Poor Sleep
-Performing A Repetitive Motion That Puts Strain On Your Back
Take a good long look at the list above. Just about everyone who suffers with back pain can relate to one or several if not all of these common causes of back pain. I, personally, can relate to every single one.
And it’s ok to have several causes or identifiers of your back pain. The more you can discover, the more weapons you will have to effectively combat and eliminate your back pain for good.
Back pain is similar to a weed. You can’t just mow over the top of it and hope you never see it again. You have to find the root of the weed or the root of the problem in order to effectively treat it.
How do you do this?
Well, you need to examine your own lifestyle. I would like you to ask yourself these questions to help determine your cause(s) of back pain:
Questions To Determine Cause Of Back Pain/Circle All ‘Yes’ Answers
1. Do I suffer from a congenital condition or was I born with a spinal condition?
2. Do I not pay attention to my posture either sitting or standing?
3. Do I not practice good posture either sitting or standing?
4. Have I suffered from a recent car accident or fall and subsequently experienced back pain not long after?
5. Do I do a lot of heavy lifting or bending over in my job or at home?
6. Do I perform an unnatural repetitive motion at work or at home?
7. Do I not practice safe lifting techniques?
8. Am I 20 pounds or more overweight?
9. Do I not eat enough fruits and vegetables?
10. Do I not drink enough water? 8-12 glasses per day?
11. Do I eat too many sweets and foods containing sugar?
12. Have I been diagnosed with osteoporosis or arthritis?
13. Do I lead a sedentary lifestyle? Am I a couch potato?
14. Am I under a lot of stress? Do I suffer with anxiety?
15. Do I have trouble sleeping?
Of course, these are just a handful of questions you could ask yourself to discover the root cause(s) of your back pain. Please circle the questions that have a ‘Yes’ next to them if you have not already.
Take a good look at the questions you circled. This method is not foolproof but it is a great way to see all the potential causes or root origins of your back pain. You should see the things you need to improve in order to help you live free of back pain.
Once you know or at least have some idea of the cause(s) of your back pain, then you can delve deeper into the plethora of ways to combat and eliminate it once and for all.
| About The Author
Mike Saros is a former back pain sufferer and author of The No More Back Pain newsletter found at http://www.backreliefelite.com/ . He will instruct you how to end your own lower back pain at http://www.SecretsToAPainFreeBack.com/Secrets_Discount.htm. |
Chiropractic-Medical Necessity
Chiropractic-Medical Necessity
Medical Necessity-A Reviewer’s Perspective
Chiropractic Medical Necessity: The Reviewer Perspective
by: AllMed Healthcare Management
Third party payers demand documentation to substantiate the medical necessity of a chiropractic treatment. This documentation should support care by providing evidence that a treatment was necessary for relief from a condition and to alleviate a patient’s symptoms. When a third party payer requests records, there are necessary documents and information that must be included for review. These include a patient’s past and present history, consultation form, chart notes and any required x-rays.
The patient’s past and present history are needed. These must explain why the patient sought chiropractic care, the nature of the complaints, the duration of the complaints and whether the patient was involved in a traumatic event. The documentation should explain if the patient has exhibited the same or similar complaints previously, whether there is a family history of illness or injury and if there are contraindications to chiropractic care.
It is important that the chiropractor include a consultation form. This reiterates the reasons the patient sought chiropractic care. The form should explain any previous medical and chiropractic treatment, as well as any prior examinations and test results, if known. This indicates whether patient’s condition is acute or chronic and what treatment, has been provided to the patient, along with the prior treatments outcome. Diagnoses are necessary.
The initial examination findings are important. These findings should describe range of motion, orthopedic and neurological, chiropractic palpation and postural abnormalities. If treatment proceeds beyond a brief course of care, progress examination findings are necessary to show progress between objective examinations.
Although x-rays can be integral in formulating a chiropractic diagnosis and treatment plan, they are not necessary for each patient. An unexplained complaint of long standing, trauma, and age, along with the consultation and examination findings and clinical experience, will determine the need for x-rays.
A patient’s chart notes are vital to assess the necessity of chiropractic care and critical to the review process. They show how the patient has improved or not, whether the objective findings (at least, range of motion, palpation and postural) reveal that the patient is improving. Chart notes also show how a patient’s response to treatment, the reasonableness of care and the treatment plan presented. If a home program was instituted, they tell whether the patient is taking charge of his or her own healthcare and if it appears that the patient’s condition is progressing or being alleviated.
| About The Author
AllMed Healthcare Management: Founded in 1995, AllMed (http://www.allmedmd.com/, http://www.allmedmd.com/blog/index.htm) is a URAC-accredited Independent Review Organization (IRO) serving insurance payers, providers, TPAs and claims managers nationwide. Reviews are conducted by board-certified physicians in active practice. AllMed’s growing customer base includes premier organizations, such as Educator’s Mutual Life, IMS Managed Care, Tenet Healthcare Corporation, HealthGuard, several Blue Cross Blue Shield organizations, TriWest Healthcare Alliance, Allianz and many other leading healthcare payers. |
Stop Health Care Fraud!
Stop healthcare fraud in your own practice!
Did you know that even though it might have been a mistake, those working for you can innocently make a mistake and cause YOU to be criminally investigated for fraud?
Target of a Healthcare Fraud Investigation?
Top 10 Things to Do When You are the Target of a Healthcare Fraud Investigation
1. Determine whether the action is civil or criminal. There is a huge distinction. In a civil action, if you lose, you may have to pay monetarily. In a criminal action, if you lose, you may go to prison.
2. Do not shred documents that you now suspect are incriminating.
Although it seems counterintuitive, do not commence a shredding campaign. Providers often fail to realize that patients’ files are often the “crime scene”. By the time you either are made aware of or suspect that you are a target, the incriminating documents are in the investigators’ hands.
3. Determine whether you are a “target” or a “subject” of an investigation.
Frequently, investigators are working closely with prosecutors months, if not years, prior to identifying the “target” of an investigation. If you are a “subject” of such an investigation, this suggests either that the investigation is in an early stage, i.e., information-gathering, or you are a conduit to the “target”. If you are a “target,” seek consultation with someone knowledgeable in health care law without delay.
4. If possible, obtain affidavits from employees.
Hire an outside attorney for this process. The purpose is to identify potential problems that may have triggered the investigation. If possible, make no changes in office procedures. Frenzied changes in policies and procedures make fraud investigators suspicious of illegal activity. Insurance carriers are suspicious of you because you are a healthcare provider. How do you know if you need to change either a policy or procedure? If it is merely a preference, don’t change it. If a change is indicated by statute, rule, or clearly established guidelines, document the date on which you were made aware of the necessary change and make the change effective immediately. Never back-date.
For example, a “peer reviewer” reports that, as a chiropractor, you are required to bill for chiropractic manipulative therapy (”CMT”) when you documented, performed, and billed for spinal manipulation. The “peer reviewer’s” preference requires no change. However, if you find that an adminstrative agency (e.g., Workers’ Compensation) has adopted a rule that requires you, as a chiropractor, to bill for CMT when billing for spinal manipulation, and you find that you have been billing incorrectly, document the date on which the information was brought to your attention and bill appropriately from that date forward. This action will reduce future liability.
5. Do not dismiss employees if they express concerns regarding current operations.
Employee-candor is desired. “Whistle-blower” violations will only compound an already complex case. Prosecutors will readily take notice if such violations appear to have occurred. Furthermore, now the aggrieved employee has a monetary inducement to make your life miserable (i.e., percentage of amount recovered).
6. Request an opportunity to review all evidence of the alleged fraud.
Frequently, the provider erroneously thinks that those snide comments that so-called “peer-reviewers” make merely give insurance carriers justification to deny payment for services rendered. What providers do not realize is that every time a “peer-reviewer” opines that the service was “medically unnecessary,” excessive,” etc., the insurance carrier is adding another piece of evidence to a potential faud case against you.
7. Assume every conversation you have with an insurance adjuster is recorded.
Staff training and proper phone etiquette are critical here. It is seldom beneficial to engage in phone wars with either insurance adjusters or “peer reviewers”. If their minds can be changed by what you say, you won’t have to engage in a phone war. If they aren’t interested, all of the shouting in the world won’t change their minds, and you are susceptible to misstatements.
8. Understand established coding procedures
This is particularly important if the issue is fraudulently billing for services rendered. Do not permit yourself to be pigeonholed into accepting the insurance adjuster’s interpretation of a code. Unfortunately, many know less than the provider and, if the adjuster’s incorrect, you still have a problem.
9. Do not make the mistake of retaining just any attorney.
Healthcare law is very complex. Stakes are extremely high and you are opposed either by the government or a multi-million, if not multi-billion, dollar foe. The government becomes more sophisticated with each passing year, creating health care fraud task units, etc. Insurance carriers often have the luxury of having attorneys who do nothing but health care fraud cases. Knowledge is key. So find an attorney that not only has healthcare experience, but also billing fraud defense experience. In a criminal case, it is beneficial to deal with an attorney who is experienced in working with prosecutors and investigators.
10. Be as cooperative as is reasonably possible.
Occasionally, such investigations arise over relatively innocent misunderstandings. You must know the difference between stonewalling and asserting justifiable defenses. Stonewalling only prolongs the agony.
Welcome!
Welcome to Dr. L.K. Christy’s Blog!
We are excited about having an opportunity to share information with you regarding health care compliance. You will find great resources, articles, links and more about Healthcare Compliance.
