Weekly News March 28, 2014
Written by Editor   
Monday, March 24, 2014 08:03 PM


House Delays SGR Cuts, and ICD-10 Implementation for One Year

The House of Representatives acted Thursday to delay for a year the switch to the ICD-10 coding system until Oct. 1, 2015. The bill containing that provision also delays by 12 months pending reimbursement cuts under Medicare's sustainable growth rate (SGR) payment formula.  With CMS firmly against another delay, Congress stepped in to give an extra year.

The bill now moves on to the Senate, where Sen. Ron Wyden (D-Ore.), the newly appointed chair of the Senate Finance Committee, which oversees Medicare, is pushing for a permanent solution to the SGR. Under the SGR formula, physician payments will drop by roughly 24% on April 1 unless the Senate passes the measure now being considered.

This just in: the Senate has passed the measure as well and it it on the way to the president for signature.  -- Wed 4-2-14

Read More



To:            Texas Workers’ Compensation System Participants
From:         Matthew Zurek, Executive Deputy Commissioner Health Care Management & System Monitoring
Date:            March 18, 2014
Subject:            Texas Workers’ Compensation Transition to ICD-10 Code Sets


Beginning October 1, 2014, the Texas workers’ compensation system will transition from the use of the International Classification of Diseases, 9th Edition, Clinical Modification and Procedure Coding System (ICD-9) to the International Classification of Disease, 10th Edition, Clinical Modification and Procedure Coding System (ICD-10) for medical billing, processing and reporting in alignment with federal regulations. These federal regulations adopt standard medical data codes sets that apply to the Medicare system, which is regulated by the Centers for Medicare and Medicaid Services (CMS).

Texas Labor Code §413.011(a) requires the Commissioner of Workers’ Compensation to adopt the most current reimbursement methodologies, models, and values or weights used by CMS, including applicable payment policies relating to coding, billing, and reporting, and may modify documentation requirements as necessary to meet the requirements of Section 413.053.

Health care providers, insurance carriers, clearinghouses, and billing services that participate in the Texas workers’ compensation system must be prepared to comply with ICD-10.

All health care services provided on or after October 1, 2014 must be billed using ICD-10 diagnosis codes or ICD-10 procedure codes as appropriate pursuant to Texas Labor Code Section 413.011 (a). This includes medical bills submitted electronically or paper forms.

Health care services provided before October 1, 2014 must continue to be billed with ICD-9 diagnosis and procedure codes. Practice management systems must be able to accommodate both ICD-9 and ICD-10 codes until all medical bills for service dates before October 1, 2014 have been processed.

It is important to prepare now for the ICD-10 transition. There are many professional, clinical, and trade associations offering ICD-10 information, educational resources, and checklists. Call or check the websites of your associations and other industry groups to see what resources are available. You may also visit CMS website for resources at http://www.cms.gov/Medicare/Coding/ICD10/Index.html.

The Division of Workers’ Compensation (DWC) recently adopted the amended 28 Texas Administrative Code (TAC) §133.10 to reflect the changes in the newly updated 1500 Health Insurance Claim Form Version 02/12 (CMS-1500) allowing for the use of the ICD-10 codes.

Additionally, the DWC adopted 28 TAC §134.803 and §134.807, which govern medical bill and payment reporting by insurance carriers to allow insurance carriers to report ICD-10 CM and ICD-10 PCS codes to the DWC.

The DWC anticipates offering guidance on the ICD-9 to ICD-10 diagnoses codes through educational and informational outreach. If there are any questions regarding the information in this memo, contact Comp Connection for Health Care Providers at 800-372-7713, option 3 (in the Austin area, dial 512-804-4000) or e-mail compconnection@tdi.texas.gov.

A Second Opinion: Good Questions

By Franz Klein D.C.

In my previous response to the TAAOM lawsuit filed against the Texas Board of Chiropractic Examiners I quoted the Texas Constitution Bill of Rights in which Sec. 26 states that monopolies shall never be allowed.  I stated that on the federal level, the TAAOM violates the Sherman Anti-Trust Act.  Please allow me to elaborate on the facts and my personal questions.


On June 17, 2010, the Federal Trade Commission (FTC) enforcement staff brought and administrative action against the North Carolina Board of State Board of Dental Examiners (NCSBDE) claiming it (NCSBDE) was violating § 5 of the FTC Act.  The NCSBDE had sent cease and desist letters to non-dentist teeth whitening service providers and distributors.  As well, cease and desist letters were sent to shopping malls telling them not to lease space to non-dentists teeth whitening service providers.

By summary judgment on February 3, 2011, the FTC found that, because a majority of the members of the NCSBDE were practicing dentists, as required by the DPA (North Carolina Dental Practice Act), for purposes of the state action doctrine the NCSBDE should be deemed a private person, rather than a part of state government.

On December 2, 2011, the FTC issued its final order against the NCSBDE finding the NCSBDE members were actual or potential competitors and were separate economic actors.  The FTC found they were capable of conspiring (and had conspired) to exclude non-dentist teeth whitening providers from the market.  The FTC found the conduct of the NCSBDE was anticompetitive.  The FTC found that it was immaterial whether or under what circumstances teeth whitening constituted the practice of dentistry, whether there is a valid public health or safety interest in the NCSBDE’s prohibiting non-dentists from whitening teeth, or whether the actions of the NCSBDE had been taken to further the goals of the DPA; it deemed such issues inapplicable to analysis under federal antitrust law.  The FTC found that the members of the NCSBDE had violated § 1 of the Sherman Act.  The statute, 15 U.S.C. § 1, includes the following provision:

Every person who shall … engage in any combination or conspiracy hereby declared to be illegal shall be deemed guilty of a felony, and, on conviction thereof, shall be punished by fine not exceeding $1,000,000, or by imprisonment not exceeding 10 years, or both said punishments, in the discretion of the court.

On February 10, 2012, the NCSBDE appealed to the Fourth Circuit Court of Appeals.  The American Medical Association (AMA) along with the medical associations for the states of North Carolina, South Carolina, Virginia and West Virginia filed a Brief for AMICI CURIAE supporting the NCSBDE and reversal of the ruling. 

The case was argued before the Fourth Circuit Court of Appeals on December 5, 2012 and was decided on May 31, 2013.  The Petition from the NCSBDE was denied and the ruling from the FTC was upheld. In the opinion were the following statements:

Decisions that are made by private parties who participate in the market that they regulate are not subject to these political constraints unless these decisions are reviewed by disinterested state actors to assure fealty to state policy.  Without such review, “there is no realistic assurance that a private party’s anticompetitive conduct promotes state policy, rather than merely the party’s individual interests.”… Therefore, allowing the antitrust laws to apply to the unsupervised decisions of self-interested regulators acts as a check to prevent conduct that is not in the public interest.

…in this case the Board’s members are separate economic actors who cannot escape liability under § 1 simply by organizing under a “single umbrella.”

Having determined that the Board is capable of conspiring…

We affirm the FTC’s mode of analysis and find that its conclusion that the Board’s behavior was likely to cause significant anticompetitive harms is supported by substantial evidence.

The Supreme Court has likewise made pellucid, however, that anticompetitive acts are not immune from § 1 because they are performed by a professional organization.

We have also noted, “we are not inclined to condone anticompetitive conduct upon an incantation of ‘good medical practice.’”

In this case, the Board’s status as a group of professional does not condone its anticompetitive practices.

At the end of the day, this case is about a state board run by private actors in the marketplace taking action outside of the procedures mandated by state law to expel a competitor from the market.

For the foregoing reasons, the Board’s petition for review is denied.

The United States Supreme Court has indicated it will take the case and it will likely be heard this Fall.


Are the TAAOM’s board members private actors and/or separate economic actors and/or actual/potential competitors and/or private market participants?

Would anticompetitive actions by the board members of the TAAOM make them subject to prosecution for a felony and if convicted make them subject to a fine of up to $1,000,000 and imprisonment up to 10 years or both?

Should the actions of the TAAOM be referred to the FTC for analysis?

Should the past and current actions of other organizations such as the Texas Medical Association, the Texas Board of Medical Examiners, etc. be referred to the FTC for analysis?

Would anticompetitive actions by the board members of the Texas Medical Association, the Texas Board of Medical Examiners, etc. make them subject to prosecution for a felony and if convicted make them subject to a fine of up to $1,000,000 and imprisonment up to 10 years or both?

I humbly ask these questions as my grasp of the law is very shallow and limited.  Thank you for your time and consideration.

Franz Klein, D.C.


Low Back Pain Afflicts Millions Around the World

Low back pain is on the rise and causes more global disability than any other condition, according to two studies from Australia.

The number of disability-adjusted life years (DALYS) due to low back pain increased from 58.2 million in 1990 to 83 million in 2010

"The global point prevalence of [low back pain] was 9.4%" they said.

Prevalence was higher in men compared with women. Both prevalence and burden of disease increased with age, with peak prevalence "at around 80 years of age," the authors wrote.

In a second study appearing in the same issue of the journal, other researchers looked specifically at the global burden of low back pain as a result of exposure to occupational ergonomic risk factors. They estimated that worldwide ergonomic work exposures were responsible for 21.7 million DALYS in 2010.  "Bottom line -- the human cost globally is much higher than previously estimated," said James McDeavitt, MD, chair of physical medicine and rehabilitation at Baylor College of Medicine in Houston.

The analysis by Hoy's group was part of the Global Burden of Disease (GBD) 2010 study. Out of 291 conditions evaluated, low back pain ranked highest in terms of years lived with disability and sixth in DALYS, the authors said.

They reviewed 117 studies and 780 estimates of burden of disease for low back pain, including data from 85 countries, and 20 of 21 world regions covered by the GBD study. The majority of studies used in the analysis included both men and women, a broad age range, and urban and rural populations.

"The results show that the prevalence and burden of low back pain is very high throughout the world," Hoy's group wrote, adding that because low back pain appears to peak in older age groups, the burden of low back pain ranked higher in regions with longer life expectancies, they said.

They called for further research on the duration, severity, and disability over the course of low back pain.

"With expanding and aging populations in many low-income and middle-income countries, the enormous burden from low back pain in these areas will grow significantly over coming decades."

In the 2000-2004 update, back pain was reported to rank 105 out of 136 disabling conditions. But "the study was flawed in that it used a definition of spine disease that was highly dependent upon high-tech imaging. Many countries in the study group would not be expected to use imaging to the extent used in developing countries." The current study attempted to address these methodological challenges.

In the second study, Tim Driscoll, PhD, of the University of Sydney, and colleagues, reported that occupational exposure was a substantial contributor to all low back pain, accounting for 28% of all DALYS from low back pain for people, ages 15 and up. The highest relative risk (3.7) was in jobs in the agricultural sector.

They found that 62% of low back pain DALYS were in men, with the largest numbers occurring in those between the ages of 35 and 55. Specifically, of the 21.7 million DALYS in 2010, 13.5 million were in males and 8.3 million in females.

Exposure prevalence was based on occupational distribution, the authors said.  The results "provide strong support" for the need to identify, develop, and implement effective interventions that minimize exposure to ergonomic risk factors.

Known risk factors for occupational conditions that lead to low back pain are rapid pace of work, repetitive motion, insufficient recovery time, vibration, heavy lifting, bending, twisting, and sustained non-neutral postures.

But they cautioned that, when considering interventions, the relationship between various risk factors and low back pain incidence may not be straightforward. Many current interventions are not supported by strong evidence, especially educational training and administrative measures, they reported.

Read More

Chiropractic Economics Annual Salary and Expense Survey

Was 2013 a prosperous year? Are you hoping 2014 brings you more financial gain? We want to know! Help us help you and your profession by quickly responding to Chiropractic Economics magazine's 17th Annual Salary and Expense Survey.
In good and bad economic times, accurate information on salaries and expenses submitted by you is critical to successful practices, and allows you to more accurately gauge the economy's current impact on chiropractic.
The results of this survey are used by the U.S. Bureau of Labor Statistics, so your response is valuable. It should only take about 10 minutes to complete, so please take the survey.
Deadline to complete the survey is April 7, 2013. Your participation is appreciated.


Herbalists Kerry Bone and Simon Mills Earn Prestigious Literature Award for a Second Time

Standard Process Inc. recognizes and congratulates the herbalists as the first authors to earn their second James A. Duke Excellence in Botanical Literature Award.  For the second time in 10 years, renowned herbalists Kerry Bone and Simon Mills have earned the American Botanical Council’s (ABC) James A. Duke Excellence in Botanical Literature Award. The 2013 honor was given to Bone and Mills for their work on the second edition of Principles and Practice of Phytotherapy: Modern Herbal Medicine (Churchill Livingstone, 2013), an herbal medicine clinical practice guide used by natural medicine practitioners throughout the world.

“The landscape of herbal medicine is evolving every day,” said Bone, co-founder and director of research and development for Australian herbal supplement manufacturer MediHerb. “With so much information now available, we needed to carefully review everything for its relevance to the clinical practitioner.”

In 2005, ABC established the James A. Duke Excellence in Botanical Literature Award to recognize books that provide significant contributions to literature in the fields of botany, taxonomy, ethnobotany, phytomedicine, and other disciplines related to the field of medicinal plants. First to receive the award were colleagues Bone and Mills for their book, The Essential Guide to Herbal Safety (Churchill Livingstone, 2005), which offered authoritative information and guidance on the safe use of herbs for all practitioners looking to integrate herbs into their practice.

The second edition of Principles and Practice of Phytotherapy, published in 2013, offers practitioners extensively updated and relevant clinical data regarding the use of herbal remedies. It also provides new insight on herbal management of approximately 100 modern health conditions.

Principles and Practice of Phytotherapy, the pair’s first collaboration, was originally published in 1999. With over 40,000 copies in circulation today, it is the leading text on herbal medicine in naturopathic and herbal colleges around the world. The second edition of the book took 14 years to publish.

Standard Process Inc. has partnered with MediHerb since 2001, as the exclusive United States distributor of MediHerb herbal supplements in the United States. With a mutual commitment to product quality, a strictly monitored manufacturing process and rigorous product testing, Standard Process and MediHerb are devoted to providing new advantages to healthy living while complementing good health.

Spinal Manipulation’s Effects May Go Beyond Those of Placebo or Expectation, Study Finds

A recent clinical trial has added to knowledge about what goes on in the body and brain when people with chronic low-back pain receive spinal manipulation (also known as spinal manipulative therapy). The researchers found that spinal manipulation, compared with placebo and no treatment, significantly reduced pain sensitivity. They also reported there was support for a potential biological target to address central sensitization of pain, a phenomenon of heightened pain sensitivity that is linked with acute pain’s transition to chronic pain, and the persistence of chronic pain. The research, supported in part by NCCAM and the National Center for Medical Rehabilitation Research, part of the National Institute of Child Health and Human Development, appeared in The Journal of Pain.

Among the major findings was that pain sensitivity significantly decreased for the actual spinal manipulation group only and when measured with a protocol for suprathreshold (i.e., above-threshold) heat response. The findings indicate that a decrease in pain sensitivity is greater in response to spinal manipulative therapy than the expectation of receiving the therapy. Also, the enhanced placebo was found as believable a treatment as spinal manipulation and had the highest patient satisfaction of any group.

The researchers noted that areas for further study include whether the observed effects occur in acute low-back pain. They also suggested adding instruction to actual spinal manipulation to state that the therapy has been shown to significantly reduce low-back pain in some people.

Read More

ACA Launches Blog for Consumers

The American Chiropractic Association (ACA) has launched a new consumer information blog to educate the public about getting healthy and how chiropractic services can help. The Get Healthy Blog provides information about improving general health and musculoskeletal conditions as well as promotes the extensive education and high professional standards of chiropractic physicians. Links to Find a Doc make it easy for patients to find an ACA member in their area.  While visiting, sign up for new posts and be sure to share the link through social media.

Multimodal Treatment of Distal Sensorimotor Polyneuropathy in Diabetic Patients: A Randomized Clinical Trial

The purpose of this study was to evaluate the effectiveness of the application of analyzing treadmill, muscle strengthening, and balance training compared with a standard care intervention in patients with diabetic neuropathy.

At the end of the treatment period, the experimental group showed a significant increase in gait endurance in a 6-minute walk test. In addition, the 6-minute walk test increased after the intervention, and an even greater difference was found at follow-up for the standard care group. The Functional Independence Measure in both groups increased and continued until the follow-up in the standard care group.

The results suggest that the experimental rehabilitation program showed positive effects on the gait endurance after 4 weeks of treatment, whereas it did not produce significant improvements of the gait speed. Both the treatments produced significant improvement of functionalities of the patient.

Read the abstract

Read the full study

Affordable Care Act Case May Be Big

A case that will be argued before the Supreme Court could open the door for employers to object to covering a host of health services otherwise mandated by the Affordable Care Act, legal scholars said.

The justices will hear arguments in a case that asks whether employers must provide birth control in employee health plans despite religious objections. Businesses must pay fines -- in some cases millions of dollars a year -- if they don't comply with the law and instead stand their religious ground.

The ACA requires health plans to cover without cost-sharing preventive services, including FDA-approved birth control such as levonorgestrel (Plan B emergency contraceptive). The ACA's contraceptive mandate took effect Aug. 1, 2012.  Nearly a hundred lawsuits have been filed on the issue, and courts have issued varying opinions. The federal government will have a tough time proving that providing birth control is a compelling public health issue to supersede religious freedoms because it has created a number of special exemptions for nonprofit religious organizations already; "The government can't really get into deciding whether someone's religious beliefs are sincere or rational or deeply held."

Justices are expected to release their opinion by June.

Read More

Standard Process Inc. Lauded for its Sustainability Efforts

Leading corporate communications publisher Ragan Communications praises whole food supplement manufacturer for its meticulous stewardship of the land

A core value at Standard Process Inc. is its commitment to the whole planet to use only environmentally safe farming practices. The company’s organic farming efforts recently earned the PR Daily Corporate Social Responsibility Award for best sustainability/green initiative from Ragan Communications. The award showcases best practices in corporate sustainability and rewards companies taking sustainability to new heights. Jet Blue received an honorable mention.

Especially proud of this accomplishment is Standard Process Engineering Manager Rick Goetz, “It is an honor for Standard Process to be recognized for our continued commitment and efforts toward sustainable business practices and the environment. We are very pleased that our corporate commitment to the planet is a role model that others can look up to.”

The award program is offered by Ragan’s PR Daily, a news site delivering public relations, marketing and social media advice for readers around the world.

Several thousand Standard Process customers travel each year to the company’s corporate headquarters in Palmyra, Wis., to witness first-hand the 85-year-old company’s level of commitment to organic farming. To show that all of its ingredients grown on the Standard Process Farm are 100 percent organic, Standard Process must demonstrate it follows the strict National Organic Program regulations from the United States Department of Agriculture to grow its crops. This means Standard Process maintains detailed farming practice records and follows quality control measures all the way back to the soil.

The Standard Process Farm team works with Goetz and his onsite engineering team, as well as the company’s research and development scientists, to determine the best plant varieties that will yield the highest nutrient content and to determine which new farming and processing technologies will help increase crop utilization and maximize crop yield per acre.

Watch “Seasons on the Farm” to learn more about Standard Process and its commitment to the environment.