Other Articles

Medical Necessity and the Role of Diagnostic Tests
Other Articles
Written by Dwight Whynot, D.C.   
Wednesday, 18 October 2006 15:43

Was it beneficial for the chiropractic profession to participate in the third party payer system (insurance system) of healthcare?

I believe the answer to that question lies in the consumer perspective. If I don’t hear it today or this week, I will next week: “You know, Doc, ten years ago you weren’t in my benefit package for health insurance. Now I have chiropractic coverage for my whole family. You guys have really moved up.”

That statement is what I frequently hear from new patients. The insurance industry has given the chiropractic profession credibility in the eyes of the consumer. We are not an alternative medicine anymore, but a mainstream primary care profession that caters to the frontline healthcare needs of the public worldwide. 

Many in our profession are frustrated and confused in their attempts at the third-party payer system. Many, many doctors of chiropractic simply just don’t know the rules and understand why it is that they get denial after denial from the insurance companies. The first rule of the insurance industry, and perhaps the most important, is that doctors of chiropractic must document properly and this proper documentation must include the rationale for the care to be deemed “medically necessary.” The most common definition of medical necessity revolves around the patient’s capacity for FUNCTION, NOT a reduction in symptoms. We can take a look at the Blue Shield Association General Policy regarding medical necessity. The policy states:  “Manipulation is a covered service when performed with the expectation of restoring the patient’s level of function which has been lost or reduced by injury or illness. Manipulation should be provided in accordance with ongoing, written treatment plan.”

This statement is the premise by which chiropractors are paid for their services. Virtually all insurance companies (including Medicare) base their medically necessary determination on this functional improvement paradigm and not a pain paradigm.

By utilizing diagnostic tests such as computerized inclinometry, computerized muscle strength testing, computerized algometry, radiographs and outcome assessment questionnaires in the office, chiropractors can provide the OBJECTIVE evidence to the third party-payers that not only is the patient dysfunctional in some capacity, but the care that is being provided to the patient is effective at returning the patient to a more functional status.

Diagnostic tests are used to confirm or deny a diagnosis. So why it is that very few chiropractors utilize them and then ask, “Why did the so-and-so insurance company deny my care?” 

Well, for starters, if all the insurance company had to evaluate and determine medical necessity were the doctors daily chart (SOAP) notes, then the doctor already lost. The daily SOAP notes do not provide evidence for and have never been devised for the purpose of providing medical necessity.  Daily SOAP notes only explain what happened that day, how the patient is feeling or reacting to care, what procedures were performed and what changes in the treatment plan may have happened.  Diagnostic tests are the tools that measure whether or not care is needed and is effective.

Diagnostic tests also provide important data to determine how long active treatment can last. By re-examining the patient periodically with the diagnostic tests mentioned previously, the doctor can chart when the patient has reached maximum functional improvement and can be released from care.  Under this paradigm, the patient is not released when they have no pain, they are released when their functional improvement has either plateaued or has reached full function.

It is especially important to utilize diagnostic tests in a personal injury situation. The doctor of chiropractic must take the patient’s subjective data and make it objective data for a courtroom situation. By using objective data, the judge can give the evidence full weight because it is no longer opinion but, indeed, a fact. If the defense attorney attempts to discredit the objective facts presented, they lose credibility with the jury.

Dr. Dwight C. Whynot is in fulltime practice in Johnson City, Tennessee. Dr. Whynot gives license-renewal lectures on Evidence-Based Chiropractic Practices which are promoted by the International Chiropractors Association and sponsored by Myologic and Spinal-logic Diagnostics. For questions regarding evidence-based practice procedures, email questions to This e-mail address is being protected from spambots. You need JavaScript enabled to view it . For 12-hours CCE license renewal lecture dates and places call the ICA at 1-800-423-4690. For more information on Myologic or Spinal-logic, go to www.myologic.com or www.spinallogic.com.

Are You Selling Your Practice—and Your Future—Short??
Other Articles
Written by Matthew Boyce, CFP   
Tuesday, 17 October 2006 11:57

While we work with many types of small business owners, chiropractors are our favorites. However, as we have worked with them, we have discovered that, like many other small business owners, doctors face the problem of properly evaluating their business. In fact, they tend to regularly value their practices at far less than they are truly worth.

When asked how much their practices are worth, we generally receive answers such as, “I’m not sure,” or “I’m guessing, but I’d estimate it to be $500,000,” or “I’m grossing X dollars per year, but I don’t know what my practice is worth.”

Conversely, these same individuals will know within a small margin of error what the value of their homes or investment portfolios are. However, for almost all of these individuals, their greatest assets are their practices.

For example, our firm recently began working with a successful doctor from the Northeast. He had come to us to prepare him for retirement. This DC had everything he thought he needed for a complete retirement plan analysis: retirement account statements, outside investment account statements, real estate assets, and insurance information. After reviewing his information, we found that he failed to include the one asset that paid for the children’s college educations, his house, his vacations, and the lifestyle to which he and his family had become accustomed, as well as, and most importantly, the asset that would provide income for his retirement years: his practice!

While his practice was grossing more than $1,000,000, he was willing to simply “walk out the door,” close up shop, and let those patients filter to other doctors in his area.  Essentially, based on a fair valuation of his practice, he was willing to give up more than $500,000 from the potential sale of his practice. He had never seriously considered selling the business prior to our conversation. That led him to perhaps a greater realization: What if he had thought of selling the practice five years prior to retirement and had done the things necessary to enhance the value of the business to a future buyer? What impact could that have on the income he would enjoy during his retirement years?

Dr. Bob Hoffman, President and CEO of The Masters Circle, states:  “A good exit strategy is to have your practice systematized so that anyone can take it over”. It should be transitioned from a personality-based practice into a systems-based practice. The doctor should have a training manual written for all aspects of the practice, including both procedure and financial information. He/She should do whatever possible to grow and expand the practice—before selling it—to raise the price or worth of the practice. The true selling point is a practice that is turnkey and, in the transition, can maximize the percentage of patients that shift from the selling doctor to the buying doctor.”

We also recommend that you implement a business structure that includes key man insurance, buy/sell agreements (as appropriate), and retirement plans. We also recommend that you have your practice professionally evaluated on a regular basis for both your overall financial planning and for the future sale of your practice. With that valuation, it is critical for you to get good advice regarding the value drivers that increase the price you will ultimately receive for all of the time you have spent building your practice. You’ll need a team of consultants to achieve the greatest returns on your business: a certified financial planning firm, a practice management consultant, a CPA, and an attorney.

Don’t wait. Get your team started to value your practice now. It could mean the difference between a good retirement and a great one!

Matt Boyce is a shareholder and Chief Financial Officer of American Financial Advisors, Inc. He graduated from Florida Southern College (Lakeland, FL) in 1995 with a bachelor’s degree in accounting, and earned the prestigious Certified Financial Planner (CFPTM) designation in 2001 from the College for Financial Planning.  He may be contacted by email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or call 1-888-679-9779.

Some Tips for Handling Personal Injury Patients from the Lawyer’s Perspective
Other Articles
Written by Matthew D. Powell, Trial Attorney   
Monday, 28 August 2006 21:04

autoaccidentmayPre-Existing Injuries and why they increase the value of an injury claim!

An all too common problem is the patient with pre-existing conditions or injuries who comes to you for care after a car crash. You may ask, how should this be handled? Very often, I hear lawyers and doctors try to ignore, forget, or bury the prior injury or condition. This is a recipe for disaster. By downplaying the pre-existing condition, you will destroy the patient’s credibility with a jury, and the insurance adjuster. Omitting or downplaying the pre-existing condition also makes the doctor look really bad on the stand, and results in a win for the defense team. The defense will know about every prior insurance claim, thanks to Insurance Office Service, Inc., which, for $25.00, will provide a full report of any and all insurance claims in their massive data base. The good news is that the law is generally quite helpful for the patient who suffers from a pre-existing condition.

The law basically says: If the patient’s injury (from the new car crash) resulted from an aggravation of an existing injury or disease (such as degenerative changes), the jury should attempt to determine what portion of the patient’s condition was caused by the car crash. If the jury cannot determine what new damages were caused by the crash, then the jury is told to award damages for the entire condition.

So, the good news is that a pre-existing condition does not hurt the patient’s claim. In my opinion, it makes it easier to explain to a jury why it does not take as much trauma to injure my client, considering he/she was already suffering from the pre-existing disease or condition. This really helps with the causation issue in a low speed crash. Juries get it that the recent car crash is really the straw that broke the camel’s back.

Once the jury understands that the crash caused the bigger problem, they have a hard job separating the new injuries from the old ones. If they can’t clearly separate the old injuries from the new ones, then they should award damages for everything.

As a practical matter, you have to really educate your patients about why a pre-existing condition can help their case. If they understand the implications of the pre-existing condition to the value of their injury case, they will give you a better history. They won’t be tempted to forget about their old problems in hopes it will help their case.

At trial, when my client has pre-existing injuries, I always bring this out early so that everyone knows we are not trying to downplay them. When I call my clients to the witness stand, I ask them a line of questions about how did they felt five minutes before the crash? Was their old neck injury bothering them at that time? How about one hour before? How about one day before the crash? When did it last bother them before this crash?

“Oh, I was doing very well for about ____ months.”
Then I ask, “How did it feel after the crash?”
“Oh, it was terrible; it was like three times worse than it had ever been before.”

Then, when I call my doctor to the stand, we talk about how my client was damaged goods before this crash due to the pre-existing conditions, why he/she was hurt more easily by the crash, and why the injury is more serious than it would have been for someone who did not have these pre-existing conditions.

If we are lucky enough to have digital motion X-rays taken before the car crash, then I request a second digital motion X-ray taken after the crash to compare the studies. With the help of some of today’s X-Ray digitizing software, such as the DxAnalyzer, we can make great objective comparisons between the two studies, allowing us to accurately show how much worse the pre-existing condition has been made due to the crash.

Don’t be shy about pre-existing conditions. Embrace them for what they are; use them to increase the value of your patient’s legal claim, not reduce it.

Matthew Powell is a trial lawyer in Tampa, Florida, who started his career representing over twenty insurance companies. After learning the defense side, he quickly found he could not represent insurance companies, and started out on his own to represent injured victims. He is a frequent speaker and instructor, teaching lawyers and chiropractors how to sharpen their skills in trying low-speed rear-end car collision cases. He has had the honor of obtaining a $1,000,000 verdict for a case the defense described as a minor fender bender. He can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Best Practices’ Chain Reaction
Other Articles
Written by TAC Staff   
Monday, 28 August 2006 20:55

CCGPP: The Wrong Approach to ­Practice Parameters

We commend the participants of the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) for their dedication and hard work. Their goal was to produce a “Best Practice” document after examining all existing guidelines, parameters, protocols and best practices in the United States and other nations.

When they began their mission, they preached consensus. Mistakes of the past were to be avoided and they pledged to have a completely transparent process. They were formed at the request of the Congress of Chiropractic State Associations (COCSA) and supported by the entire alphabet of national chiropractic organizations: ACA, ICA, FCER, ACC, CCE, FACS, NACA, NICR, and a host of vendors. The profession would, at last, have a document guiding chiropractors and third party payors that would avoid the perceived mistakes of the Mercy Guidelines.

But, now that the document has been released for comment, questions abound about the process used to create the document and its clinical conclusions. CCGPP has all but abandoned transparency and consensus. The profession must now decide if there is anything worth salvaging from this document or to repudiate it if it is ultimately published.

CCGPP and Worker’s Compensation

CCGPP has stated that requests from the worker’s compensation systems of California and Texas were the major impetus for the creation of a best practices document. Chiropractic costs for providing worker’s compensation care, according to the Worker’s Compensation Research Institute (WCRI), are far higher in those states than others covered by their survey data.

In the case of California, the state decided to adopt the American College of Occupational and Environmental Medicine (ACOEM) guidelines, which are detested by chiropractors, and to limit injured workers to no more than twenty-four chiropractic, twenty-four occupational therapy, and twenty-four physical therapy visits per industrial injury.

Unfortunately, these visit limitations would not be altered by CCGPP’s best practices document. The CCGPP document would, however, likely damage patients and chiropractors in the area of physical therapy services. The ACOEM guidelines state that physical therapy has “no proven efficacy.” CCGPP replicates this biased system that poorly grades physical therapy, not because physical therapy is ineffective, but merely because insufficient research has been done to substantiate its effectiveness. Add CCGPP to ACOEM and you have disaster for injured workers.

Instead of battling ACOEM or adopting reasonable WC treatment guidelines, as has been done in Wisconsin and Minnesota, CCGPP produced a best practices document that will not allow chiropractors in California to provide additional care, but will have a potential devastating impact on injured workers if they are denied physical therapy modalities.

CCGPP’s Impact on the Quality of Care

CCGPP appears to have ignored the evolution of best practices guidelines (see the cover story in the May 29, 2006, issue of Business Week) that were designed to help MD’s determine the best treatment based on a plethora of well researched options.

Instead of studying the applicability of this model to the entire spectrum of chiropractic treatment, it seems as if a judgment was made that, since the model would work well for chiropractic manipulation, which is well researched, it would be applied to all chiropractic services—regardless of the consequences. Now that the document has been released, the profession is beginning to understand the negative consequences for patients who need physical therapy, because this model was inappropriately applied to chiropractic.

It was not reasonable for CCGPP to adopt an unreferenced grading scale for modalities when they knew the inherent bias in the grading system would negatively impact the quality of patient care. If an ABCD grading system is used, it is fair to expect there will be A and B choices. That was not possible for physical therapy modalities because, to have A or B choices, there has to be relevant research. And, by CCGPP’s own admission, there is none.

So what will happen if CCGPP’s best practices guidelines are published? Patients will suffer, as it is likely that insurers and managed care companies will gradually eliminate reimbursement for any service that does not receive an A or B grade. After all, why should an insurer pay for something that received a C or D in a “Best Practice” document produced by the chiropractic profession itself?

The consequences will be devastating. In the real world, if reimbursement is denied for modalities, patients will have to pay for these services out of their own pockets. The overwhelming majority of patients will not be able to do so and, as a result, will forgo the care. Their health will greatly suffer as a result.

“Best Practices” Document or a “Guideline”

It has been fascinating to watch as CCGPP struggles with the identity of this document. Is it a best practice document that will help chiropractors to select the optimal care for their patients? Or is it a guidelines document that will be used by insurers and managed care organizations to impose artificial limits on care?

Throughout the national conference calls COCSA and CCGPP have held on this document, the words “best practices document” and “guidelines document” have been used almost interchangeably, except when a CCGPP member suddenly realized it was politically incorrect to do so.

CCGPP has been trying to make the case that a “best practices” document does not lay out numeric parameters for care and, therefore, should not be misused. But a best practices document that assigns a C or D grade to commonly used services will absolutely be used as a guideline by some insurers or managed care companies. They won’t just limit chiropractors to a few uses of physical therapy—they will refuse to pay for it at all.

ACN has already written that they intend to create fee schedules based on best practice documents. CCGPP is hiding behind the words “best practices” when, in fact, they have created a guidelines document that will be used to deny needed chiropractic care, which will have a devastating clinical and economic impact on the profession.

Consensus or Personal Opinion

The best practices process was sold to the country as a completely transparent process that would be consensus driven at every step. Like some states, the Wisconsin Chiropractic Association invited Gene Lewis, DC, the then Chair of CCGPP, to make a presentation to our board where he stressed the importance of consensus. If you read Dr. Lewis’ article on the CCGPP website, consensus is stressed over and over again.

But that was then and this is now. In a conference call between CCGPP and the COCSA Board of Directors (available on CD from COCSA), COCSA was told, in no uncertain terms, by CCGPP that they have no rights to approve or disapprove the document. Chair Jay Triano, DC, stated, “It is not a matter of ratification and never has been.”

There is more. After all, if CCGPP does not intend for COCSA or the states to be allowed to approve the best practice document, can we trust in their judgment not to produce a document that will be harmful to the profession? Their response: “In nuts and bolts, that is what it really comes down to. If we think this is going to harm us, do we publish it anyway? And I think the only answer is, in an actually honest world, yes.”

The Path Ahead

As of this writing, seventeen states have completed evaluations of the CCGPP document, many utilizing the AGREE Instrument which is specifically designed to assess documents of this type. Of the seventeen states, sixteen have requested that CCGPP withdraw the document. One state has determined the document should be published only if changes are made. More than a dozen states are still in the process of evaluating the document.

These sixteen states go far beyond challenging the process used to create the document. They have significant clinical concerns about research that has been overlooked or misinterpreted and questions about its practice applications. Each of these clinical questions would, by themselves, need an entire article to explore.

We are at a critical junction. While CCGPP says that states do not have the right to ratify this document, we believe they will change their minds if the majority of states take the position that the document should be withdrawn. For that to happen, many states need more information and time to respond.

COCSA has scheduled a special meeting to discuss the best practice document on Nov. 11. If CCGPP is really interested in providing the information necessary for states to reach a conclusion and to reach true consensus, they should extend their comment period until after COCSA’s special meeting. If they just want to publish a document based on the personal opinion of the ten people involved in its creation, then it should be disavowed.

Russ Leonard can be reached by e-mail at This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Chiropractic Best Practices: Not Fear, Just Facts

We appreciate the opportunity to provide your readers with factual information about the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) and our Best Practice document, as well as the chance to correct some of the factual errors and points of misinformation, which have recently been disseminated, including that by Mr. Leonard of the Wisconsin Chiropractic Association.

The Congress of Chiropractic State Associations (COCSA) and nearly all of the other recognized chiropractic organizations in the United States created the CCGPP in 1995 to examine evidence to support chiropractors in practice. COCSA created CCGPP, specifically, to respond to a pervasive and crucial problem: disparity and discrimination by third party payors against the chiropractic profession.

Real Tools to Fight Back with

The real purposes of the CCGPP Best Practices document are the following:

1. To give providers, our patients, and other stakeholders a scientifically sound and defensible library of peer reviewed evidence pertaining to chiropractic care, including conditions, diagnosis and treatments commonly used by DC’s.

2. To rank the evidence in a scientific manner to help doctors and patients make informed choices.

3. To develop ways to make this information useable and relevant to the average DC by using multiple platforms for dissemination and implementation of the information, including interactive websites, seminars, online data bases and other approaches.

4. To set up an ongoing process which would grow and develop over time, incorporating not only new literature evidence, but also consensus evidence.

5. To protect and encourage respect for and use of the clinician’s experience and clinical acumen, as well as patient preferences in contrast to a reliance on only scientific literature, particularly for coverage decisions.

It’s Not 1950

Much has changed in the chiropractic world in the past fifty years, and in the world of health care as well. People who pay the bills for health care, including insurers, employers and, yes, patients, are demanding evidence of treatment effectiveness beyond mere anecdote. The newspapers are full of stories about “proven” treatments that have now been shown to be useless. Provider groups of all types have heard the call, and are using evidence from their own perspectives to increase their market share over competitors who are slower to respond. Certainly, the PT’s have made it clear that they expect to dominate manual treatment in the future, and are using scientific literature in addition to politics to further their goals, at our expense.

In addition, care purchasers who must make a “pay or don’t pay” decision on every claim, are demanding evidence of efficacy. Numerous internal (insurance) carrier guidelines which limit chiropractic care and access are used tens of thousands of times every day to make such coverage decisions, and they were not written with chiropractic input.

In addition to providing a library of information for chiropractors, CCGPP was created to provide a more realistic and fair effect on substantiation of care by insurers. CCGPP was structured to provide a comprehensive look at what the scientific literature says, and filter it through a chiropractic perspective. CCGPP also addresses what to do when the scientific literature is lacking, contradictory or equivocal, by employing internationally established protocols to set consensus by chiropractors concerning chiropractic care.

It’s about the Process

If a chiropractic “best practice” document is to have credibility and legitimacy, it must be able not only to withstand scientific scrutiny, but, more importantly, it must follow a very carefully circumscribed process to positively influence decisions by government regulators, legislators, and insurance payors.

In the world of health care, the internationally recognized standard of construction and evaluation of documents such as best practices is the AGREE protocol. AGREE sets out how to collect evidence, rate it, and determine what to do at each phase of the project. Fail to follow the AGREE protocol and a document will be considered flawed. Follow it carefully, and legitimacy and credibility will be the likely result.

CCGPP has been very careful to follow the process laid out by AGREE, which includes transparency, specific feedback approaches, and editorial independence. The process calls for throwing a wide net to look at all relevant literature, but also specifies what kind of literature we look at to derive conclusions. For example, we do not use case studies, though certainly they have value. This is because case studies do not have the same impact that studies with larger sample sizes do (and are universally excluded). This has been a source of frustration for some of our critics, but it is necessary to remain true to the established process.

Another aspect of the process, with which some critics have problems, is the system used to grade evidence. There are several scales used but, generally, they follow an alphabetical scheme. “A”- level studies have the most evidence, followed by B, C and D. However, a lower grade does not connote worthlessness. It simply means there is less compelling evidence. That can be for a variety of reasons, as we shall see.

Modality Services.

Many treatment approaches, such as physical therapy modalities, have inconclusive or conflicting research evidence for several reasons. For one thing, specific modalities are not often studied independently, e.g., electrotherapy vs. placebo. It is more likely that electrotherapy or some other modality be used in conjunction with another treatment, which makes it difficult to tell how effective it is by itself. Researchers also have perhaps not asked the right questions, such as when the therapy is to be employed. Is ultrasound just as useful on the twenty-fifth visit as it is on the first? Research design can significantly affect the results.

What has been quite clear for many years is that the evidence shows that active treatment is more effective than passive treatment. That reality has been reflected, in part, in insurance payment policies and the reimbursement policies of Medicare and other government agencies for more than a decade.

The CCGPP stratification of evidence for modalities is certainly nothing new, despite recent cries that the sky is falling. Some have made dire pronouncements of financial losses looming for DC’s who use modalities. We believe such tactics simply play on doctors’ fears of anything new, and fail to recognize the facts.

First, the market has already corrected for the disparity in evidence for different treatments (it is referred to as the relative value, and is used to calculate fees).

Secondly, there are hundreds, if not thousands, of treatments with similar ratings, used by providers of all stripes, which are reimbursed every day. To assume that all treatments with less than a “B” rating are suddenly no longer going to be reimbursed is not logical or realistic. What the lower ratings really mean is that there may be better treatments to consider first (like manipulation/adjustment, exercise and advice), but modalities still have their place, and will still be reimbursed. Again, our rankings are nothing new, and are no secret to the carriers. They are simply an honest appraisal by a mature profession.

What does the low back chapter say?

Among other things, it gives “A” ratings to the things most of us do most of the time: manipulation/adjustments, advice to our patients, and instruction in exercise. It helps us decide what tests are most effective and when we should order them, and it reviews the other types of treatments we should consider when treating our patients for certain conditions.

Are there going to be areas of controversy? Of course! We’re talking about chiropractic here, and much of what we do and are taught we don’t all agree on. However, we can use evidence and consensus as a starting point for discussion about how to resolve some of these controversies, which can only benefit our profession and, ultimately, our patients.

We also cannot forget that, in this chapter and others to follow, a major reason for the document is to provide current literature to give answers for chiropractors who are wading through the ever-increasing volumes of literature emerging from around the world and who are seeking information on expeditious responses for their patients. This is certainly a major focus of the lower back chapter: making practice easier in this age of information overload by pointing the way to verified answers to the questions of everyday patient contact. The low back chapter and others are aimed at helping the chiropractor.

Guidelines vs. Best Practices

This profession has a justifiable concern about guidelines, given that guidelines developed by non-DC’s have often been used to curb care. Guidelines place an unreasonable emphasis on scientific evidence, particularly randomized controlled trials. As most of us know all too well, those studies often do not reflect real life, and fail to take into account the perspective of the doctor who is actually treating the patient, and the needs and desires of that unique patient. They also frequently do not address the complexities of practice: comorbidities, age, previous history and the many other presentations that make some cases much more difficult to provide care for than others.

Best practices in an evidence-based health care context recognizes this inherent defect, and specifically articulates that appropriate care is to be based on a triad which includes the best scientific evidence, coupled with physician experience and perspective, as well as patient preferences. One important factor to recognize is that, with guidelines, the scientific literature trumps all. With best practices, when the literature is equivocal or conflicting, the doctor and patient perspective becomes paramount.

The CCGPP best practices document also addresses the aforementioned accompanying factors that influence the process of care, in order to provide a more realistic snapshot of the corresponding actions of the provider.

Where from here?

The low back chapter is only the first step in a long series of steps. There are other chapters ahead, including neck, upper and lower extremities, soft tissue, pediatrics, wellness and geriatrics, among others. First, we collect and organize the literature, rate the evidence and, where there is little or conflicting evidence, develop a consensus.

Then the real work begins, as we develop a process to translate research and consensus into practical information which practicing doctors can use to answer the question, “What is the best care I can give my patient?” What are my options here, and what is the evidence for each, in terms of diagnostic testing and treatment? What works best, and when?

We expect to have an interactive website which providers and patients can access to answer their questions, providing greater consistency and predictability of care for our patients. The process is “iterative,” meaning, this is the first draft, and we will refine, update and change it every two years as more evidence appears.

Lastly, we have a rapid response team dedicated to fighting abusive practices by third party payors who attempt to misinterpret the document.

And if we do nothing?

Then we continue to be at the mercy of insurance companies, workers compensation carriers, the government, and others with their own agendas that do not include a mainstream chiropractic perspective. It is incredibly naive to believe that no one will notice that we have not tried to substantiate what we do as a profession, or that others outside the profession do not have access to the same information we have. This document is an information base, designed to provide all stakeholders with reliable, verifiable and scientific evidence, describing a chiropractic perspective, from which rational and supportable treatment decisions can be made.

Some, have advocated that CCGPP do nothing or use an ad hoc process (e.g., “A few smart doctors should be able to quickly put something together.”) that would be disregarded as lacking credibility and are trying hard to convince others to parrot these views without even bothering to read the document or investigate the process that more than 135 people involved in CCGPP have volunteered countless hours toward for the past eleven years.

Others, thankfully, recognize that the profession is at a crossroads, and is already overdue in creating our own database, our own defensible and credible description of what chiropractic practice is for the majority of DC’s. Some will use vague scare tactics, predictions of dire consequences, or try to muddy the waters by attempting to make this about personalities, philosophy or their own agendas. We believe the majority of DC’s will recognize, as we do, that we must have the intellectual and scientific integrity to examine honestly what we do as DC’s, and use that information to better serve our reason for existing: our patients and their welfare.

Visit CCGPP’s website at www.ccgpp.org to learn more about the CCGPP and the new best practice document and how you can support and donate to this project. A CCGPP representative will gladly travel to your state to present information and answer questions.

It’s 10:00 P.M.
Other Articles
Written by Stanley Greenfield, R.H.U.   
Monday, 28 August 2006 20:42

moneystackDo you remember that warning on TV from years ago? It asked, "It’s 10:00 P.M., parents; do you know where your kids are?" It was done as a public service announcement in the hope that parents did know where their kids were all the time and were aware of the dangers in not knowing.

I would like to use this article as a public service announcement asking you to be aware of something other than your kids. My public service announcement would go something like this: "Hey, Mr. & Mrs. DC, it’s August; do you know where your money is?"

Well do you?? Better yet, do you know where it is and what it is doing for you or against you? Again, I ask, do you?

If you can honestly answer, "Yes," to those questions, good for you. If you hesitated or don’t know the answers, I suggest you read on. This was written with your name on it! It may be the best thing you ever did.

When was the last time you sat down and took a good long look at your bank statements? Do you really know how much they are charging you in fees each year? Have you ever added them all up? It’s time that you did. Now add up what they paid you in interest on all of the money that you had in all of your accounts. I will bet you that you paid more in fees than they paid you in interest. That needs to be corrected now! Armed with your figures, it is time to march down to your friendly bank and tell them that this is no longer acceptable. If you haven’t noticed, there are as many banks around as there are Starbucks! They all want your business. See who will give you the best deal. Remember, it’s August and you need to know that your money is safe and working as hard as possible for you—not your bank!

Have you checked your credit card statements lately to see what you are paying in interest? It is the "APR" number that is usually posted at the bottom in the fine print. If it is over 12%, it is time to give them a call on their 800 number and tell them you get offers every day for interest charges below 10%. You can save a bundle here too. All of your credit card companies may not lower your rate; so you also want to ask for an increase in your total credit limit. This way you will cancel, in writing, the high ones and transfer the balances to the ones that will lower your rate. All it takes is a few calls from you to know where your money is and how well it is being treated.

Time to dig out those insurance policies and do a review. We are just going to look at the property and casualty ones, that is, your homeowners, auto, and any "floater" policies. If you don’t want to waste an evening doing that, call your agents and ask them to send you a list of those policies and what the deductibles are on them. They all have deductibles. I would suggest that you raise your deductibles to at least $1,000 on all of them. Why? Because, if you had a small claim, you probably would not submit it in fear that they would raise your rates or even drop you. If that is the case, then why pay for a low deductible? This can save you some money too. By the way, you should request a summary of all of your policies so that you can really see what you have and what you are paying for. You need that updated every year. It might also help knowing which premiums are for personal coverage and which are for your practice, and which ones are deductible.

I have given you three areas to take a good look at and see what can be done to improve the health and welfare of your money. Money can and will work hard for you if you make sure that it is being treated properly. Be kind to your money and it will be kind to you!

In future columns, we will expand the search to help you liberate more of your money and get it back to work in a safe environment. So, hopefully, the next time you’re asked, "It’s August; do you know where your money is and what it is doing for you?" you can just sit back and smile!

Stanley B. Greenfield has been engaged in the fields of Financial Management and Insurance since 1962. He is a Registered Financial Consultant, and was awarded the designation of RHU, Registered Professional Disability and Health Insurance Underwriter, in 1979, as one of its Charter Members. Mr. Greenfield has authored thousands of articles concerning tax, financial, and practice management, and has spoken throughout the world on these subjects to both business and professional associations. He is a regular contributor to numerous other professional journals. Mr. Greenfield also serves as a member of the Board of Directors of the Florida Chiropractic Foundation for Education and Research. You may reach him at This e-mail address is being protected from spambots. You need JavaScript enabled to view it , call 800-585-1555 or 904-513-2229 or visit his website, www.stanleygreenfield.com.



Page 54 of 63
TAC Cover
TCA Cover
BL Cover
Buyers Guide

Click on image above
to view the
Digital Edition






TAC Publications

The American Chiropractor Magazine: Digital Issues | Past Issues | Buyer's Guide


More Information

TAC Editorial: About | Circulation | Contact

Sales: Advertising | Subscriptions | Media Kit