Perspective


Insurance Management: A Third Party Billing Service May Be Your Solution
Perspective
Written by Claude Cote   
Monday, 24 December 2012 01:49
M
anaging insurance is certainly one of the hardest tasks chiropractors have to perform in their office, and it is one of the reasons some chiropractors have decided to turn their office into a cash practice.  But turning your practice to an all cash practice is not an easy task.  It is difficult to convince your patients to pay cash when so many other chiropractors or health professionals in your area are managing insurance for them. Managing insurance requires a lot of skill and knowledge, and in order to get paid well and be able to comply with all the rules and regulations the billing staff needs to know and follow a lot of procedures. If you have a great billing employee working with you in your office, make sure you treat her (or him) well because they are hard to replace, believe me. But if you are not happy with your billing staff, or if your billing employee had to leave your office for some reason, a third party billing service may be your solution.  What is a third party billing service exactly?  Let's see, step-by-step, how a third party billing service works.
 
What a third party billing service (TPBS) will do for you?
3rdpartybillingA third party billing service will be your billing staff and will work remotely through the internet.  They will send your claims to insurance carriers and will post all payments received in each patient file.  A good TPBS will follow up on unpaid claims, just as an on-site billing employee would do.  If you ever decide to use a TPBS, make sure they will follow up on unpaid claims, because not all of them do.  Make sure they do not write off claims without proper explanations and documentation. The service will give you access to all available insurance reports.  This way, you will be able to see exactly where your claims stand. They will also keep you informed about rules and procedure changes that insurance carriers put into effect.  Essentially, they will work as your insurance management expert.
 
What a TPBS will not do in your office?
A TPBS is not a chiropractic assistant. They will not give appointments to patients or educate your patients about the benefits of chiropractic care.  Also, a TPBS will not add or change any medical information in the system. Only the chiropractor is authorized to do that. They will not recommend any number of visits, or present or explain any kind of care plans to patients.  Remember, they are not on-site; they work remotely.
 
Advantages of using a TPBS
TPBS are insurance management experts.They manage insurance for hundreds or thousands of other clinics. They know all the ins and outs of insurance management. For this reason, a good TPBS will be very effective for you. Financially, using a TPBS may be very beneficial. Usually, you may expect to pay anywhere between 5 and 8 percent of paid claims for such a service. If you make the calculations, this is quite a cheap way to replace your billing staff. There will be no vacation, sick leave or any other benefits to pay. If you choose the right TPBS, it is very possible that this service gets paid by itself with a very efficient paid claim percentage. With all information provided by the TPBS, you will be kept on top of your insurance management. You will be kept informed constantly about claims paid, submitted or on hold.  You will be asked to update clinical information if required by the insurance company.  As soon as this is done, your TPBS will make sure to send the transaction with the next insurance submission. The process is well covered and easy to work with.  Some chiropractors are not very excited about managing employees, but operating a chiropractic office forces them to do so.  Giving the insurance management to a TBPS may be a relief for this often time-consuming task. This saved energy may be transferred to where it should be: patients and chiropractic care.
 
In chiropractic, just like any other profession, there is no magic solution for everything.  Using a third party billing service will not necessarily suit all chiropractors’ offices, but may certainly help a lot of them.
 
Claude Cote  is an expert in EHR systems, insurance billing and chiropractic clinic management for 22 years.  He has installed EHR system in 18 countries over 5 continents and nationwide in USA.  He is the President and Founder of Platinum System C.R. Corp (www.platinumsystem.com).  For comments or questions, please email to This e-mail address is being protected from spambots. You need JavaScript enabled to view it
 
Could It Be B12? A Question All Healthcare Providers Need to Ask Themselves: Interview with Sally Pacholok
Perspective
Written by Dr. William H. Koch   
Sunday, 25 November 2012 21:05
coulditbeb12Could it be B12? An Epidemic of Misdiagnosis by Sally Pacholok and Jeffrey J. Stuart is one of the most important books I have read in a long time.  It is one that should be read by every doctor and health care professional regardless of specialty.  It will change and save lives as the information it contains dictates new standards of care. 
 
Sally Pacholok, R.N., and Jeffrey Stuart, D.O., have done an incredible job of assembling a wealth of information and have provided extensive scientific documentation to back up every assertion that they make.
 
As I read this book, I found it incredible and quite disturbing that most of this information has been available, but largely ignored for many decades.
 
This book left me with a hollow feeling in my gut, wondering how many patients I have seen over the years that had an undiagnosed B12 deficiency that I had missed.  I have vowed not to miss another.  Beyond that, I have pledged my support in helping Sally Pacholok and Dr. Stuart to raise awareness of what they correctly term an “epidemic of misdiagnosis.”
 
KOCH: Sally, I was not exaggerating when I said that this is one of the most important books I have read in decades. The effects of vitamin B12 deficiency have been badly underplayed and ignored in favor of more exotic, and more expensive-to-treat, diagnoses.
 
PACHOLOK:  You are right, Bill. It is very frustrating when intelligent, well-educated doctors choose to turn a blind eye, as if such an easily diagnosed and inexpensively treated condition were beneath them.
 
KOCH: It is hard for me to wrap my head around that kind of attitude. My take on it is that it makes it easy for any of us to be a hero for getting it right. The short- and long-term ramifications are enormous.

PACHOLOK: As you know, my husband and I work in the emergency room of a busy hospital. Amazingly, diagnosing B12 deficiency is not considered to be appropriate for ER doctors and nurses. Yet how can you not, when we see the same patients appear over and over again with injuries from one fall after another simply because of weakness, balance problems, leg and back pains or glove and stocking numbness of hands and feet. Many walk with a slow, foot-slapping gait because they can’t tell when the bottoms of their feet are touching the floor. In addition, B12 deficiency can cause visual disturbances, dizziness, vertigo or postural hypotension.  These problems dramatically increase the risk of falls, and falls in turn can lead to broken bones, hospital stays and often an end to an independent life for many seniors.
 
KOCH: What I find equally amazing is the mental and emotional manifestations of B12 deficiency. You cite so many cases of elderly people who have been diagnosed with Alzheimer’s disease or senile dementia yet have regained their mental faculties after the deficiency was recognized and treated.

Yes. I believe that untreated patients who are suffering from an undiagnosed deficiency of B12 will eventually develop disorders of the nervous system.

 
Likewise, there are many people of all ages suffering from severe anxiety, depression and a host of other neuro-emotional disorders, who become hooked on dangerous psychotropic drugs when the underlying problem is vitamin B12 deficiency.
 
PACHOLOK: Yes. I believe that untreated patients who are suffering from an undiagnosed deficiency of B12 will eventually develop disorders of the nervous system.

KOCH: Sally, all of the information and the cases you present in your book are absolutely relevant to the day-to-day practice of chiropractic. That is why I felt the urgency to call my colleagues’ attention to it.
 
Every chiropractor needs to be aware of the far-reaching neurological consequence of B12 deficiency and how it can masquerade as multiple sclerosis, Parkinson’s and other dreaded neurological disorders.
 
PACHOLOK: It is frightening to think of how many people are suffering and dying because this simple diagnosis is never even considered.
 
KOCH: One of the most important points you make in your book is the urgent need for revision of what should be considered normal serum B12 levels. When serum B12 is tested, the labs and doctors use a “range of normal” scale which current data shows to be obsolete. 
 
Please tell our readers what the currently accepted serum B12 range is, and how it needs to be revised to correctly reflect levels appropriate for optimal health.
 
PACHOLOK: That is where the reform must first take place. Laboratories and doctors must be made aware that the serum values of vitamin B12 that have been thought to be normal or acceptable are, in fact, marginal or woefully inadequate for optimal health.

The current guidelines for serum vitamin B12 suggest 271-870 pg/ml as the normal range and less than 200 pg/ml as deficient. We advocate treatment in all symptomatic patients with serum B12 below 450 pg/ml. At this time, we believe normal serum B12 levels should be greater than 550 pg/ml. For brain and nervous system health and prevention of disease in older adults, serum B12 should be maintained near or above 1,000 pg/ml.
 
KOCH: Sally, you and Dr. Stuart have done a masterful job of covering all aspects of the subject of B12 deficiency. You have made it so easy to access the information you present through the many appendices you provide. You have referenced all of your information and backed up every statement you make so clearly that anyone can feel secure in quoting you. 
 
Congratulations on providing an important work that will undoubtedly serve millions of people.
 
Dr. Bill Koch is a 1967 Cum Laude graduate of Palmer. After 30 years of practice in The Hamptons, NY, he retired and moved to Abaco, Bahamas, where he and his wife Kiana travel by boat to provide Chiropractic care to the residents of the remote out islands.  Dr. Koch, author of the book Chiropractic the Superior Alternative,writes a blog: Mentoring Young Chiropractors http://DrWilliamHKoch.com and is working on three new books: ChiroPractice Made Perfect,  The Out Island Chiropractor and Conversations with the Chiropractic Technique Masters.  He may be contacted at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
 
Seeing Is Believing
Perspective
Written by Eric S. Kaplan, D.C.   
Monday, 03 September 2012 23:35
Leaders See The Future
One quality that all leaders have in common is that they have a clear and exciting vision for the future. This is something that only a leader can have. Only a leader can think about the future and plan for it each day. Do you have goals for your practice? Do you have a plan to execute your goals? A goal without a plan is nothing more than a wish. Are you wishing for your practice to grow, or are you working it? How can we help you this week? How do you see your future? Is it the practice of your dreams? Or, are you stuck in a rut? What you see is what you believe. If you see your practice overflowing with new patients it will happen, but you must see it first.
 
visionfutureA Clear Vision
Excellent doctors take the time to think through and develop a clear picture of where they want their practice to be in one, three and five years. The great doctors, the profession’s leaders, have the ability to communicate this vision in such a way that others "buy in" and eventually see the vision as belonging to them. Your staff and your patients must share in your vision. President Obama has a health plan (not to be political), do you? Whether you like his plan or not is not the question. Do you have a plan? My plan is for every American to receive chiropractic care. Imagine every person you speak with, look at, or engage in business with is a potential patient. Now you can help me execute my vision of a less subluxated society.
 
"If you see the invisible, you can do the impossible."
 
How We Motivate Patients 
It is the vision of the future possibilities, of what can be, that arouses emotion and motivates people to give their best. The most powerful vision is always qualitative, aimed at and described in terms of values and mission, rather than quantitative, described in terms of money. Of course, money is important, but the decision and commitment to "be the best in the business" is far more exciting. 
 
To encourage others, to instill confidence in them, to help them to perform at their best requires first of all that you lead by example. Being a doctor is a 24/7 job. Whether you realize it or not you are now committed to changing lives, to healing, to helping others. Once a doctor, always a doctor. 24/7. No matter what time of day, or where you are, you are a doctor. People expect, actually demand, that you lead by example. "If you want to lead the band, you have to face the music." My father taught me this early on; there is a responsibility to leadership, but the rewards are great.
 
Prepare For Greatness
A recent study examined the qualities that companies look for in promoting young managers toward senior executive positions, especially the position of Chief Executive Officer. The study concluded that there were two important qualities required for great success in leadership. The first is the ability to put together a team and function as a good team player. Since all work is ultimately done by teams, and the manager’s output is the output of the team, the ability to select team members, set objectives, delegate responsibility and, finally, get the job done, was central to success in management.
 
You are the CEO of your life, of your office; you must lead your staff, your team. If your staff does not follow your lead, then why would any patient? If you have members on your team, in your staff, that don't believe in you, then it is time for you to move on and get teammates that believe in their captain, that share in your vision. At Concierge Coaches, I am the CEO of my life, which stands for CHIEF EMPOWERING OFFICER; my goal is to empower my clients to be the best doctors they can possibly be. Your goal is to empower the patients, by being the best doctor you can possibly be. Patients want to be proud of their doctor. They want to go to the best. They want a doctor to lead by example.
 
When your patients are proud of you, believe in you, they will refer to you. How many referrals have you had in the last month? If your answer is low, you must work harder to be better. If you are going to be, be the best. Why just be a human being? Be a human doing!
 
Always Maintain Your Composure
Another key quality required for success was found to be the ability to function well under pressure, and especially in a crisis. To me this is germane to being a great doctor. Keeping your cool in a crisis means to practice patience and self-control under difficult or disappointing circumstances. How you handle your patients in acute and chronic pain is observed by your staff. How you handle office adversity can determine your future success. Some days are tougher than others.  How do you respond when the office is slow, no money comes in the mail, your staff call in sick? It is these moments that you must expect and during which you must act with respect and dignity. It is these moments that help define your future. 
 
Dr. Eric S. Kaplan, is a two time # 1 Best Selling Author, his latest book The 5 Minute Motivator, www.5minutemotivator.com, his resume includes former President COO of a NASAQ traded public company, which included Nutrisystem, Currently he is CEO of Concierge Coaches, Inc., www. conciergecoaches.com, a comprehensive coaching firm with a successful, documented history of assisting doctors create profitable practices nationwide, providing over 30 New Patient marketing Programs. Teaching doctors nationally how to develop a successful business in the health care industry of today. Dr. Kaplan is the best selling author of Dying to be Young, and Lifestyle of the Fit and Famous and Co-developer and President of Discforce and Palm Beach Massage Centers, www.pbmassage.com, the next Generation Chiropractic Practices, massage and Spinal decompression. For more information coaching or spinal decompression, call 1-888.990 9660.
 
Unhealthy Doctors Are Poor Role Models for Patients
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Perspective
Written by Corey Mote, DC   
Monday, 03 September 2012 22:31
I
t seems that today’s doctors, from all specialties, are doing a poorer job of representation when it comes to health and well-being. You see it everywhere now – doctors that are obese themselves are consulting with patients on how to lose weight. Some doctors even smoke, yet will have patients dying of lung cancer that they deliver care for. The problem is not at all limited to chiropractic physicians. Ask yourself this: Would you trust a doctor who doesn’t him or herself display the image of health? Would you be more likely to trust a doctor who does?
  
obesedoctorIt is human nature for one to have more confidence in a dental practice where the dentist has flawless teeth, or in a salon where the hairstylist has a chic hair-do. The same is true of doctors who maintain a healthy weight, which may help explain why those who are overweight are less likely to raise the topic of weight loss to their patients.
 
In a study consisting of five hundred primary care physicians around the United States, researchers at the Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins University School of Medicine found that a doctor’s own body weight influenced how he or she cared for patients with weight problems. Overweight or obese doctors were less likely to discuss weight loss with overweight patients: only 18% of the overweight physicians discussed losing weight with their patients, while 30% of healthy-weight physicians did.
 
Additionally, the researchers found that 93% of the doctors were diagnosing obesity in their patients only if they believed their own weight was equal to or less than the weight of their patients; only 7% of the physicians who believed their weight exceeded that of their patients actually diagnosed obesity.
 
In the study, when overweight or obese doctors did address obesity, they were more likely than the healthy-weight physicians to prescribe anti-obesity medications (26% vs. 18%), as opposed to recommending healthy lifestyle changes such as diet and exercise. This finding likely reflects a lack of confidence in these approaches to weight loss, either due to the physician’s own personal experiences or as a consequence of their subconscious concern that such advice would be viewed as less reliable to patients coming from someone who wasn’t of a healthier weight. 
 
Compared with overweight doctors, the physicians of normal body weight were more confident in their ability to offer advice on diet and exercise to their heavier patients, and 72% believed that they should be models of healthy weight for their patients. Only 56% of the overweight or obese doctors believed that their own weight was viewed as a reflection of any kind for their patients.
 
These results represent one of several other challenges in the war against obesity - doctors are notoriously bad at taking care of themselves and consequently many are poor role models for their patients - but the study also signals an opportunity for significant improvement in weight management with patients. “If we improve physician well-being, and improve their lifestyles toward weight loss or weight maintenance, that can go a long way toward influencing the care they provide their patients,” says Sara Bleich, an assistant professor of health policy at Johns Hopkins Bloomberg School of Public Health.
 
Doctors who successfully lose weight, eat well, and exercise regularly may be more likely to share their own personal experiences with patients, increasing the likelihood that their patients will then follow their advice. With healthier physicians, we could help pave the path for the general population to live more healthfully.
 
Dr. Corey Mote is a chiropractic physician, professional natural bodybuilder, exercise physiologist, columnist for various fitness magazines nationally and internationally, regular contributor to various healthcare profession magazines and journals, as well as a consultant for a United Kingdom-based vocational fitness program known as U-Phorm. For more information on Dr. Mote, visit his site at www.CoreyMote.com, or email him at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
 
Subluxation Vs. Disc Herniation: A New Paradigm for Chiropractic
Perspective
Written by John W. Fiore D.C.   
Wednesday, 29 August 2012 21:29
A
lmost every Doctor of Chiropractic that has been in practice for 8-10 yrs. or more has experienced the chagrin of treating a patient for a subluxation and afterwards having them discontinue care, only to find out later that the patient was doing very well after a surgical disc operation.  After experiencing 1 or 2 of these embarrassing scenarios, we may come to realize that there may be more information involving a subluxation than meets our chiropractic eyes.
 
subluxvsdischerniation4This embarrassment of missed diagnosis should never happen to a Doctor of Chiropractic. A DC should and can be in a position of being CORRECT in his/her diagnosis, before a patient has an operation for a herniated disc. If a DC is not correct, not only does he/she lose credibility with their patient, but their reputation is harmed. Imagine, if nearly all DCs have one or two of these missed diagnoses periodically, our entire profession loses credibility on a large scale. 
 
One of the many definitions of chiropractic that has stood the test of time states that “Chiropractic is the art, science, and philosophy of locating and correcting nerve interference, without the use of drugs or surgery.” Notice that it does not say what is causing the nerve interference, nor does it say what is used to correct the nerve interference or how it is to be corrected. This allows the chiropractic profession to have great latitude in describing what we do, but that does not excuse us from making an incorrect diagnosis.  
 
In order to understand how to correct spinal pain we MUST have a correct hypothesis of what is causing the nerve interference. Many hypotheses appeared in the chiropractic profession, the most popular of which has been the subluxation (or bone out of place) theory. This idea was accepted broadly by nearly the entire profession. Not so by medical surgeons. It is only common sense to them that when a chiropractor works on a patient and proclaims that the cause of the patient’s pain is a SUBLUXATION, and a surgeon operates and resolves the patient’s pain by removing the disc bulge, WE LOSE CREDIBILITY.  
 
However, the DCs continue the drumbeat to remove subluxations that they analyze to be displaced, a missed diagnosis. 
 
After the subluxation theory 60 years ago, along came Nimmo’s pressure theory.  Then came the “fixation theory” that theorized that “fixations” were the cause of the nerve interference.  Kinesiology then came into being proposing that imbalance of the muscular systems caused much of the nerve interference. Also there were reflex techniques, full spine techniques, cranial-sacral techniques, and many others. All had some success, but they had obscure, vague, ambiguous, and even conflicting hypotheses of what the actual mechanism was that caused the nerve interference or pain. And when it came time for a report of findings, it was difficult, to say the least, to convey understandable causation to the patient. In light of all the new information that has been revealed in the present-day healing world, the profession may need to come to grips and accept a new paradigm in order to make progress and grow.
 
Some of these theories appeared in chiropractic simultaneously, and resulted in much confusion in the profession. Chiropractic must come to the realization that, along with slight subluxation, herniated discs play a major role in compressing the SNR to cause spinal pain. 
 
A subluxation, which is defined as a vertebral displacement less than a luxation, can occur when extreme motion takes place in the spine that is beyond a motor unit’s normal physiological range of movement. And if this movement is in forward flexion of the spine, the increase in pressure will be concentrated on the front of the discs’ nucleus pulposis (NP). If this pressure is great enough it can suddenly thrust the NP posteriorly, breaking through many of the internal annular rings of the annulous fibrosis which then could bulge the outer rings of the disc into the intervertebral foramina (IVF) space and exert pressure on the spinal nerve root (SNR). (The majority of disc herniations are internal in nature, similar to a bulge on an auto tire or an inquinal hernia, where the outer skin still contains the internal ruptured parts).
 
We now have a subluxation and a herniation of a disc occurring at the same moment. Not all subluxations and disc herniations occur this way, some disc herniations can occur

without a subluxation, i.e. a subject can jump down from a 10 ft. wall and herniate a disc, and a  person could have a subluxation without enough force to cause disc herniation.  
 
However, there is strong evidence that many disc herniations are associated with a subluxation. The frequency of which could be very high. Could this be one of the most prevalent causes of spinal pain? If we conclude that a bulged disc is in fact causing pressure on an SNR, shouldn’t we as DCs include this in our diagnoses? If we conclude that a bulged disc is in fact causing pressure on an SNR, shouldn’t we as DCs include this in our diagnoses?
 
So, it’s not SUBLUXATION VS. DISC HERNIATION – it’s subluxation WITH disc herniation. This is a change in the chiropractic philosophy as to the cause of nerve interference that, if adopted, could give real relevance to our profession. Why should we adopt this change? The answer is, of course, that there is OVERWHELMING clinical evidence that in most cases of SPINAL PAIN, it is the bulge of the disc that presses or squeezes the SNR, and not the bone pinching the SNR. 
 
A Hypothesis of Disc Pain Causation by Clinical Evidence
 
Here are some examples of strong clinical evidence that a high percentage of spinal pain is caused by subluxation/disc herniation. 
 
1. MRIs have proven that there are frequent, multiple disc bulges in most spines. Even though some of them may not be symptomatic, they can become so as people do repetitious bending while doing normal daily activities. Multiple spinal flexions may gradually increase the size of these dormant bulges.  They can then begin to touch the SNR, becoming symptomatic. 
 
2. Most histories of patients demonstrating back pain occur when the subject is in a forward bent position, i.e. lifting a box over other articles in the trunk of a car, bending over to pick up a heavy item, picking up a pencil off the floor, bending over doing toe touches, or as simple an action as lifting the corner of a bed mattress to tuck in sheets. It’s easy to visualize what is happening within the spinal disc. 
 
3. Thinking about all the above activities that may cause back pain, the idea of the disc placing pressure on the SNR reasonably begins to dovetail to the subluxation/disc protrusion scenario. (Bending first, nucleus pulposis of disc suddenly slipping backward, second = sudden cause of back pain). Of course, it doesn’t always occur suddenly, the disc NP may slip backwards gradually. 
 
4. People that stand constantly in their job have a high incidence of low back and leg pain because discs tend to flatten with many hours of weight bearing. This can cause circular peripheral bulging of the disc and place pressure on the SNR.
 
5. For the same reason overweight individuals experience frequent disc, back and leg pain. 
 
6. Lumbar spinal decompression by expensive machines is adding strong evidence to the credibility of disc herniation, claiming results up to 80%. If subluxation was the ONLY major cause of back pain, I doubt if decompression results could be so effective, for they do not claim to replace the subluxated bones. However, decompression could tend to draw in or suck in the disc bulge or protrusion.

Chiropractic first, medicine second, and surgery last.


7. Very much credit must be given to Dr. James Cox for his persistent teaching of the herniated disc theory over 30 years ago.  I believe he was the first DC that instituted traction or distraction to correct bulged or herniated discs. Moreover, he invented a chiropractic table and taught seminars on how to correct these problems. His work is great evidence that validates that the majority of spinal pain is caused by disc pressure on spinal nerve roots.  
 
8. Long Term Cryotherapy (LTCT) is very effective in reducing disc pain because it tends to contract the disc, and the tissues surrounding the swollen disc, relieving pressure on the SNR. If the source of the spinal pain was subluxation alone, cryotherapy could not contract the hard substance of the offending bone to produce the relief that LTCT consistently does. 
 
9. There are medical pain clinics springing up in various areas of the nation who advertise aggressively their minimal surgical technique to shrink the NP by laser surgery. They claim nearly 95% results. If the disc was not the offending cause, would they even get close to that % if only the subluxation existed?  They are so confident of their results that some of them don’t even accept insurance.  Cash only.  Cost to the patient?  10 to 20 thousand. 
 
10. Could this be why the chiropractic general adjustment works so well? When adjusting bilaterally down the entire length of the spine we often hear many audible releases. Could those releases be small protrusions being replaced (anteriorly) toward their normal positions? 
 
However, chiropractors need not worry, because our treatment is less costly and will one day become the treatment of choice.

For we can correct a large percent of subluxations/herniations a lot more reasonably and with far better outcomes than any other  method.  That doesn’t mean we can correct all disc protrusions, but most of them, in almost all areas of the spine. Therefore, it would be reasonable for people to try chiropractic first, medicine second, and surgery last, in that order to rid themselves of musculo-skeletal pain.
 
We all can do the job, but chiropractic can and should be tried first for 3 major reasons:
 
1. We can reduce multiple protrusions during each patient’s treatment, saving the patient untold amounts of future health care costs.  No other health profession can do this.
 
2. Even though repeated treatments may be needed, because discs can re-bulge with time, chiropractic is the lowest cost of all disc reduction methods. 
 
3. Since we can reduce the majority of disc herniations, then the few that won’t respond to chiropractic can be referred to other more costly and risky methods (decompression, laser, drugs, orthoscopic surgery, bone fusion, or the newest attempts of disc replacement). However, the most reasonable route to improvement is firstly the low-cost chiropractic way. 
 
In Conclusion:
 
Therefore, when disc involvement is detected by physical exams, MRIs, CT scans, etc., our diagnosis must include disc bulge, protrusion, or herniation along with subluxation. Whenever the profession adopts this finding, progress can be made with insurance acceptance, and with other healing professions. When the occasional patient isn’t responding well, the DC, having diagnosed the patient with subluxation/herniation, can refer them to the next level of appropriate treatment. He/she will have been credited with a correct diagnosis and will look good in the eyes of his/her patients, medical doctors, and surgeons. Subsequently, the chiropractic profession will gain in stature.
 
When this truth is fully accepted by chiropractic, the public, and other healing professions, then and only then will people use “Chiropractic first, medicine second, and surgery last.” Whoever created that phraseology was “right on target”.
 
Can you envision it?  If everyone used Chiropractic FIRST, there literally wouldn’t be enough DCs to take care of the people. This may be a long way off, but it could happen in our future. 
 
The TRUTH of a correct hypothesis shall set us free.

John W. Fiore, DC, attended Purdue University, majoring in Chemistry, Physics, and Biology graduating from Lincoln College in 1954.  Practiced together with his brother for 40 years and invented the “Back-Huggar” in 1968, and the “Neck-Huggar” in 1982, and founded Bodyline Comfort Systems in 1968.  Served five years as secretary of Florida Chiropractic Association.  Author of “Discaltic Aberrations of the Spine”  (Disc Theory of Chiropractic) published in the 1974 Edition of the Journal of Clinical Chiropractic.
 
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