Chiropractic Care in the VA Medical Benefits Package – Part 2

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Hello everyone. I want to thank ChiroSecure for the opportunity to share my experience in treating veterans in my office. I would like to first introduce myself. This is also part two of my, I did a previous show last week. I am a chiropractic physician in Canton, Ohio. I’ve been practicing for 38 years. I am very active in my local chiropractic district, the North Central Academy of Chiropractic. I have been president for two years. I am currently a vice president.

I’ve been active in the Ohio State Chiropractic Association. I served as vice president from 2002 to 2006. I was the president of Ohio State Chiropractic Association in 2007. I was the chairman of the Ohio State Chiropractic Association Workers’ Compensation Committee from 2010 through 2018. I was instructor for the Workers’ Compensation Seminars from 2000 through 2015. I received the President’s Award of the Ohio State Chiropractic Association on the three occasions as a member of the Ohio State Chiropractic Association Opiod Task Force. I’m a member of the Stark County Ohio Opiod Task Force. I am an ambassador member of the Foundation for Chiropractic Progress. I am an ambassador member of the Patriot Project created by Dr. Tim Novelli.

My most special award though, which when you start the slide show here in a second was provided to me by a patient of mine who was a Special Forces patient and he provided me this award one year ago. I received an American flag and a certificate. The American flag was flown on January 31st, 2019 over the United States Embassy in Kabul, Afghanistan. This was the picture of the flag and the certificate that I received, probably the most special and awesome order I’ve ever received in my career here. Actually, the certificate says, “Be it known to all this flag was flown in the face of the enemy, illuminated in the dark and the light of justice and bears witness to the removal of terrorist forces threatening the freedom of the United States of America. It was flown with great honor and pride over our nation’s Embassy, where each day Americans fight the global war and terrorism in resemblance of all who lost their lives.”

On the bottom of certificate. This is a quote from John F. Kennedy. It says, “Let every nation know, whether it wishes us well or ill that we will pay any price, bear any burden, meet any hardship, support any friend oppose any foe in order to assure the survival and the success of liberty.”

This flag and certificate’s in front of my office, which is pretty cool. I was very appreciative of this award.

Okay, so today my talking points as part two regarding my experience with treating military veterans over the past eight years. Chiropractic care, now, as I said before, is included in the VA Administration Medical Back Benefits Package. This is just data regarding myself, my address, the town I work, my phone number, my email. You especially can contact me any day between 12:00 and 2:00.

As I said, my talk today is based upon my experience in treating veterans for the past eight years. My topics today are going to be VA referral procedure, billing codes, documentation requirements, foundation for chiropractic PR information, the Veteran Appeal. Last, I will supply military and chiropractic research and articles for you know.

Just to summarize some of the information from last week, now, the Washington DC recommended a treatment plan, which I don’t know whether I agree with them or not, but at least they have started a program and recommended a program which we have to abide by. They did, so initially when you get an authorization for chiropractic care for 12 treatments over 90 days. The second authorization is for six chiropractic treatments for 30 days. The third authorization is usually eight chiropractic treatments over 180 days. The VA’s initial acupuncture authorization is 12 treatments over the over 45 days but this schedule is not etched in stone. This schedule will be changed frequently.

Now I have received additional visits exceeding the recommended treatment plans, but this is dependent upon your documentation. The documentation must show that the vet’s improved with your treatment plan and your notes has to be legible. You have to educate the vets to inform their primary care physicians that you are helping him. Now, the best, the best thing you can do is obtain testimonials from veterans, which will help you on this issue here.

Now, initial reports should be sent to the referring entity as soon as possible. Update reports need to be completed with emphasis on how well the veteran is doing. Documentation has to be good. DCs cannot send poor documentation.

What the initial report does upon their initial visit is that it opens up the claim. The claim will be started. The pay process will get going. They need the initial report because that documents the veteran’s initial visit.

Now I provided a link to the VA community care of Optum. You click that link. It puts you right into Optum and you click the medical provider section and you can get credentialed. The biggest thing you need to do, the first thing you need to do is you have to sign up for Optum as provider. Okay?

The next thing, veterans must be signed up through the VA to receive benefits and for the VA to pay for our treatments. Now, the veteran either has a request or is referred for chiropractic or acupuncture treatment, which is created upon by the primary care physician. That is the first step. The primary care physician has to review and submit an approval.

The next thing that happens in your office is the VA facility calls and faxes authorization of the treatment request. They will fax the authorization. They’ll be able to list a number of treatments approved. They will provide copies of the medical records, which includes diagnostic testing. The records will list the VA’s diagnosis.

The information that you received by fax is about all the information you need. It includes past history. It includes previous treatments. It includes diagnostic testing and there’s a lot of pages there.

Now, as we go on with the documentation, your EOBs that you submit to the VA must include the VA diagnosis within the appropriate section. You do not include any other diagnoses. I usually will document my diagnosis of the veteran’s condition within the assessment section of my initial case note. I recommend submitting an initial narrative report with your billing. I recommend submitting your office notes with your billings. The more information you provide, the better off you’re going to be okay.

Coding and the modifiers has been a headache for our office for many, many months. We go around for the third party payers. We only tried west and we haven’t had any problems with Optum so far, but we’ll see what happens. Usually when we’re billing 98940 and 98941, we use modifier AT. For all physical therapies, we use the modifier GP. For the initial examination and the update examination codes, you use a modifier 25 when performing manipulation on the same day as the examination.

Now the initial narrative report, I know most of you know how to do this, but these are a guideline of what to put in your report. The VA gets every referral that I sent to the office, they get a report and it goes all these steps. The report should include the mechanism, injury and pertinent past history. The written report should include our list of obtained copies of diagnostic testing, and list of pertinent findings. I don’t include every diagnostic test, but just the pertinent findings of your treatment plan.

The narrative report should include types of treatment of previous treatments, and also include the list of medications prescribed, which are some of those lists are just unbelievable. It’s important to document the partial or permanent disability in the narrative report.

Part in my reports includes subjective complaints of the veteran and I do use the Visual Analog Scale and Oswestry Disability Evaluation Forms. In my report, I also include the clinical findings, which of course you’ll list the palpation, range of motion, neurological reflexes, orthopedic testing, all that.

Now the narrative report should also include a treatment plan, which in my case, I usually say that the purpose of my treatment plan is to improve functional mobility, provide pain relief treatment, discipline over the counter NSAIDS, prescriptive medications, injections, or additional surgeries, which then reduces the probability of the veteran developing additional health problems, drug addiction, or even experiencing life threatening situations.

My report also states that I try to improve the veteran’s ability for daily activities. The treatment plan should also include home treatment record or home self-management techniques to include home treatment methods, home exercises, and lifestyle modifications.

Now I’ve been probably 90% successful in helping the veterans. Most of them do well with our chiropractic treatment plan, which includes acupuncture.

Now, I also recommend that you submit reevaluation progress reports to the VA on a periodic basis. I usually recommend every 10 and 12 visits and you document the improvement with the use of the Visual Analog Scales, the Oswestry self-perceived disability forms and the veteran’s testimony. Again, the office notes have to be legible. We have to do a good job. We have to inform the VA that we are effective and we can document our treatment plan’s improvement.

Now I’m going to talk about F4CP here a little bit. F4CP resources are just top-notch. They are awesome. F4CP is a huge resource that every DC needs to utilize. I recommend that every DC in all state associations should sign up for members of F4CP.

There are three levels of membership: gold, silver, and bronze, and I’m going to submit examples of some of their documentation for you all to see so here we go.

This is a poster that I have in my office with lots of colors in it. It does submit the message, “Chiropractors are safer strategies than opioids”. I have many of these in the office. This is a brochure that I worked with F4CP to outline chiropractic care for veterans. This is a trifold brochure, which is real sweet. These brochures, I always provide to all the veterans to pass out to other veterans when they meet.

F4CP also has another brochure about save lives, stop opiate abuse, use chiropractic care. These brochures, every one of you should have in your office.

Now, they have what they call infograms. I have three or four of these listed. I’m not going to read them verbatim, but they’re impressive. They’re lots of colors. The messages are short and sweet. Again, these are brochures or infograms should be listed in your office. I also submitted them on my social media.

Here’s another one titled Chiropractic on the front lines for veterans. There’s great information, good data. Again, it’s very colorful. These work real well when you submit to them on your social media.

Now this, we created this as a district, which actually lists the veteran’s rights and the big message we wanted to get is get the care you deserve. We list the veteran’s rights to choose chiropractic or acupuncture treatment. Again, this is a real pretty brochure. Again, we put it in the office and at the bottom, it’s a very generic poster. We say, “To locate a doctor of chiropractic near you, click on this website, which is my local district’s website or the Patriot Project website”.

Now we’ve gotten crazy and some imagination to try too. We’ve had some opportunity to attend veteran association meetings and stuff like that, and seems to have what brings them to your tables are bright things. I contacted the Bent Pen People and, we put our information on the bent pens. You can see those are blurred, but it says, “Chiropractic first. Stop opiate abuse.” It says things like military veterans have the right to choose chiropractic. These eye catching things are really good to use in your office, or if you’re doing any talks or if you’re set up at any meetings as these colored pens are pretty cool.

We also put together our buttons that we wear in the office. We also take these to meaning it says, “Stop opiod use. Chiropractic first.”

These are just little things that we accomplish and F4CP definitely helped us before. They’ve actually even made us some T-shirts, but these little advertisements work real well.

This is an example of a table in my office. This is in my waiting room. You can see, I have lots information on table. I have the veteran’s rights poster. I had the chiropractic a safer strategy for opioids. I have an injured worker’s rights on the left. You can see on the left. There’s information regarding a F4CP. There’s notebooks or booklets. There’s those tool kits. You see our buttons and this is pretty cool. We take all this information if we go to any meetings or any get togethers.

Now, I like this. I like to stat that I found. It talks about the nearly one-third of the United States veterans receiving VA chiropractic service also received an opioid prescription, yet the frequency of opiate prescriptions was lower after the chiropractic visit than before. All these posters and information work real well.

Now we’ll change course a little bit about veteran’s appeals. Now, sometimes primary care will deny your care. That’s only happened to me once or twice. I did that compose what I call a veteran appeal and then it’s listed here in the next several slides. I’m not going to read through it for you, but provided to you to use in case. It’s like a paper follow up when they deny. It’s a little strong, but these veterans do need us and for our primary care to deny it, it’s just not fair.

You file the appeal usually to the Veteran’s Representative in the US House or the US Senate. I had one conflict. We filed the appeal and I’ll tell you what, our approval for chiropractic care came across pretty quickly. I have two cases now that we’re dealing with. We’ll see how it goes. Anyway, so here’s the appeal and it’s sent to the primary care physician as well as the Veteran’s Advocate.

I’m not going to read this, but you can read through this. It gives you an idea of what to say. All right. This seems to get some notice when you send it. He said it was pointed, but I didn’t care to tell you the truth.

Now, what I’m going to provide is our military data in articles. There’s a whole list of them. These articles are pretty cool because most of the data out there shows that chiropractic benefits are military. Most of the injuries are musculoskeletal and most of the time, lots from the military are related to lower back pain.

In this study, it talks about that musculoskeletal conditions resulted in more soldiers missing time from work than any other healthcare condition. In Afghanistan and Iraq, they found out that the time to, or some of the shoulder shoulders and missing time from their work, they found that 24% had musculoskeletal disorders as compared to only 14% who suffered combat injuries. Lower back pain is the number one disabling condition for our military.

Actually, the Washington post posted that the weight of the combat gear is taking a toll. The loads are contributing to injuries that are keeping some troops on the sidelines. This is like they carry anywhere between 70 to 100 pounds of material on their backs on a daily basis.

Now this already again from the Washington Post states, the bulk of the musculoskeletal injuries are cause for a hospitalization and outpatient visits for active-duty soldiers are leading up 888,000 visits per year. I think chiropractic can reduce these number of visits per year, don’t you think?

This Colonel states that they refer soldiers as tactical athletes in this Washington Post article. They want to keep to help them taking care of them early so they can get back to work or back in the game.

The other issue that they have problems with is timely treatment of veterans. Many veterans have to wait many, many days to get care. In Cleveland, Ohio, there was up to 59,000 veterans waiting 90 days for treatment. I think we could step in there and reduce this time. Just time that they have to wait big time.

There’s more data that this is an Akron Beacon Journal was a local newspaper. They say that more than 900 veterans across the state were delayed over 90 days. There is a real problem of timely treatment of veterans.

This next report here is a report done in 2000, it didn’t get much press and it sure does have a lot of good data on it. It states in report that military personnel who use chiropractic care for the treatment of lower back pain experience superior outcome, compared to patients who received care from medical providers. It talks about chiropractic care will improve the access to healthcare services for military personnel. It will lead to recovery of 111,000 to 371,000 additional duty days per year. This study also showed that chiropractic care can save up to $25 million per year.

Most of the other studies, I’m not going to go through these per se, but you can see from all the studies I provided to you, that it just shows how beneficial chiropractic care is. It’s a shame that nobody’s listening to us right now. Part of that has to do with education and we can educate the people and education VA. We can definitely can make a difference.

Our satisfaction rate with the military is phenomenal. This one study does show that 94% satisfaction in the army and 12 of the 19 Air Force bases are 100% satisfaction. The Navy also reported satisfaction ratings up to 90%. even TRICARE outpatient satisfaction surveys rated chiropractors at 80%, which is 10% higher than the overall satisfaction rate for all providers. Our chiropractors do a good job. We just have to have increased access to these veterans and the active military. It does state that chiropractors do return our military to duty faster.

Let’s see what it says here. This study actually shows the chiropractors might be for preventing some of their patients from receiving procedures of unproven cost utility value or dubious efficiency.

This study in 2018 talks about chiropractic care is now a tier 1 integrative pain treatment modality that maybe incorporated into the veteran’s patient-centered care plan. Actually chiropractic care reduces the reliance on opiod use in this article. This is a recent article too, and it said, “US Army Service members who received nondrug therapy, which includes chiropractic and acupuncture treatment has significant lower risk of alcohol or drug disorders. 35% decline in the risk of accidental poisoning from opiod-related narcotics, barbiturates, or sedatives, also suicide and self-inflicted injuries, including suicide attempts.”

Now TRICARE, which is the insurance company for active military does not cover chiropractic yet. There is a rumor that they may cover chiropractic care in 2021. We need to put more pressure on TRICARE because our active military need us as soon as possible.

Now the last slide for the day. Chiropractic treatment can be an answer to the four major problems facing TRICARE and the Department of Defense. The four major problems include over utilization of opioids, prescribed medications, antidepressants, epidural injections, or surgery. Second issue is suicide numbers remain high with 33% of those suicides attributed to medication side effects. Third problem is lower back pain remains the number one disabling problem with the military. The last issue is timely treatment of Veterans.

This concludes my slide presentation. I appreciate the time spent with you. I appreciate the time from ChiroSecure and I hope everybody can use the information. If you have any questions, please contact me or contact ChiroSecure. Thank you for your time today.

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