Military Veterans can Request Evidence-Based Non-Pharmaceutical Chiropractic Treatment – Pt 1

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Hello. I want to thank Chiro Secure for inviting me onto this program. It’s a two-part program, and we’re going to be talking about veterans, how to treat veterans, and how to obtain referrals in your offices. I want to first introduce myself. I’m Judson Sprandel II. I’m a chiropractic physician. I graduated from National College of Chiropractic in 1981. I’ve been in practice for 38 years and my practice is in Canton, Ohio. I have been very active in my local chiropractic district. I was a past president for two years. I am active in the current state association, the Ohio State Chiropractic Association. I’ve been the vice president of Ohio State Chiropractic Association from 2002 through 2006. I was the president of the Ohio State Chiropractic Association in 2007. I was the chairman of the Ohio State Chiropractic Associations Workers’ Compensation Committee from 2010 through 2018. I received the president’s award of the Chiropractic Association three times. I’ve conducted seminars in Ohio regarding workers’ compensation issue for chiropractors from 2000 to 2015. I’m currently a member of the Ohio State Chiropractic Association Opiod Task Force. I’m currently a member of the Stark County Opioid Ohio Task Force, 2017 through 2020. I am currently a member of the Foundation For Chiropractic Progress. I’m currently an ambassador/member.

Okay, so that’s enough about me. Let’s start talking about the veterans. The end of my slideshow, veterans can request evidence-based non-pharmaceutical chiropractic treatment. Today’s discussion is based on our experience in treating veterans over the past eight years. I’ve been treating veterans for eight years and each veteran’s condition is significantly complicated. We have chronic injuries, established disabilities. Their treatment histories are just unbelievable. They relied on prescriptive medications over-the-counter NSAIDs, injections, and so many surgeries. I have one veteran, he had 18 surgeries so far. He had four failed back surgeries. He’s had nine surgeries on his hands. He had four surgeries to remove a ganglion cyst on his right hand, and he’s still having trouble. I’ve had one one veteran who’s had six failed back surgeries, one who’s had five failed back surgeries. And I had one veteran, or have several veterans who had exploratory surgeries which were performed, and didn’t help them. So, the veterans definitely need a non-pharmaceutical treatment option, and that’s what we are doing. And we are definitely needed for the whole system, and now we can treat them.

So the goals today are to educate DCs, that the VA has placed chiropractic treatment within the Standard Medical Benefit Program, or the Veterans Administration. DCs can now treat military veterans within your community offices. Our second goal is to educate our military veterans, that they have coverage through the VA for chiropractic treatment. And the third goal is to reinforce the necessity of eligible good documentation, and solid treatment programs from treating DCs. We have to be very respectful for the veterans. We have to perform examination. We have to treat them very well. They are very impressed with our way of treating, and our way of handling these people. I go above board to help them as much as I can, and we all have to do this, but the documentation is necessary to convince the VA administration that we are good documenters, and we’re good treaters.

And so the necessity of update examinations and showing progress is part of our treatment program. And today’s presentation is just an introduction today. In part two, I’ll be talking about billing and how to educate the veterans through the Foundation For Chiropractic Progress, who has been phenomenal in helping me educate my patients about chiropractic care and educating these veterans that they can see chiropractors. Now, military life is tremendous with physical challenges. They carry heavy loads. They’re running with body armor. They’re jumping out of airplanes. They have a high probability of significant musculoskeletal injuries. These challenges resolve the longterm impact on the person’s body. Over 9 million men and women who served, in the VA, more than half have experienced chronic pain. 25% of the veterans report lower back pain. Veterans are twice more likely than non-veterans to die from accidental overdoses and highly addictive painkillers.

So the question we have, does the VA provide for chiropractic treatment? Yes, it does. VA medical centers and clinics offer chiropractic spinal manipulation for problems with the spine. Veterans can receive chiropractic care and after receiving a referral from their primary provider, however, the service is not offered at all VA facilities. The eligible veterans, which we’ll talk about that in a minute, are able to receive chiropractic care through VA’s outpatient fee-basis program after a referral from their primary care provider, and prior authorization by the department.

This scenario, the veteran has to stimulate it, and he has to get ahold of the primary care physician. I’m very persistent on talking with the veterans to contact their primary care. They cannot wait for the primary care to get around and refer them to us. We have to talk to the veterans to get that primary care consult, get that evaluation done. And the prior authorization from the VA usually comes across pretty timely. And the authorization will outline the treatment authorization. And when they send you the information, it has all the medical documentation we need. It has MRI reports, x-ray reports, previous treatment, physician treatment plans. It’s very good packet information that we need.

Okay, hence veterans can obtain chiropractic/acupuncture treatment in community. Chiropractic facilities for musculoskeletal pain and dysfunction. Now in 2002, we didn’t know it back then, but President Bush signed into legislation that chiropractic care would become a permanent benefit for recipients of veterans’ healthcare services. We didn’t know it, neither did veterans. And until this day, even up to today, veterans don’t know that they can come see us. And most of our colleagues don’t know that they can treat veterans. The 2002 legislation did add chiropractors to 30 VA medical centers, but there was no treatment of veterans in the communities.

Now this is right out of the VA website, and it’s pretty significant documentation, because they created a directive. It’s called the 1210 Chiropractic Care. It was released on May of 25, 2018. And actually, this is right out of the VA information on their website. It says, “Chiropractic care is included in the Medical Benefits Package, the standard health benefits plan generally available to all enrolled veterans.” The directive also states, which is pretty cool, that the chiropractic care is included in the joint commission pain standard of care evidence shows that patients receiving chiropractic care are less likely to use healthcare services. They’re more constantly to have greater risk, such as opioid medications, spinal imaging, and injections, and elective spinal surgeries. It also states “Patients, when they see chiropractic treatments, have lower healthcare costs for episodes of non-operative spine related disorders.” So this information is there, but they don’t know it. And it would be cool if they could take this information, and just post it everywhere, because these veterans would then come in to see us. It’s just, it seems like they ignore this data.

Now, I threw in this is information about Optum. I don’t know if everybody knows, but Optum is probably the largest insurance company in the world. They did a study on lower back pain, and they published a study at the National Academies of Sciences, Engineering, and Medicine. This was done in December of 2018. What they did was this was, this was a research study, which was based upon educating the patient to decide their pathway out for spinal episodes. Now, Optum data does show that patients sought primary care 30% of the time, and the cost of episode was $728. They consulted a specialist 40% of the time, and the cost of the episode was $1,728. Now they did consult conservative physical therapists and chiropractors, which included the 31% of the cost per episode, which is we did a better job on the cost side. That was $619. So Optum data showed us, 70% of the time patients with lower back pain consulted primary care physicians and specialists to treat the lower back pain. This, they thought, had to change.

So what the data showed that if patients can consult with conservative care, which included chiropractic acupuncture and physical therapy, that we can save them $230 million in annual medical expenses. So what Optum did was in the next two years through to 2020, which is now, they will increase the use of conservative chiropractic care. They wanted to raise referrals to DCs from MDs from 2% to 10%. And they wanted to raise the use of the conservative care pathway, which is increasing patient access to DCs from 31% to 50%. So wouldn’t that have been good for everybody? Absolutely. So do you think this will help these patients, who are being steered to drugs because they only have coverage for drugs? I think so. So the data showed that DCs can reduce opiod prescribing by 26%, which is huge. And the cost savings is $230 million per year. So, this is pretty good stuff.

So what they are planning to do is they’re planning to … how they’re going to do this is they’re going to waive out-of-pocket costs. They’re going to waive copays and deductible cost for conservative care. Now, all insurance companies does this, this is going to help every chiropractor in the nation. Now, what they’re also going to do is Build in Options for ease of choice< who is available, performance of provider, appointment availability, which we can do very well because we can do a better job at doing that. They said that they believe that conservative care providers will be more easily accessible, which I do agree with that. So they’re going to help patients become better consumers for care for spinal episodes. So I included a link of the video, if you haven’t seen it, click that, that is really, really impressive. The instructor is very passionate about chiropractic care, and it was a very good video for you all to have, and to review.

Now, getting back to the veterans and treating veterans, I’m giving you the link to the VA community care provider section of Optum. You have to click this to be certified. What happened was TriWest was the third party payer administrator for the VA for several years, up until 2020. In 2020, Optum took over for TriWest. And what Optum did was they wanted to credential every one of their providers. And this is a long process. I mean, we treated veterans for seven years prior to that. We spent four months trying to get certified. I mean, my staff was on the phone for hours, multiples times, filling out paperwork. I talked to physicians across the country. It was a real pain to go through this process, but you have to be patient. You have to be persistent because these veterans really need us to treat them.

And so we started in January, and we didn’t get certified until May 24th, 2020. Now the VA will not send veterans unless you’re certified. So, I mean, we didn’t see any new patients for a long period of time. And so, now we’re starting to see the patients, especially with this COVID virus, things settling down. So this is a process and you have to be persistent. And if they don’t answer you, call them back. I mean, I’m always a … oh, what do I want to say? I’m a stickler about things, and I push things. I don’t ever wait for things to happen. I’m going to push it. And then, so I made a lot of contacts through how I do things and we finally got situated.

So, and one thing too, if anybody needs help with this, I mean, I’m always available. I’m sure Chiro Secure can give you my phone number, and my email too, because I’m always willing to help. Any day between 12:00 and 2:00 is my lunchtime. And I can answer your questions for everybody. So this is a process that we all have to go through, okay?So the reason why there is a lack of, if you were getting referrals before and you’re not getting referrals now, it’s because you’re not certified. I mean, some of my veterans were referred to other chiropractors, because I was not certified. And they didn’t want to do that, so they waited around until we got certified. So you really have to be persistent, and get your paperwork done.

The other issue is the veterans do not know they have coverage for chiropractic or acupuncture treatment. They just don’t know. And part of our action plan is to request the Department of Veteran Affairs, to include chiropractic and acupuncture on the first page of the veteran benefit description on the website. Chiropractic and acupuncture, benefits are not easily located. You almost have to dig three or four pages into the website to even find anything about chiropractic. I think we’re under braces, or prosthetics, or something, which is ridiculous. So one of the things we need to do is get them to put our chiropractic right underneath their benefit package on the first page. The second issue, which we’ll talk about more next time I talk to you guys is educating the veterans. And how we have to do this as a visit local veteran facilities, such as American Legions.

And then we need to provide the F4CP, as the Foundation For Progress Chiropractic, chiropractic and acupuncture information. The Foundation For Chiropractic Progress is just tremendous. Their information is spectacular. Every association and every DC should be taking part in F4CP material. There’s no need to create the wheel. They have so much stuff, and they’re willing to work with us tremendously. So I did talk to a DC, who was a captain in, I think, the Army. He was from Missouri, and he spent lots of time talking to all of the VA facilities, and he really didn’t get any of the referrals until I talked to him about educating the veteran facilities. And so he’s doing that, and this is what we need to do to educate these people that they can come see us.

Now in Washington, DC they have set up treatment plans, which I don’t agree with these treatment plans, but at least at something. All right, the initial chiropractic authorization is for 12 treatments in 90 days. And on this slide, I’ve included all of the codes that they will pay for, which includes the examination codes, both new and updated examination codes. So it’s 12 visits for 90 days. And this is where the documentation is important. You have to provide documentation of benefit. You have to use the Oswestry Disability Questionnaire. In my opinion now, the pain scales, the documentation has to show improvement to obtain more visits than the 12 visits they’re authorizing, okay? And the second issue to the veteran has to state that they’re getting benefit from your treatment plan.

Now, the recommended treatment plan from Washington, there’s also a second authorization, which is like six visits over 30 days, and the third authorization is eight chiropractic visits over 180 days. Again, our patients, our veterans are complicated conditions and they can’t really abide by these type of treatment plan. But what you need to do when you’re going through a treatment plan is you get halfway through, and if the veteran is improving, you document it. And then you ask the veteran to contact the primary care physician saying, “Hey, I’m better. I need additional care. I can’t handle just six visits in 30 days, or I won’t be able to do well with eight visits in 180 days.”

And so, if you’re into the third authorization and you’re on number six, that’s the time you tell the veteran to contact the primary care physician, get that consult, get that approval, log the information, and then your chances on getting an authorization are greater. The other thing they need to do is the initial visit, you need to do a narrative report on the initial visit. And you need to send that that week, because as the VA sees the initial visit, the claim is open, and the payment plan starts. But if you don’t get the initial visit in there, or the narrative report, this takes a long time to get processed. So you have to get that information to them as soon as possible.

Now, my last slide for the day is … this is just the acupuncture approvement plan, which is 12 days or 45 days. These are all codes that they pay for. The only problem I have is that they don’t include chiropractic manipulation codes with acupuncture, and that’s just another issue that we’ll talk in another day, but this is a good start for us. We can definitely help these veterans. And I really want to, thanks Chiro Secure for allowing me to talk to you all today. And we’re going to do it at the same time next week. And next week, we’re going to talk about coding. We’re going to talk about documentation. We’re talking about data from F4CP, and some other things. So anyway, thank you for your time today, and I’ll talk to you all next week. Thank you.

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