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Hello? Good afternoon. My name is Judson Sprandel. The second I am a chiropractic physician in Canton, Ohio. I’ve been in practice for 39 years today. I thought I’d revisit seeking chiropractic care and acupuncture through the VA system is important to revisit the information. Do the fact that there are so many veterans out there who don’t even know that they have the right to choose chiropractic care or acupuncture. I think the number is 10 million, um, veterans in across the country. And it’s also important that I think that majority of the DCS out there don’t know that they can treat veterans and have the VA cover the services that are rendered so well, let’s get started. Next slide, please.
Hang on one second for me. Give me one second. I’ll get this. No problem. No problem. Can you say that now? Yes, sir. Whenever you’re ready. Wait. Latrines. Okay. Um, technical difficulties. Computer’s always a fun thing. Aren’t they? Um, so anyway, the talk will, will be veterans can request evidence-based non-pharmaceutical chiropractic treatment and acupuncture today’s information is based upon my experience with treating veterans for the past nine years. Okay. Um, they’re the department of veteran affairs. They created a VA directive, um, titled 12, 10 chiropractic care. The directive is dated May 25th, 2018. This is this document which now includes chiropractic care in the medical benefits package, the standard health benefits plan available to all VA eligible enrolled veterans.
Actually the, the, the wording in, within the VA website, it states very clearly that chiropractic care is included in the joint commission pain management standards. And Evans shows that the patients receiving chiropractic care are less likely to use other healthcare services that are more costly and have greater risks such as opioid medications, spinal imaging, and injections, and the elective spinal surgeries, and the information states that patients have lower health or overall health care costs for episodes of non-operative spine related disorders. Um, this is wording right in the, in the veterans information. This is right. Uh, w I’ve had some back and forth discussions with the VA centers and says, actually, this is what it stays as according to the 2018 mission act, veterans are eligible for community care. When the VA is unable to schedule an appointment that is within the average drive time standard or the wait time standards now chiropractic and acupuncture care falls under the 60 minute average drive time for special care from the data requests, unless the veteran agrees to a later date in consultation with the VA healthcare provider. Now this document also states that all community care requests are approved timely based on the boat criteria. This is, this is a gray area, which we’ll address later on. Okay, next slide.
Now VA enrolled. It has the veterans have to be enrolled in the VA to obtain chiropractic and acupuncture care. Okay. Now VA enrolled veterans can request chiropractic clinic in community facilities. They, um, they can receive chiropractic acupuncture care through the VA’s outpatient fee based program after referral by their primary care physician or their pain management provider. And they then receive authorization, um, by the VA department or the VA third party administrator, which is Optum. Now the VA referral procedure. Now the veteran can either request the care, um, go to a chiropractor or acupuncture, or he is referred for that service. Now veterans have to obtain a consultation evaluation with their primary care physician and or the pain management physician prior to entering our offices for treatment. The VA facility calls and fax of the authorization for the treatment request, which was agreed upon by the VA primary care physician and PMNR, to be able to fax the authorization to the chiropractic physician, which the, the authorization will list. The number of treatments approved, provide copies of the medical records, which includes diagnostic testing and we’ll list the VA diagnosis.
Now there is definitely a VA or a DC credentialing requirement through the VA third party administrator Optum, um, DCS need to contact Optum’s VA community care email@example.com to start the physician certification process. This is a long process. It is not a smooth process. It took our office four months to get approved. I would say you have to be very patient and persistent to make sure this gets done. This is not ever done on a timely basis. Now. Um, there are standard episodes of care created by the VA administration center in Washington, DC. Um, the chiropractic treatment authorization varies a number and duration. However, it’s been my experience that the treatment frequency recommendations are based upon the primary care physician or the pain management physician.
Now, initially, usually the initial chiropractic authorization is for 12 treatments within a 90 day timeframe. The second authorization is usually six chiropractic treatments. Over 30 days. The third authorization is eight treatments over 180 days. These treatment plan recommendations can, it probably will change frequently. They really don’t deviate from the treatment duration. Um, there’s no extension. Uh, if you have 10 visits, uh, completed after that initial 90 days, that’s all the visit you’ll get, they printed these they really strict or, or stay focused on the, on the treatment duration period. Now on the chiropractic authorization form that you received, they list the codes at the cover, and I have them listed for you. Now, the initial acupuncture request, it’s usually about 12 treatments over 45 days, and I’m including the codes that they said they, uh, Coza. They include, um, as authorization. Now, the problem we have here is that, um, chiropractic manipulation is not included in the acupuncture codes.
And this is a problem for us as, as chiropractors who are certified to do acupuncture. Like I am that, um, we cannot do everything we’re trained to do for these veterans in my office. I do very well with treating them with both chiropractic and acupuncture. All right, now our documentation has to be top notch. The, um, initial port in my re in experience should be completed and submitted to the referring entity timely. We tried to get these reports to the, to the referring entity within the first week, uh, cause upon receipt of the initial report, the VA opens the claim. The longer you take to get the initial report, the longer it takes for the claim to be opened. Now, the VA, uh, requires office notes and they’d definitely, uh, request records and these should be sent to them timely. And I notes have to be legible.
We cannot send, um, handwritten scratch, scratchy looking notes. We have to, we have to be better than that. Um, the office notes must document the veteran’s response to treatment let’s document the improvement, your updated progress reports should also be completed and emphasize how well the veteran is doing the best way to document improvement is to use a visual analog scales or the modified disability questionnaires that are out there are even talking about. They’re able to perform daily activities with less degree of pain and soreness. Okay. Next one. Now on ELBs they sh they must have the VA diagnosis listed in the appropriate section. You did not include any of the other diagnosis. Um, what I do is I include my diagnosis in the veteran’s initial report in the assessment section. Um, there’ll be also will what they will do. They’ll request copies of your office notes upon completion of the treatment authorization period.
So what we do in the office, if we have initial 12 visits, um, a treatment period, we will submit the office notes close to the time that we’re finished with those 12 visits. So usually we submit them at the end around 11 visit. Now, when you build the manipulation codes, you got to use modifier 18 and all other physical therapy codes use the modifier GP. Now, if you examine the veteran any adjustment, the same time you got to use the modifier 25. So it’s been our experience that manipulation codes include 18 modifier and, uh, and all other codes should be a GP modifier.
Now additional treatment requests is a headache for, for me. And I know it will be for all of you too. Um, and it’s been my experience that, that the authorizations for treatment requests are frequently delayed. Uh, there are some that are authorized appropriately, and then there’s some that aren’t, um, and it takes a while to get these, uh, additional treatment, um, recommendations, prude. It’s been my opinion, that chiropractic treatment plan that is ongoing and approvement is established and there should be. And when there’s a stoppage of care, which could be months before authorization that received the progress has definitely slowed down. And the improvement is lost with these veteran conditions. Um, treatment plans are not short term the, of the treatment plans with dependent upon the veteran’s improvement improvements should be documented with clinical findings. And in veteran testimony is my opinion, too, that once that stationary plateau is reached with three, with treatment, there should be consideration for a supportive care treatment plan to Maine to maintain the veterans maximum medical improvement level of function.
Okay. Now, most of all veterans, every one of them present with chronic longterm, longstanding, permanent musculoskeletal pain and dysfunction, their cases are complicated. Their previous treatments include long-term reliance upon prescription medications, injections, and multiple surgeries. Veterans need to, to signal in pharmaceutical treatment, which we can do. Now. I am supplying four case examples of actual cases of mine, and these definitely document the complicated nature of these condition of the other conditions. And I’ll highlight some of these for you. Um, the first one is a 54 year old veteran, longstanding cervical pain with previous episodes of seizures with radiating pain and the numbness into his left arm. He had frequent headaches. He, he was assaulted by a group of men. He was experienced sharp stabbing pain in his neck with pins and needles. In his left hand, he was experiencing a burning sensation in his scalp, which radiated to his neck and mid back.
You stated that he was experiencing pain 24 hours per day. The spine stimulator was recommended, but she denied the BA diagnosis was spondylosis with radiculopathy in the cervical spinal region. 12 acupuncture treatments were authorized as veteran responded very well, very fast to care. The issue we had here is that we asked for additional treatments in the authorization period was long longstanding. And I actually lost track of this veteran because I think he got frustrated with the system. He, the stress was too much for him, and I’m pretty sure he now has contacted his Medicare provider in this doing medications. So in this case, it was a shame that we couldn’t continue care because of the, um, delay process for getting additional treatments.
The next case is a 72 year old veteran. He presents with chronic pain and lower back pain. He had unsuccessful hip surgery. They, they actually broke a surgical tool told during the surgery. Um, he moved from California to Ohio and California. He was receiving canisters of academe on a monthly basis, um, entered my office and he was acupuncture was again approved. His improvement was, was, um, he improved very well. We’ve had long periods of, um, authorization with wait time. Um, every time the patient was not able to follow through with the treatment plan, his condition worsened, he has returned to our office now, and he comes into the office about one to two treatments. A but on this case, this veteran did definitely experienced a worsening of his clinical condition and without care in my office. Okay. Next case.
Now this is a 78 year old veteran who presented with chronic lower back pain with bilateral leg pain and numbness. He couldn’t not do anything. The VA pushed diagnosis with spinal stenosis. Um, he was referred to our office for 12 or acupuncture treatments. He had two year duration of lumbar pain with numbness in his legs. Um, it has been his treatments previously included prescriptive medications, which included a gamma Pentin, which he is currently taking 600 milligrams of gamma pen three times a day. Um, he, um, responded very well to our acupuncture manual therapy program. He experienced improved function, decreased leg pain and numbness decrease reliance on prescription medications. He declined spinal injection and recommendations, and he was able to complete his daily activities with a lesser degree of pain and numbness. Uh, he was last, I last evaluated him in December of 2020. He was asking for additional treatment. But again, the authorization period was definitely delayed and really we felt lost track of him. So this delay and asking for additional treatments remains a, a, um, issue that we have to work out.
Okay. The last last case I have here is, um, I have a 50 year old veteran who presents with chronic neck and lower back pain pains, or, um, PanAms into his lower extremities. He’s had pain for about 25 years. He was prescribed, he was prescribed it to 32 pills a day for 15 years. He had to rely on the wheelchair for about 10 years. Um, he states his lower back pain was service related, um, which required him to jump out of airplanes, climbing mountain ridges. Um, he responded very well to our treatment program. His objections, um, previous treatments included injections, PT, water therapy, shots, nerve blocks, and is prescribed several pills. He’s currently taking Tramadol twice a day. He improved very well with my chiropractic and acupuncture treatment. Again, his requests for additional treatment have been delayed.
There’s a question. And I appreciate the question. This is if they get approved for acupuncture, does that include manipulation? No, it doesn’t. Um, this is an issue that we, that we have with them is cause they should really approve treatment for what we’re trained to do. And many chiros are, are authorized to do acupuncture and there should be no delay in, or they should not try to separate the two visits. I actually had discussion with a VA nurse where she said that, well, you want to try chiropractic first? If that doesn’t work, then we do acupuncture. Now, like I said before, when I can treat the veteran with both acupuncture and chiropractic, I do very well that way. And this is the message that we have to get across to the VA officials. Okay. Next one. Now, um, uh, I’ve only had one case in the last nine years where the were, the veterans treatment was denied.
Um, we could not get it approved. We actually, there is a veteran’s appeal that I, that I have an appeal that I, that I can send you if you, if anybody needs it. But we mentioned that we had to do, we had to ask the veteran to contact his, uh, us house of representatives or us Senator upon con or contacting them is a scare was approved very quickly, but this is not a real big problem. Like I said, it only one case out of nine, but it’s there. So you know that you can always appeal. Like we always do. You know what I’m known for appealing adverse decisions. Okay. Next one now was very important in the notes too. Going back to the gnosis is to list the treatment goals. And these are mine. I really don’t need to read these, but in your notes too, you have to include that your treatment plans and food, lifestyle modifications, nutritional information, home treatment recommendations, and providing home exercises, make sure you document everything that you do. Um, it’s very important that they know that we’re trying to do everything we can to help these veterans because they have such complicated cases.
Now, my, my model is our, our model in the office has always been do what’s right for patients. Our veterans require everything we can to help them. They have so much pain and dysfunction for years. Just my opinion. If I can improve their pain and improve their function, increase the quality of life without prescription drugs, injections, or surgery. Then I think our treatments should be continued timely now, um, actual steps that we need to do, um, it’s, it’s very important because any meetings that I’ve had with veterans down the road is that, um, they don’t know then come see us. So what we can do right now is get on education bandwagon. And, and what you have to do is create an, a, um, information packet. I sent examples of mine to ChiroSecure. I’m sure a little sending them to anybody who needs them, but I really rely on effort, the foundation for chiropractic progress.
They have any information you can, you need, they have white papers, they have brochures, they have everything, and then they’ll do anything you ask for them. So all everybody needs to be a member of the foundation for chiropractic progress. But my, my attack plan or my action step plan should be, and these are what I have included. And I have copies I sent to FRCP, um, including the, for chiropractic progress, chiropractic care for veterans brochure, which I had some input with. Um, we created a veterans right to post their here in Canton that everybody can use. Um, we also have a chiropractic military benefit explanation sheet, which is one page, very simple. Uh, we include a pro chiropractic, uh, veteran military treatment effectiveness, cost savings, um, data sheet. Uh, I also recommend that DCS visit veteran facilities, such as American legions, veterans of foreign affairs and wounded warrior facilities.
And you need to provide this information to them. And the last thing we’d need to do is attend and provide, uh, F4CP chiropractic information at all. Veteran events goes real well and their information is top-notch. Okay. Last slide. Now, lastly, I just want to talk about three things real quickly currently. Um, we all need to support these three issues, uh, need to support the September, 2021 drug-free pain management awareness month. The foundation for chiropractic progress as a weekly marketing guide, which I have also sent that to Ford or, um, ChiroSecure as a weekly, um, description and, uh, about submitting brochures and information. So this, everybody can follow. Um, the second thing we should do is there in November and the support to November of 2021 military veteran care month, and again, the foundation for chiropractic progress as weekly marketing guide that you need to follow.
And lastly, we definitely need to request our legislators to support the, the, uh, increased patient access to chiropractic care bill, uh, HR 26 54. You need to ask the legislators to sponsor this bill. As you all know, Medicare is the basis for all insurances and mostly all our headaches that we have to deal with. If we can get Medicare to open up their, their benefit package and reimburse for what we do, it’ll definitely help our Medicare patients, but also help every, each one of our offices. But we cannot sit around and not do anything and just let everybody else do the work you need to contact the legislators. We have been, look, we were successful in getting Congressman Gonzalez to be a co-sponsor to this bill, which this should be done across the country. All right. So that completes my, my topic. I want to thank ChiroSecure for letting me share my experience with this. Um, so next week, uh, please join us and Mark Studin and will be the, will be the presenter. Y’all have a good day. Thank you.