Blog, Chirosecure Live Event December 30, 2020

Veterans Can Request Evidence-Based, Non-Pharmaceutical Chiropractic Treatment

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Hello. I am. My name is Judson Sprandel. The second I am an Ohio chiropractic physician. I’ve been in practice for 38 years. I want to thank ChiroSecure for inviting me on the show and to discuss my experience in treating veterans for the past eight years. My talk today is I have four important points to cover. Today is number one is DCS need to be certified through the Optum TPA. Uh, the department of veteran affairs. Number two is veterans need to be certified and credentialed through the VA to receive chiropractic or acupuncture treatment. The third issue is that veterans need to know that they have the right to seek chiropractic or acupuncture treatment. And the fourth issue we’ll talk about today is DC documentation for the veterans. So let’s go to the PowerPoint now. Um, veterans can seek evidence-based non chiropractic, uh, non-pharmaceutical chiropractic treatment in the community, right?

This is what the discussion will be today. All right. My information is able to, based upon our experience with treating veterans for the past eight years question, first question we’ll cover is does the VA provide coverage for chiropractic treatment acupuncture? Well, the answer is yes, this started in 2002, uh, public law, one Oh seven dash one 35, ensured that chiropractic would be coming permanent benefit for reciprocate. And so for veterans health care services, and as a result of this, of this law chiropractic care was gradually added to more than 30, um, VA medical centers. The issue that we have here is that nobody knew that this happened. I didn’t know this happened either. Okay. What was pretty great until in 2018, I’m a director was established by the VA. It was called 12, 10 chiropractic care. And this is actually written in the, um, website for the VA.

And it States that chiropractic care is included in the medical benefits package, the standard health benefit plan, um, plan general, available to enroll veterans. And actually this wording actually is listed within the website and it says, and it says within the VA website, the chiropractic care is included in the VA joint commission pain management standards. The evidence shows that patients received chiropractic care are less likely to use other health care services that are more costly and ready to risk such as opioid medications, spinal imaging, and injections and elective spinal surgeries. And it States that, um, patients receiving chiropractic care have lower healthcare costs of four episodes of non operative spine related disorders. So these, this, uh, documentation is throughout the country. I mean, this is just not localized in Ohio. I mean, it shouldn’t be across the country again, I don’t think many of our little, our DC colleagues know that fact.

Okay. Um, one problem that we have across the country, including here in Ohio is veterans do not know they have the right to choose now, or they even have a benefit coverage for non-pharmaceutical chiropractic care or acupuncture. So what should be done basically local action steps are needed. Um, these, these who treat veterans should have the foundation for chiropractic services and for graphs and articles readily available to distribute to patients in the office and on social media, the foundation for chiropractic progress, the information is just top notch. Um, it’s, um, very easily to the could under social media. And it’s really great to get patients.

I am attaching, uh, I have, uh, examples of the foundation for comprehensive progress into grams and brochures. Um, and these we’ll we’ll over here briefly. Um, the two brochures are chiropractic care for veterans and the chiropractic for the veterans. The programs include caring for veterans, our military combating the opioid epidemic chiropractic on the frontline for veterans and the opiod white paper. The other programs that they have that, uh, deals with the veterans is veterans with chronic pain veterans, opioid related overdoses veterans with lower back pain chiropractic care for veterans, veterans and back pain and finding relief after battle. These are the Instagrams that I found through the foundation of chiropractic progress that deal with veterans. So, um, examples of what they look like or are attached here, they are just very top notch, very well done. And what I’ve done is I’ve sent copies of all of these different graphs to ChiroSecure.

And after the, after the show, if you need to get the copies of these, of these info graphs, then contact Aerosphere, they’ll send them to you or better yet. Hopefully you’re all members of the foundation for chiropractic progress. They have these either there’s many more than just veteran info, grams and brochures. Um, all you have to do is hit the print materials and you can find these on their website and they’re easily downloaded for your office or, um, on social media. The next, the next example, um, that I have is a brochure. It’s a one-page brochure talks about chiropractic care and treating veterans. And also it talks about that 12, 10 chiropractic, um, uh, directive. Yeah. As you can see, they’re very well done. And again, you can get these through being a member of FRCP or join FRCP, or you can contact ChiroSecure, and they’ll send you copies of these, um, great tools to use as education pieces.

Now, the foundation with comprehensive progress has an awesome white paper regarding veterans. It is, um, it is titled the future of wellness. How chiropractic care is helping to improve the line, the lives of veterans. There are many topics before discussing the minutes, but this white paper you can use in office as an educational piece. So you can, um, take it to any type of meetings or you can talk to politicians. This is very well done. And the paper talks about all, all the pro um, positive effects of the chiropractic profession can provide for our veterans. Now, th this paper includes statements such as nearly 20% of Americans suffer from chronic pain, including 65% of veterans chiropractic care is on the rise and is making a difference, especially with our veterans. Other additional topics include that it States that the VA and government agencies are recognizing the chiropractic care as a safe and drug-free solution for veterans to manage pain.

Veterans suffer from chronic pain at a much higher rate than the general public. More and more studies performed by the VA and other military health officials regarding chronic pain. The veterans are finding that a chiropractic care path shouldn’t be pursued earlier and more often Elvia with that statement, uh, additional information that States that chiropractic care has a role to play in decreasing opioid use and abuse research has shown that the percentage of veterans receiving opioid prescriptions was lower, and those who have received chiropractic care Nelia for this, this paper is referenced. There’s many references on, on the, on the back page. It’s a very good article to, uh, paper to send to the printer and print them up and then put them in your office or send them it on a social media or, or just to take with you to meetings. Um, FRCP has the tools for us to educate our veterans.

I don’t want to lay there.

Okay, so we needed some local action or a local DC action steps are necessary. And, um, as part of it educating our veterans, what you need to do is you locate in the military VA sensors, such as the veterans of foreign oars, wounded warrior facilities, American Legion, or others in your local area upon doing this, you will want to request a meeting or an opportunity to inform the attendees that the veterans have chiropractic acupuncture benefit package. Now these facilities have a commander, um, and I did contact the American Legion. They were very open arms to our information. Um, I had a meeting with the commander, but very well, he accepted all RF or CP information, but the key here is I didn’t go into the American Legion as an individual doc. I went in there as a representative of my local chiropractic district, which I represent five counties in Ohio.

Um, that seemed to work very well. Cause that was not saying, come send all your veterans to me. I was, I was, I told them that they should be sent to chiropractors or located closer to the veterans and what we use. We have a local website that I instructed them to contact the website and find that DC closer to them. Now what we prior to this meeting, and we created a veteran facilities information packet. Now I sent this packet to Carol secure, and if anybody needs it, they can, they can, uh, contact Kairos here or contact me and I can send it to you. But the, the information packet is a description of chiropractic benefit. It has a veterans poster. We have several brochures that use from the foundation for chiropractic progress. Um, and what the American Legion did for us is that they put the information on a closed circuit TV.

So during, during when their lunch and dinner, and in fact, tails, this, this art, this program, um, was, was gone the whole day. So, but still there’s definitely needs more work to do, to do on this issue. Okay. I also have a few questions where I don’t have answers for, um, the, and these we’ll all have to work on maybe for the next show, but, um, if you pull up the VA website, the chiropractic acupuncture benefit, it’s not easily seen. Um, you click the health, healthcare benefits. There’s, there’s a whole list of benefits, but we’re not listing the only way the veteran can find us if they go into the search mode and type in chiropractic or acupuncture, and then the information we’ll, um, we’ll come, we’ll come out for them, but they don’t, again, they don’t know. So, I mean, I sent a request to get this changed.

Um, it wasn’t done, so we’re going to have to do it again. So I think that our benefit of chiropractic care and acupuncture should be listed right underneath the weight with all the other benefits. Um, it’s a step in the right direction if they, if they do this now, addressing what veterans seeking chiropractic care, the first thing they have to do, they have to be certified through the VA. Um, so attain coverage, once they’re certified through the VA, the veteran, either requests chiropractic care or acupuncture, or ask their primary care physician or their pain management physician to go to a chiropractor. And I tell you most of the time, the primary care physician and the in pain management physician will agree. Uh, I’ve only had one case where there had a problem and we were able to fix that problem. So once everything is certified and the veteran, um, request the care and, um, is an, and, um, obtains the consultation labs. And once it gets to the, once they get the approval after the consultation, okay, the VA facility will then call and fax the authorization to our office with, for the treatment request that was agreed upon by the primary care or the pain management, the authorization will list the number of treatments approved and provide copies of the medical records, which includes diagnostic testing and we’ll list the VA diagnosis.

Now, another question I have, which I don’t know if I have the right answer for this, does the veteran had the right to choose his or her physician physician physician type? Um, I would say the answer would be, yes. However, I was a veteran who was instructed that they could not go to their community chiropractor. They had to go to the, to the, um, the, the C’s that were on staff. Um, so that veteran did not consultant community Cairo, but I S I instructed that chiropractor that if the veteran has to wait more than 30 days, then, um, to see the staff chiropractor, then that veteran can go to a community chiropractor. Okay. Some of the criteria for the VA is kind of hard to get through. I used to, okay, now there is a proximity requirement for our VA veterans to consult a community chiropractic physician is 40 miles. Usually they say that if your veteran is more than 40 miles away, that they can consult a local chiropractor. Well, that’s really not etched in stone. If I think if the veteran can request an individual chiropractor and usually those requests that are authorized, but again, this is another issue that’s kind of up in the air. All right.

Now, um, regarding active duty military personnel or ADM piggies, they do have access to chiropractic and acupuncture at various military facilities. My question is the, that this rights should be extended to all of us, military facilities. Don’t you agree? Um, my question I have for the VA too, is will our active duty personnel have the right to seek chiropractic care in the community, or whether the families have the right to seek us in the community. Now, the active duty military personnel have an insurance company called Tri-Care. Now Tri-Care has made a statement that they were going to improve their benefit packages for chiropractic care in 2020 and 2021. Obviously that didn’t happen. Um, hopefully in 2021, this, this occurs.

I sure hope that there’s a timeline again, this, with this issue, but, uh, we’ll, we’re going to have to follow through with this and see what happens now. Um, another issue in our talking points is, is there a DC credentialing requirement through the BA with the third-party administrator Optum? And of course the answer is yes, have the certification process outlined in the next couple of slides, but Optum is the current third-party payer administrator that used to be tri West. Uh, they discontinue the use of, of, uh, tri West in 2019, or starting up 2020. Um, Optum is now in charge of, uh, third party administration of chiropractic care for the VA. So what a DC needs to do, they need to visit the optimum VA community care network. There’s a link there I put for you that to, um, click on the

One second.

Uh, the certification process is not smooth by all means our, so our certificate creation process took four months. We started in January of 2020, and we didn’t get approved until may of 2020. Uh, this is not a smooth process. Uh, you have to be patient and you have to be persistent. We consistently checked on the status. We can sit with consistent or checked on the status. Um, and finally we were authorized to may of 2020. So this is not a smooth process, but before you be persistent, if you want to treat veterans, the only way you can treat a veteran is to be certified through Optum. Now, again, the certification process, you click the link, you click the provider button, then click the button that says, join the network PDF. And then you click the join, the VA community care network link, and then follow the instructions. This is pretty straightforward once you get into the Optum website,


So another question, what chiropractic procedures and treatments does lopped them cover well covered chiropractic procedures and treatments. It is my understanding that there are Washington DC recommended chiropractic and acupuncture treatment plans. I don’t know who established these, but we have to, we have to work within their parameters. The number of authorized treatments varies the number and duration, however, per my experience, um, the treatment frequency recommendations are based upon the primary care physician and or the pain management, um, rehabilitation MDs consultation. Now, when you received the authorization by fax, um, usually the initial chiropractic authorization is for 12 chiropractic treatments, uh, within the fax with a negative period within the facts. There are codes that they would cover. They cover most of our bar examination, manipulation codes and therapy codes. Okay. Now additional care is, is, uh, approved. And usually the second chiropractic authorization is eight, six chiropractic business. Over 30 days in the third authorization is in chiropractic visits over 180 days. Uh, these treatment plans I would think will, will change frequently. Um, I don’t, like I said, I don’t know who is to have a season. We’ll have to watch, we’ll see what happens, but, um, we’ll get into the asking for additional care here in a minute.

Now, um, they will send a observation rank of puncture to, and usually, and they, the initial acupuncture authorization is for 12 treatments over 45 days, they list the codes at the cover and notice that there is no manipulation codes. This becomes a problem for the chiropractic physician who is also certified to do acupuncture. Um, we’ve had discussions with the VA before, and it appears that they have one, one way of approving the chiropractic care and the other, another way of doing the, um, acupuncture care. Um, I’m both, I’m certified to do the, um, acupuncture in addition to chiropractic. And I do very well by treating the veteran with both. Um, this has to be an educational process. Um, the VA sometimes will tell a veteran, well, we want to try chiropractic first, if it doesn’t work, and then we’ll do acupuncture that doesn’t really work well with me. If I can do both, I do a lot better. So we’ll see how this goes, but so let’s go to the next one. So what black mutation does it be able to acquire?


The initial report is a recommendation that I have, and it should be submitted after the initial evaluation within that first week. It’s very important for the VA to receive the initial report because the initial report outlines the initial visit. Once the initial visit is, um, registered through the BA the claim was called open, which means is now the claim is open and they’re going to start the process over reimbursing reimbursement. So, um, it’s very important that this goes out to them and the initial evaluation has to be then, well, we can’t, we can’t provide poor documentation. Okay. Your notes have to be awesome. You know, we can’t, we can’t give them chicken scratch. I’ve seen several, several examples of office notes, especially, you know, how it we’re comp where our colleagues are not doing real well with these documentation. Um, the VA does request your office notes.

We send them, we send them timely. Uh, in my office, I use a diary and speaking, and my notes are done within 24 hours of the completion of the visit. Um, it, my notes are easily read. We have no problems with sending the notes and they’re been pretty happy with us. Um, update and progress reports need to be completed with emphasis on how well the veteran is doing. And again, DCS cannot send in poor documentation, but the office notes is so important for the veteran to Al or for you to outline the improvement. And it’s so important for the veteran to tell them that they’re improved. So how do we document improvements? Well, it’s very simple. It’s, uh, your, your pain scales, your Oswestry disabilities, or just statements will now the patient can stand. Um, he couldn’t even help his wife do the dishes. Now he’s able to stay in because of the numbness in his legs is gone due to your treatment plan. Um, this is definitely documentation that they need to hear no more. They see good notes and improvements with our care, the more we’ll be accepted. And maybe we gets rid of some of these headaches that we have to deal with. Now, additional visits, exceeding the recommended treatment plans can be authorized, but additional treatment requests will be based on the documentation. And as I said before, documentation of the veteran’s improvement and the office notes, and also the ability of the veteran to communicate that the chiropractic interactive puncture treatment, um, is beneficial.

These are the criteria that’s necessary to obtain approval for your additional authorizations. The, um, veterans cases are definitely complicated. They are not simple sprain strain injuries. Most veterans have trouble with year, for years. Uh, their rate of improvement with our care is definitely slow, but it does. We do get great results with these veterans, but as, as a veterans complicated case, they had one veteran who said in 19 surgeries, we had four failed back surgeries at nine surgery on his hands. And one veteran, he was taking 32 pills a day for 10 years. Another veteran, he was taking 35 pills for year after year. So they are definitely complicated cases. They are not easily treat, but, um, our veterans need this re re need our care, and we can definitely get them off the drugs and stuff that they’ve been relying upon for years and years and years now on your ELBs, you must have the VA that diagnosis listed on the appropriate section do not include any other diagnosis. Um, I document my diagnosis with the veteran’s condition in the assessment of my initial report. So because sometimes the authorized diagnosis is pain. It is a non-specific thing. I mean, they’re very, some of the diagnoses are very generic and not specific, but you still have to use those in your, in your documentation. That’s why you put, if I think it’s a disc or sciatica or brachial syndrome or any type of thing, those are all listed in my report minus the report.

Okay. Now what we’ve recently found is that, um, send you a new initial report. We were sending the office case notes as we, as we completed the business, but the local VA said they wanted the whole block over. And that’s when, when the treatment plan is coming to an end. So what we have done now, instead of sending the notes on a very frequent basis, once the we’re getting close to the end of our treatment periods, say it’s 12 visits. Once we get to like a lab visit or sending all the notes, and that seems to work with them, um, it is important to have communication with, with the, um, the VA facility that is sending patients to you. The more you work with them to make, the more we make it easier for them, the better it is for us. And most importantly, better for the veteran.

So when you’re billing the manipulation codes, you want to use the 18 modifier. And when you’re billing physical therapy codes, you want to use the GP modifier, right? And as I said, additional care is necessary. Um, and they, most veterans do need additional care. Um, sometimes initial authorizations are for six visits, which doesn’t make much sense to me, but, but once the improvement is, is received or at once the veteran receives improvement, my discussion with the veteran is contact the primary care and tell them that you’re better and tell them you’re getting better. And you want additional care. That is the major. And that was a major plus to get additional care. All right.

But, um, additional care is a real problem for us because they need additional care. And the authorization of care can take months, which does hurt the, the veterans, um, treatment progress. Um, there was definitely frustration for the veterans when you request additional care, did a long delay of authorization. Uh, there are cases where in the veteran has been told that they use up all their visits in the, and they cannot ask for additional care. Uh, and one case where he, uh, he was a Vietnam vet. I treated him up on four occasions and his pain level went from eight to a one. Pretty awesome. Now that doesn’t happen to me all the time, but it does. It was pretty awesome. And you had an appointment with a primary, with a pain management and then pain management physician stated that, well, you had, you have 12, that’s all, you’re going to get any additional care you’re going to pay out of pocket. So they come in as a judge, I guess, don’t have to pay after they get done with this block of business. I said, no, we’ll file the appeal. We’ll ask you to ask for more. And they were successful in doing that.

I feel that once the veteran improves with our treatment plan are, then that plan should be authorized. It’s all about doing what’s right for the veterans. Okay. Um, again, the additional treatment recommendations are dependent upon veteran improvement with, with our care. So our solutions now, the solution we have is basically education. We need a consistent education pro uh, campaign, uh, which is I rely upon the foundation for chiropractic progress. They have all the tools we need to document the benefits and cost effectiveness of what we do. Uh, everybody should be a member for CP or a foundation for chiropractic progress. I don’t know why anybody would not be a member of them. Um, it’s very easy to, to use their tools. I think the only way we’re going to be successful in obtaining or getting more veterans to come into our offices is to initiate a grassroots effort across the country.

I mean, if we can get every veteran to, um, submit the information, or if we get every DC, I’m sorry. If they get to submit the veteran information on the grassroots effort, it’ll, it’ll, uh, um, increase access for all of us. Now, the solution not only in the veteran arena are also in our, in our third party or in our insurance arenas is that these third-party payers such as Tri-Care Medicare and Medicaid must acknowledge that restricting and or providing zero coverage for what we do feels the opioid drug reliance, drug addiction effects of the opioid epidemic.

The third-party payers have been told, or there are at least five or six national guidelines out there saying that that, um, insurance benefits should be expanded to non-pharmaceutical chiropractic treatment acupuncture, however, nobody’s listening. So this is an issue that we have to address. If we can get the third-party payers to open up the doors for what we do, um, it’ll help our veterans as well as all, as well as all our patients. Well, all right. That concludes my presentation. I want to thank ChiroSecure for allowing me to, to, um, outline the experience that I have with veterans. They are, um, uh, most deserving group of people. Um, and I do whatever I can to help them. Um, uh, if you have any questions, you can submit it to Carol secure and I can, uh, I’ll answer them to you next week. We have Yvette Nicole, she’s going to be on our show on next Tuesday. Uh, please, um, click into her. She’s got awesome information for us all to you. So anyway, um, everybody have a good happy new year. Hopefully 2021 is a lot better than 2020, and I’m signed up for additional shows next year. So we’ll talk more about the veterans. Thank you very much for your time.

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