Chiropractors Affected By COVID, 2019 Opioid Overdoses, Insurance Compensation For Chiropractic

CF 139: Chiropractors Affected By COVID, 2019 Opioid Overdoses, Insurance Compensation For Chiropractic
Today we’re going to talk about Chiropractors Affected By COVID, 2019 Opioid Overdoses, Insurance Compensation For Chiropractic
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. 
We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.
I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  
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Chiropractic’s Effect On Strength and More, Status of Muscle Relaxers, And The Best Recovery Posture

 
You have found yourself smack dab in the middle of Episode #139
Now if you missed last week’s episode , we talked about NSAIDs, cognitive behavioral therapy and vitalists ignoring stuff. Make sure you don’t miss that info. Keep up with the class. 
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points. 
Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper. 
On the personal end of things…..
Personal means personal right? Well, I’m still working on getting the whole voice-over gig set up and rocking and rolling. What’s voice over you may ask? Well, the voices you hear on commercials, eLearning, promos, radio bumpers, and even cartoons and stuff like that. That’s voice overwork. 
Here’s my thought and I’ve said it here before; I don’t want to die in my office working on people when I’m 80. God bless those of you that love the daily grind so much that that’s your goal. It takes all sorts, doesn’t it? But that’s not me. I want to hire an associate and mentor them over the course of a certain amount of time and then sell my practice to them eventually. 
I’m a musician/singer/songwriter. I’m a sculptor. A portrait artist, furniture builder, and all kinds of other things. I love to travel as well. So, what kind of work could I do that would allow me some retirement income and can be done literally from anywhere in the world with an internet connection? Voice over of course. So, I started working on it once the Rona showed up. I’m taking some classes and building some skills and equipment and knowledge. 
The thought process is, if I start now, in 5 years it may be a very viable way to add to my weekly income in retirement. I have other things I’m looking at as well but this is the one I’m knee-deep in right now. 
I have friends that tell me they only get 24 hours in a day and I get more like 48. Lol. That’s not true of course but I do keep moving, keep thinking, keep working pretty much non-stop and move from one thing to another fairly quickly trying to multi-task and get it all done on some sort of time scale. 
I adhere to an old saying I try to always remember; time is just time. You’re either investing in it or you’re wasting it. I don’t like to waste time all that much. There’s always time to sit and relax here and there but, in general, I’m not much for wasting it. 
As far as business, we’re marketing like crazy. I’ve put more into marketing in the last 3 months than I have in the last three years and guess what…..80%. We’re still at about 80% of where I was and like I said last week, that’s my new normal and I’m done making myself crazy about it. I’ll take this extra time and I’ll continue to invest in it. 
So I’m anxious to see what happens. I have things working inside chiropractic. I have things working outside chiropractic. Let’s see which mud sticks to the wall. If any of it sticks at all, right? We never know but it’s exciting to be productive. It’s exciting to be creative. And it’s exciting to have the prospect of more income and more options as to your future. 
That’s where I’m at right now. I just turned 48. I  have less time in front than behind. I’m not getting younger so it’s time to step on the gas. And that’s what I’m doing. This pandemic crap isn’t going to last forever and I plan on sitting pretty in time to retire so let’s just get started right now shall we?
Item #1
Speaking of ‘pandemic crap’, here’s a paper called “The impact of COVID-19 on the chiropractic profession: a cross-sectional survey on opinions, professional changes, and personal hardships of US chiropractors” by Neff et. al(Neff S 2020). published in Chiropractic and Manual Therapies posted on 15 of July 2020 and dammit if that’s not hot then I don’t know what is, people. 
Now, before I get going on this one, I recognize three of the authors’ names from the Forward Thinking Chiropractic Alliance group on Facebook. Once again, if you’re considering yourself an evidence-based, patient-centered chiropractor rather than a vitalist, get in that group. You can learn a ton. Anyway, Shawn Neff, Rebecca Deyo who I’ve mentioned on this show before, and Annabelle MacAuley. All very smart, very talented doctors of chiropractic. 
Why They Did It
The research was conducted to collect self-reported data on how COVID-19 has affected U.S. doctors of chiropractic. I’m glad someone is paying attention to us and all. Honestly, chiropractors get the fat end of the bat don’t we? Who got PPE delivered to your office by the state back in April?
Yeah, me either. Anyway……
How They Did It
An electronic survey was sent to U.S. chiropractors nationwide via social media and email. 
The survey collected 
personal and practice demographic information, 
office protocols, 
changes made during COVID-19, 
chiropractic profession opinions/stances, 
information related to stress, and 
personal beliefs/opinions.
Data were analyzed using descriptive statistics.
What They Found
750 U.S. chiropractors responded. 
Just over half of respondents reported moderate levels of stress, and 
Just over 30% reported severe levels due to a variety of reasons related to both personal and professional circumstances. 
The primary stressors were financial and business concerns. 
The highest stress levels were among employers responsible for others. 
A majority reported beliefs that the chiropractic profession should not advertise that spinal manipulation provides any immune system benefit. 
13% of the respondents believed chiropractors should be marketing immune benefits during this time. 
A shift toward telehealth was reported, with 18% adding it to their services.
Wrap It Up
“Stress levels were high across the population. A range of opinions existed regarding spinal manipulation and immunity benefits. The majority reported there was not sufficient evidence to support such a belief; however, a group of respondents believed that chiropractors should be marketing immune-enhancing benefits to the population. A logical next step would be to study why such beliefs persist. This information may be useful in better understanding how chiropractors have experienced the global effects of COVID-19 across the United States.”
Adjusting Disc Herniations and Bulges

 
So…..if you want to know how many are vitalists and how many are evidence-based or, at minimum….agnostic….then doesn’t this give us some hints? A vitalist would claim to take the pressure off of nerves allowing the innate life force to better express itself rendering you immune to the disease. That sounds like about 13% of chiropractors surveyed. 
That tells me 87% call shenanigans on the rest of it. It’s been a while since I heard a number. We know its the minority but damnit they’re a loud minority, aren’t they? They’ve kept us right here without cultural authority for over 100 years at this point. 87% is pretty high though. Maybe it’s changing. 
I saw another recent survey where only a very small percentage of chiropractors were interested in learning more about chiropractic philosophy. I think it’s fine as a historical thing. Just not as something that keeps controlling our profession and keeps us at the bottom of the barrel. 
Love me or hate me, at least I’m honest and you know where I stand. 
Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. I love new toys! If you’re into soft tissue work, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend.
Getting Patients Returning, Shoulder Impingement, Cervical Manipulation, & X-rays and Neurodegenerative Disease

 
Drop Release uses fast stretch to stimulate the Golgi Tendon Organ reflex.  Which causes instant and dramatic muscle relaxation and can restore full ROM to restricted joints like shoulders and hips in seconds.  
Picture a T bar with a built-in drop piece.  This greatly reduces the time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day.  Drop Release is like nothing else out there, and you almost gotta see it to understand, so check out the videos on the website.
It’s inventor, Dr. Chris Howson, from the great state of North Dakota, is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase.
Go check Drop Release at droprelease.com and tell Dr. Howson I sent you.
Item #2
This second one is a report from CNN on opioids called “Drug overdose deaths jump in 2019 to nearly 71,000, a record high, CDC says” by Shelby Lin Erdman on July 16, 2020(Erdman 2020). Hot stuff….come on now. Make way people!
This was an article so we’ll be like a boat on the lake and just skip across the high spots. How about that?
Drug overdose deaths in the US jumped last year by about 4.8%. 
2018 was slightly down from 2017
2019 bumped back up to 71,000 overdose deaths. 
The former president of the American Medical Association, Dr. Patrice Harris, said the numbers show why it’s important to remove any obstacles to treatment for those addicted to drugs. While I think that’s worthy, I think it’s important to not that there should be no obstacles in place to see alternative practitioners in the first place when some of these folks presented with pain. The White House report in 2016 and The Lancet report on back pain both agreed there are obstacles in place preventing these kinds of patients from seeing chiropractors. 
Item #3
This one is called “Trends in Insurance Coverage for Complementary Health Care Services” by Whedon et. al(Whedon JM 2020). published in the Journal of Alternative and Complementary Medicine on July 7, 2020. The roof, the roof…it’s on fire. 
Why They Did It
Complementary health care professionals deliver a substantial component of clinical services in the United States, but insurance coverage for many such services may be inadequate. The objective of this project was to follow up on an earlier single-year study with an evaluation of trends in reimbursement for complementary health care services over a 7-year period.
How They Did It
The authors employed a retrospective serial cross-sectional design to analyze health insurance claims for services provided by licensed acupuncturists, chiropractors, and naturopaths in New Hampshire (NH) from 2011 to 2017. 
They restricted the analyses to claims in nonemergent outpatient settings for Current Procedural Terminology code 99213, which is one of the most commonly used clinical procedure codes across all specialties. 
They evaluated by year the likelihood of reimbursement, as compared with primary care physicians as the gold standard. 
What They Found
The total number of clinical services claimed was 
26,725 for acupuncture, 
8317 for naturopathic medicine, 
2,539,144 for chiropractic, and 
1,860,271 for primary care. 
Initially, the likelihood of reimbursement for naturopathic physicians was higher relative to primary care physicians but was lower from 2014 onward. 
Odds of reimbursement for both acupuncture and chiropractic claims remained lower throughout the study period. 
In 2017, as compared with primary care the likelihood of reimbursement was 
77% lower for acupuncturists, 
72% lower for chiropractors, and 
64% lower for naturopaths.
Wrap It Up
“The likelihood of reimbursement for complementary health care services is significantly lower than that for primary care physicians in NH. Lack of insurance coverage may result in reduced patient access to such services.”
So when we talk about barriers to seeing safer, non-invasive practitioners, don’t tell me there are none. Don’t piss on my leg and tell me it’s raining. 
What was the Tommy Boy reference? You can get a good look at a t-bone by sticking your head up a bull’s ass but wouldn’t you rather take the butcher’s word for it? Or no…..it’s gotta be YOUR bull. Lol. Great movie. 
Anyway….buncha hullabaloo. Research and surveys are so clear and mostly consistent when they say spinal pain is so bad yet chiropractic is so good at treating it. Not only in terms of effectiveness but also in terms of patient satisfaction and even long term outcomes when compared to traditional treatment. The damn White House report a few years ago said there are barriers. The Lancet said it. I’ve seen it other places that aren’t coming to mind but it’s clear there are barriers in place set up by the stakeholders, the insurance gurus, the medical professionals….. All go 180 degrees from what the research tells them to do. 
And they keep going that way. It feels like it’s not turning around. At all. So…..shenanigans. I’m calling shenanigans. 
Alright, that’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week. 
Key Takeaways
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The Message
I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few.
It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient.
And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health!
Key Point:
At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….
That’s Chiropractic!
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We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
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About the Author & Host
Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
 
Bibliography
Erdman, S. L. (2020) “Drug overdose deaths jump in 2019 to nearly 71,000, a record high, CDC says.” CNN.
Neff S, D. R., MacAuley A, Lawrence D, (2020). “The impact of COVID-19 on the chiropractic profession: a cross-sectional survey on opinions, professional changes, and personal hardships of U.S. chiropractors.” BMC Chiro Man Ther.
Whedon JM, e. a. (2020). “Trends in Insurance coverage for Complementary Health Care Services.” J Altern Complement Med.
 
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