The Secondary Insurance Plan
I have a patient that has Medicare, but also has a secondary insurance plan that does cover acupuncture. How do I bill Medicare to get a denial so that I may bill this secondary payer?
Why Take X-Rays When You Already Have an MRI?
Let's clear up the issue regarding the efficacy of plain-film studies when an MRI study has already been performed. I review imaging studies primarily for chiropractors, and often their patients have been to other health care providers before finding their way to a DC.
The Certified Practitioner
Certified Chinese herb practitioners often identify themselves with the credentials "LAc" (Licensed acupuncturist).
#TechPain: Causes, Solutions
For the past several decades, the science of ergonomics has blossomed. The workplace is much safer and life is generally more pleasant thanks to the application of ergonomic principles.
Does Dairy Cause Dampness?
The topic of dairy consumption was brought up at a scalp acupuncture seminar I recently attended.
The Classical Texts & Integrative Medicine
The acupuncture profession has been undergoing many changes in the past years. There has been a shift towards a more integrative approach to medicine as more hospitals include integrative departments.
The Hidden Hip in LBP: Critical Screening Tests
In 1998, Harvey used this test on 117 elite athletes and found excellent interrater reliability to differentially assess iliopsoas, quadriceps or TFL/ITB tightness.
Trending: CBD / Hemp Oil
A recent survey of DCs regarding cannabidiol (CBD) / hemp oil provides food for thought as to the viability of CBD-based products as a component of chiropractic patient care. Here are some observations from the executive summary of the survey:
"Community Care" for Vets: It's Really a Big Deal!
As a preamble, while I regrettably never served in the military, I have the highest respect for those who did and those who currently serve.
NCCAOM: A Route to National Certification
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) is offering a route to achieve national certification—without having to take any of the NCCAOM exams. This is specifically for California licensed acupuncturists that meet the eligibility requirements.
Autoimmunity, Gut Health and Diet: Connect the Dots
According to the National Institute of Health (NIH), autoimmune disease is recognized in approximately 24 million individuals in the U.S., consisting of more than 80 various disorders that contribute to the top 10 causes of death in female children and women of all age groups.
Vaccines & Autism (Part 1)
It turns out chronic inflammation is the driver of autism expression. Unfortunately, those who emotionally embrace the vaccine issue rarely, if ever, consider this relationship, which hinders a rational view of the vaccine issue.
UnitedHealthcare Can't Seem to Keep Chiropractic Down
AA decade ago, UnitedHealthcare announced changes to its chiropractic services policy that declared manipulative therapy for headache unproven.
Treating Pain With Nutrition
Back in 1910, when D.D. Palmer published The Chiropractor's Adjuster and introduced the world to what he called the "triad of health" – thoughts, trauma and toxins – he explained that the body can only be made optimally healthy if all three aspects of health are addressed.
Help Shape the New Neck Pain Best Practices Guideline
The Clinical Compass (originally the Council on Guidelines and Practice Parameters – CCGPP) has issued a call for interested chiropractic clinicians to help shape a new best practices guideline for chiropractic care of neck pain.
It's All About That Ki
As an industry are we shifting too much toward a Western mind set? We strive to understand how acupuncture works using imaging and extensive studies. We spend numerous hours of our training learning Western medicine and learning to speak their language. What happened to our core though?
Art of the Associateship: It's OK to Trust, But Verify
Trust is a valuable part of any business relationship. It serves as the foundation for all business operations and ultimately long-term success for owners, employees and customers. This is especially true in the world of health care.
Blockchain Health Records?
Keeping data secure has become a nightmare for the average consumer. Just consider general user account hacks on Yahoo (3 billion records compromised), eBay (145 million records compromised) and Facebook (87 million records compromised), to health record breaches involving Anthem Blue Cross (78 million records compromised) and TRICARE (almost 5 million records compromised).
A Resting of the Soul
In my pursuit of being a skilled health care provider, I focus on reading journals, attending classes, staying current on medicinal research, and choosing the correct billing codes. However, most of us would never have started down this career path if there wasn't something more.
CBD for Athletes: The Advantages of Cannibidiol
For athletes, pain is often part of their sport or activity. And to a certain extent, it is to be expected. However, after pushing themselves to the limit, soreness and fatigue set in, hampering their ability to perform and recover.
Reducing Hip, Knee & Shoulder Replacements (Part 2)
In the first article in this series, "Early Detection Reduces Hip, Knee, & Shoulder Replacements," I described time tested screening procedures and perspectives as indicators of when to encourage your patients to seek further medical evaluation.
End of Life Treatment
TCM looks death in the face. We do not camouflage it as if it were poisonous. "We must allow our patients to die but we cannot allow them to perish," was my first lesson the day I met my teacher as a teenager.
Why the Automatic Denials for Modifiers 25 and 59?
Your experience is one shared by many chiropractic providers who bill through those plans. It appears to be the national trend, but by far is more prominent in Texas and Illinois.
Valuable Adjunctive Therapies
Based on the latest CDC statistics, more than 795,000 Americans have strokes per year, 140,000 of which are lethal. Approximately 87 percent of all strokes are ischemic with an estimated health care and missed work cost of $34 billion annually.1
Confessions of a Former Drug Rep: Statins Are Endangering Your Overweight Patients
As I sit at my desk on the sixth anniversary of my successful liver transplant, I can't help but reflect on what caused that life-threatening ordeal. Looking back on my personal situation, I want to offer my insight into what is happening routinely to many patients.
Facebook Marketing 101
Many of the health care practitioners we work with have smaller practices. The provider tends to wear many hats – office manager, salesperson and healer.
News in Brief
WFC Among Founding Members of Global Rehab Alliance; HealthSource Selects GoChiroTV as Exclusive Digital Signage Partner; Western States' Online Degree Programs Among Best in the Nation; Logan University, University of Missouri-St. Louis Forge Partnership.
Doc, Are You a Social Media Holdout? Your Future Is Now
Whether you like it or not, to compete in any business, even chiropractic, you really should know and consider using social media. It is no longer a small, sleepy, local world we live in; it has become a far-reaching community.
A Bold Strategy to Take Chiropractic to New Heights
Building public awareness of an entire profession requires strategic planning – especially when it pertains to the exploration of ground-breaking marketing tactics that target new audiences with key messaging about the value of chiropractic care.
September, 2012, Vol. 12, Issue 09
Research Shows Acupressure Reduces Chronic Neck Pain
By Massage Therapy Foundation Contributor
Contributed By Derek R. Austin, MS, CMT, April Neufeld, BS, LMT, NCTMB, Sandra K. Anderson, BA, LMT, ABT
In this month's Massage Therapy Foundation Research Column, we are taking a critical look at the effects of acupressure.Widely accepted in Japan, many Americans are unaware of the many benefits of manual acupressure. It is a noninvasive technique in which, instead of needles, the practitioner's fingers press on traditional acupuncture points. Acupressure has been shown to be calming, relieve pain and induce relaxation.
Lead author Dr. Takako Matsubara, PT, an Associate Professor in the Department of Rehabilitation at Nihon Fukushi University, Japan, and his colleagues studied an area of interest to most massage therapists - chronic neck pain. Their research article, "Comparative Effects of Acupressure at Local and Distal Acupuncture Points on Pain Conditions and Autonomic Function in Females with Chronic Neck Pain" was published in the journal Evidence-Based Complementary and Alternative Medicine.
Matsubara and colleagues randomly allocated 33 female subjects (n=33) to three groups. Group one subjects received acupressure at three tender points consistent with local acupuncture points (LP) "Jianjing" (GB 21), "Jianwaishu" (SI 14), and "Jianzhongshu" (SI 15). These local acupuncture points align with tender points in the trapezius muscle with acupressure (see Figure 1). Group two subjects received acupressure at three distal acupuncture points (DP); in this study, distal meant points distal to the location of the neck pain. These points were "Hegu" (LI 4), "Shousanli" (LI 10), and "Quchi" (LI 11). These distal acupuncture points are traditionally associated with neck-shoulder-arm disorders in Chinese/Japanese traditional medicine (see Figure 2). A third group, termed the control, received no acupressure at all.
Subjects were assessed about pain intensity using a verbal rating scale (VRS); the intensity of neck pain or stiffness was evaluated on a numerical scale from 0 to 3 (0: no pain, 1: mild pain, 2: moderate pain, and 3: severe pain). Subjects were also assessed about pain-related disability using the Neck Disability Index (NDI), pain-related anxiety using State-Trait Anxiety Inventory-I (STAI-I), and about muscle hardness (MH) on bilateral trapezius muscles. Pain-associated stress was assessed using salivary alpha-amylase (sAA) activity and heart rate variability (HRV) to determine parasympathetic and sympathetic activity. Low electrical frequency fluctuations in heart are indicators of sympathetic and parasympathetic activity, and high electrical frequency fluctuations are indicators of parasympathetic activity.
Parasympathetic and sympathetic activity in the test subjects was measured because several previous reports showed that the effects of acupuncture and acupressure are due to influencing the autonomic nervous system. The acupressure treatment lasted about ten minutes per session. Three sets of acupressure were applied with thumb pressure in a rotary fashion at 20-25 cycles per minutes for 30 seconds on each of the three assigned local or distal points on the right side of the subject's body; the same procedure was followed on the left side. The same investigator applied acupressure in all cases.
There were no significant differences among the three groups pre-treatment. There were no measured changes in pain, stiffness or autonomic activity in the control group throughout the study. However, in the LP and DP groups, the VRS, STAI-I, and MH significantly decreased immediately following treatment, indicating a decrease in pain and stiffness. The next day, the NDI was significantly lower compared with pre-treatment in the LP and DP groups. The subjects' heart rates significantly decreased and high frequency component of HRV significantly increased, indicating a parasympathetic autonomic response, only in the LP group.
This study is notable for its use of both local and distal acupressure therapy. Both appear to be effective in relieving chronic neck pain in only a single ten minute session, with significant next-day effects on the NDI, a validated measure of pain-related disability. Interestingly, reduction in pain in the LP and DP groups as assessed by the VRS were not significantly different from the control group at the one day follow-up.
This study by Matsubara et al., is limited by the lack of longer term follow-up beyond one day, the small sample size of 11 participants per group, and the inherent inability to blind the practitioner and participants from knowing which treatment was administered or received. As a primary measurement of pain intensity, the authors could have used a 10-cm visual analog scale (VAS), which may have been more sensitive to differences between groups at the one-day follow-up. Also, the addition of a "sham acupressure" group would have helped rule out the possibility of placebo effects or effects stemming from touch, not acupressure per se. Finally, the sample used in this study only included women; men might respond differently to acupressure applied to the points used in this study.
In conclusion, acupressure to both local and distal acupuncture points significantly reduces chronic neck pain in this randomized, controlled trial. The researchers point out that most clinicians combine local and distal acupuncture points in clinical practice, and they suggest that further research should assess combinatorial effects. This Open Access journal article is freely available in PubMedCentral at www.ncbi.nlm.nih.gov/pmc/articles/PMC2952311/.
Author's Note: For additional research about accupressure, please see Robinson et al.'s 2011 Open Access review entitled, "The Evidence for Shiatsu: a systematic review of Shiatsu and acupressure" published in BMC Complementary & Alternative Medicine and available at www.biomedcentral.com.proxy.library.vcu.edu/1472-6882/11/88.
Editor's note: For more information about massage therapy research, visit the Massage Therapy Foundation at www.massagetherapyfoundation.org.
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