March 2002 Issue

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In this issue:

• US Medicare Blocks Physical Therapists from Performing Chiropractic Adjustments
• Home Births Safe for Most
• Nurses Give Chiropractic High Marks
• Patients Urged to Guard Against Medical Errors
• College Football Team Benefits With Chiropractic
• Survey Says Parents Overtreat Harmless Fevers in Kids
• Insurance Coverage Increases Usage of Chiropractic Care

US Medicare Blocks Physical Therapists from Performing Chiropractic Adjustments

The U.S. Department of Health and Human Services issued a letter dated January 15, 2002 which was a reversal from their previous position dating back to December 14, 1994 that had allowed Physical Therapists (PTs) to perform chiropractic services under the US Medicare law.  With the new ruling, PT's are not allowed to do chiropractic procedures under Medicare.

In actuality there was never an abundance of PTs performing chiropractic adjustments.  But the ruling as it previously was in the past allowed certain HMOs and insurance companies to exclude Doctors of Chiropractic from their provider lists because they claimed they were offering required chiropractic services when needed through their Physical Therapists.  With this new letter and ruling, all Medicare insurance companies and HMO's will not be able to use PT's as an excuse not to have chiropractors on their provider lists.

The chiropractic profession has been fighting this problem for years with both legislation and an ongoing lawsuit.  This ruling does not completely fix the problems but it is viewed by most as a good first step toward protecting the public and making chiropractic care available to Medicare beneficiaries without undue harassment. 

The letter itself stated: "Section 1861(r) of the Social Security Act provides the definition of a physician for Medicare coverages purposes, which includes a chiropractor for treatment of manual manipulation of the spine to correct a subluxation. (As a  standard Medicare Part B benefit, manual manipulation of the spine to correct subluxations must be made available to enrollees in all Medicare + Choice plans)  The statute specifically references manual manipulation of the spine to correct a subluxation as a physician service. Thus, Medicare + Choice organizations must use physicians, which include chiropractors, to perform this service. They may not use non-physician physical therapists for manual manipulation of the spine to correct a subluxation." 

Home Births Safe for Most

The above headline is from Feb. 6, 2002 online Web MD.  Web MD was reporting on a February 5, 2002 study published in the Canadian Medical Association Journal.  In this study researchers compared the outcomes of 862 planned home births attended by midwives with those of planned hospital births attended by either midwives (571) or physicians (743) during the years 1998 and 1999. 

The results of the study showed that women who gave birth at home attended by a midwife had fewer procedures during labor compared with women who gave birth in a hospital attended by a physician. The study also suggests that home births have a lower incidence of infection and use of drugs for pain.  Additionally, women in the home birth group were less likely to have epidural analgesia, have their labor induced, or have an episiotomy.

In as far as the overall safety of home births, the researchers concluded that the infant mortality rate was similar to that found in other studies and the difference in the mortality rate between the two groups was too small to be statistically important.  The conclusions of the researchers as published in the journal were as follows: "Interpretation: There was no increased maternal or neonatal risk associated with planned home birth under the care of a regulated midwife. The rates of some adverse outcomes were too low for us to draw statistical comparisons, and ongoing evaluation of home birth is warranted. There was no increased maternal or neonatal risk associated with planned home birth under the care of a regulated midwife," the authors wrote.

In a commentary article in the same issue, Régis Blais, MD, from the Université de Montréal, agrees that this "study provides valuable information about the safety of home birth that should help expectant parents make their choice of place of birth and caregiver." 

Nurses Give Chiropractic High Marks

A survey of 1000-nurses showed that even though they consider themselves poorly trained in non-medical care, they gave chiropractic high marks.  The survey was published in the June 2001 issue of the Journal of Community Health.  The survey asked a variety of questions on a number of health care procedures termed by the study as "Complementary Alternative Medicine" (CAM). Chiropractic was included in this survey and received some of the best reviews from the nurses surveyed.

The Journal article starts by stating, "In 1997, 42-percent of the American adult population made 62-million visits to alternative health care practitioners and spent $27-billion out-of-pocket for these services.  It has been estimated that in the year 2000, Americans will spend $60-billion on complementary and alternative medical therapies."  The Journal uses these figures as a basis for wanting to understand how the nurses view these types of procedures.  

The survey to the nurses covered areas including, perceived effectiveness; perceived safety; recommendations made to friends, clients and associates; and personal use.  An interesting finding of the study was that the nurses felt that they themselves were poorly trained in understanding CAM procedures as only 21% of the respondents considered themselves to have received "good" or "excellent" professional preparation in dealing with these types of care, which include chiropractic.  Conversely, the vast majority (79%) of nurses perceived their professional preparation in the area of alternative and complementary medical therapies to be fair or poor.

In the area of effectiveness, the nurses ranked chiropractic first, in a tie with biofeedback. They overwhelmingly rejected the idea that chiropractic or the other CAM procedures were only effective because of the placebo effect.  According to the nurses chiropractic ranked second in safety behind hypnotherapy.  

The study also showed that approximately 14% of the nurses surveyed had used chiropractic themselves.  Even more surprising is that the study revealed that nearly one quarter (23%) of the nurses said they "periodically" or "regularly" recommend chiropractic care to their friends, patients and associates, while another 27% said they recommend it occasionally.  Apparently, as the survey results suggest, the more knowledge of CAM procedures such as chiropractic the nurses had, the more likely they were to use them themselves and refer others to them. 

Patients Urged to Guard Against Medical Errors

In two separate articles from Intelihealth dated January 28, 2002, patients are warned they themselves are the best defense against medical errors.  The first article starts by relaying two tragic cases in the same week, about serious surgical mistakes in hospitals.  In Connecticut, two women died during surgery when they were accidentally given nitrous oxide instead of oxygen. In Rhode Island, a man had a successful brain operation, but only after the surgeon first drilled into the wrong side of his skull.

A preponderance of these types of problems led the Institute of Medicine of the National Academy of Sciences to release a report in 1999 titled: "To Err Is Human: Building a Safer Health System" a private institute which is an advisory body to the U.S. government.  Their report estimates that 44,000 to 98,000 deaths occur each year in hospitals alone as the result of medical mistakes.

Stressing the role that the patient needs to take, an instructor of medicine at Harvard Medical School, Dr. Gandhi, says patients need to keep involved and ask questions. "Nurses, pharmacists and physicians all double-check things, but the patient is the last check."  Some experts are recommending that patients or doctors in advance mark the spot to be operated on with permanent marker. 

Kenneth W. Kizer, M.D., M.P.H., president of the National Quality Forum, says,  "If you're getting surgery on a knee, for instance, make sure the correct side is marked 'yes' and the wrong side 'no'.  Make sure all staff members in the operating room know what procedure they are going to perform.  Say, 'We're operating on my right leg, right?' Patients tend to be too bashful to do that. They assume that everybody knows. Patients should never assume anything," he concluded.

The Joint Commission on Accreditation of Healthcare Organizations, the U.S. government's Agency for Healthcare Research and Quality, developed some recommendations that patients should utilize themselves. These include;

• Take part in every decision about your health care. Ask questions, and speak up about anything that you don't understand or that causes you concern.
• Keep a list of everything you take. Make sure you know the dosages and the purpose of the medicines. Read medicine labels, including warnings. Learn what side effects to watch out for, whether the medicine has dangerous interactions with other drugs, and whether you should avoid certain activities — such as drinking alcohol or spending time in the sun — while you are taking it.
• Make sure the medicine you receive is what the doctor actually prescribed. If it looks different than what you expected, ask the pharmacist about it.
• Ask the people who care for you if they have washed their hands. This may make them wash more often.
• Insist that your surgeon write his or her initials or words such as "yes" or "this side" (in permanent ink) on the part of the body that is supposed to be operated on.

College Football Team Benefits With Chiropractic

Virginia Tech's football team has had an impressive record over the last several years.  Head Coach Frank Beamer took the "Hokies" to a Big East Conference championship where they finished number 2 in the Associated Press.  Some of the credit for their physical health and recovery from injuries is attributed to chiropractic care.

Dr. Greg Tilley, a chiropractor from Blacksburg Virginia started caring for various members of the team after approaching the team physician to discuss how he could assist the team. "In the beginning there were times when I only saw one or two patients," says Dr. Tilley. "Now I have been allocated an office in the sports complex where I have my own portable table, and they have a schedule where the trainers can schedule times for their athletes to see me. 

Junior quarterback Grant Noel began receiving adjustments in July of 2001. He feels that chiropractic gives him better flexibility and range of motion. "Just getting my back adjusted and loose helps with my trunk mobility as far as twisting and throwing."

With the success and testimonials of the football team, other athletes have also begun chiropractic.  Athletes from the schools swimming, diving, lacrosse, soccer, and basketball programs have begun regular adjustments.  Mike Gentry, the assistant athletic director for athletic performance, summed it up by saying, "I see chiropractic as having two functions from my perspective. It helps our athletes return to competition faster if they have sustained some injuries, and secondly, it seems to be preventative, in the sense that it keeps our athletes more mobile and flexible and feeling better." 

Survey Says Parents Overtreat Harmless Fevers in Kids

Results of a Survey on Fevers that was reported in a February 6, 2002 release from Reuters Health showed that parents often over react by treating fevers in children earlier than necessary.  The survey compared attitudes of doctors, nurses and parents towards treating fevers in children. The results revealed that parents tend to treat high temperatures much more aggressively than health professionals do.

Israeli researchers conducted their survey from a questionnaire sent to more than 2,000 parents, doctors and nurses regarding fevers in children older than 3 months.  For the purposes of this study the researchers defined fever as 1.8 degrees Fahrenheit above normal body temperature, which is around 98.6 degrees. The survey included questions on risks of fever, dosages of anti-fever drugs and when children should be treated.  

Dr. Michael Sarrell and colleagues from the IPROS Network of the Israel Ambulatory Pediatric Association in Tel Aviv published the survey results in the January 2002 issue of Patient Education and Counseling.  The results showed that only 43% of parents knew that a fever below 100.4 degrees can be beneficial to a child. This was in contrast to 86% of the doctors and 64% of the nurses who responded to the survey.  The survey also showed that the majority of parents said they would treat a fever below 100.4 even if the child has no other symptoms, something with which only 11% of doctors said they would do.

"A fever can actually help sick children", explained Dr. Donna D'Alessandro from the department of pediatrics at the University of Iowa Hospitals and Clinics. "The body, basically, is trying to do the right thing," she said. "Bugs like to live at body temperature. So if you raise the temperature, you kill them off."  Twenty percent of parents responding to the study said the only reason they treat their child's fever is to reduce the risk of seizure associated with high temperatures. Dr. D'Alessandro noted that this is a concern but that it is only a risk in children with temperatures around 108 degrees. She also states that parents need to look beyond the fever, "Well, what's really causing the fever? It's not the fever itself, it's the underlying cause that's the problem." 

Insurance Coverage Increases Usage of Chiropractic Care

In the February 11, 2002 issue of the Archives of Internal Medicine comes an article on a study performed to see if there is a relationship between the usage of what the study called CAM (Complementary and Alternative Medicine) and insurance coverage. Included in the CAM professions, one of the most regularly used is chiropractic care.  Past studies showed that an estimated 44% of the US population used at least 1 CAM procedure in 1997. Of those using CAM, 52% had seen at least 1 CAM provider in the last year.  

This study was performed by conducting a nationally representative, random household telephone survey of 2055 adults.  Not surprising, the study showed that factors independently associated with frequent use (more than 8 visits per year) of a CAM provider were full insurance coverage for the CAM service.  This basically means that patients with insurance coverage tended to go to their CAM provider more often than those without insurance.  According to the study some of the other factors that increased usage of CAM care include patients with back and neck problems as well as people desiring wellness or preventative care.

In concluding the study states, "A small minority of persons accounted for more than 75% of visits to CAM providers. Extent of insurance coverage for CAM providers and use for wellness are strong correlates of frequent use of CAM providers."