We Get Letters

If Coke and Pepsi can do it, so can we ...

Dear Editor:

Referring to your January 14, 1994 "Report of My Findings" -- best stuff you've talked about yet. Finally, someone who is talking about marketing chiropractic to the public on a mass scale. If Coke and Pepsi can do it, so can we. National TV advertising using celebrities to promote all chiropractic. Keep up the mission.

Anthony P. Lauro, DC
Pomona, New York

Dear Editor:

After reading your January 14, 1994 editorial regarding yellow pages advertising, I decided to do a little research locally. All of the seven chiropractors in Emporia have small, professional ads. To me, it is a perfect example of the money that is saved when common sense is used by everyone.

I called Southwestern Bell yellow pages and got some figures regarding the cost of our advertising. All of the ads and listings cost $2,057.00 per year. If we were silly enough to do what most chiropractors do, we would all have full page ads. Not only would this not serve any additional benefit, the cost of the seven full page ads in our area would be $32,424.00. In other words, the seven chiropractors in Emporia, Kansas saved $30,000.00 last year by keeping their ads small and professional.

I salute you for your editorial. Hopefully more DCs around the country will follow the recommendations you made.

James D. Edwards, DC
Emporia, Kansas 66801

Dear Editor:

Several weeks ago Dr. Bruce Born of Southfield, Michigan wrote a letter to Dynamic Chiropractic taking exception to my article, "Reasons for Selling Your Practice."

In my article, I mentioned a friend in Atlanta whom I encouraged to sell his practice (I did not offer to represent the sale), because the neighborhood was deteriorating. He failed to act and in time his practice had to be closed. It was not sold by the owner or anyone.

I regret that Dr. Born did not check with me before he formed his opinion that did not have the basis or facts concerning this practice being sold and handled, to the disservice of the owner.

The true facts: A friend advised to sell his practice by me and Practice Consultants. We did not offer to assist him in the sale, and he chose not to sell and by doing so lost his practice because the neighborhood continued to depreciate.

Fair is fair and right is right! Dr. Born did not get the true facts, and as a result his interpretation of the facts was in error.

Dr. Born, the Society of Chiropractic Management Consultants is made up of sincere, qualified, and competent individuals who bring high levels of ethics and service to the profession, which I am proud to be a member.

William M. Harris, DC
President, Practice Consultants
Alpharetta, Georgia

Dear Editor:

I have read with interest the article stating the Texas Chiropractic Association (TCA) E & M Coding Committee position on the use of CPT codes for billing of medical services rendered by a chiropractic physician.

I am of the opinion that the committee's position is incorrect and is not consistent with the objectives the coding process was intended to achieve. The ACA position is consistent with the other health providers and in keeping with the objectives of CPT codings. I believe it is inappropriate that we, as primary health care providers, adopt a use model that is in conflict with other providers (MDs and DOs) and in my opinion, and as I stated, inconsistent with the intended use of the CPT Coding objectives.

Coding provides the opportunity to not only identify levels of care, but also types of services rendered by a health care provider. Bundling of services, as your associations position suggests thwarts this intent and has several other counterproductive ramifications.

Coding provides opportunity for statistical analysis of services for diagnostic classifications. Codes are also intended to identify the components of medical services administered to the patient on the particular therapeutic encounter. The TCA model reduces the quality of the physicians records as procedural content is hidden in the bundled services.

It also assumes that an adjustment is performed at each patient encounter. This may not be the case. Confusion could then result in the process of the provider attempting to identify the type and level of service provided at that encounter, leading to inconsistent used of the codes.

An example of this might be as follows:

On any given patient encounter, a doctor would inquire as to the patient's subjective status and if any complications or new difficulties have been noted, the doctor would then determine the patient pain level perception using an analog pain scale of 0-10. Objective assessment methods would then be applied to evaluate the patient's status at this encounter. The could consist of ROM evaluation of the involved spinal level of involvement, checking the pertinent objective findings that were uncovered at the initial examination or persisted at follow-up examination and joint play assessment and palpation of the involved areas.

At this point decisions would be made on what therapeutic approaches are appropriate (in certain circumstances this may not include an adjustment) at that time.

The above patient encounter scenario encompasses listening to the patient to evaluate subjective status, objectively measuring patient response (or lack of response) to therapeutic interventions, making therapeutic decisions, and recording the event in the patient record using SOAP protocols.

The decision process (if an adjustment is to be delivered) is now required and the physician would then address the specific nature of the manipulative method and its mode of application.

There is a clear division between these two components of the patient encounter. The assessment component "drives" the therapeutic measures that will be applied and each are separate and distinct functions of health care delivery process and should be coded in such a manner.

I believe the ACA position presents the clinically correct model for the office procedure for the care of patients and the proper use of the E & M Codes as they were intended.

Ronald O. Williams, DC
Morrison, Illinois