Ensuring Accurate Clinical Documentation
Dear Editor:
The importance of clinical documentation has been referred to often in recent issues of Dynamic Chiropractic. Eight years ago, I turned to one of the computerized note-taking systems, but eventually found that even with random text generation and programming in my "pet" phrases, the notes were not individualized enough. In addition, as the number of customized phrases increased, the system became more unmanageable to use.
My solution has been the use of a voice recognition system in combination with the chiropractic note-taking program. Since I already had many files and progress notes in the system, I decided to keep using it as a data- base for organizing patient files, as well as taking advantage of the many excellent pre-programmed features (exam formats, graphing, diagnosis codes, and such). However, I can now dictate directly into the patient notes for the day (SOAP format). I find this to be especially helpful in the "Subjective" section (for example, rather than "Patient injured himself when at home," it is much more personalized to be able to dictate, "Patient was lifting 45-pound pelican from garage floor to trunk of his car when he felt a sharp, stabbing pain in his low back.") The same event-specific information can be dictated into any part of the daily record.
If one is dictating into Microsoft Word or the word processor that comes with the particular software program I use, notes can be spoken into a hand-held recorder and then downloaded and printed at the end of the day.
The voice recognition system I use cost less than $200, with upgrades costing about half that amount. Unlike other health care professionals, we chiropractors do not yet have a "professional" version offered to us, which would have extensive specialized vocabulary built into the system (and cost about $800). This is not a major problem since the system has the ability to learn vocabulary from narratives and other documents already on your hard drive. It is also very easy to add new words during dictation.
Granted, there is an initial learning curve, but I found that to be relatively brief. The average progress note takes less than two minutes to complete and is available immediately to e-mail or fax or print. I've used a transcription service in the past and find the voice recognition system to be much more economical and convenient.
Ted Johnson, DC
Reno, Nevada
Is the Medicare Demonstration Project Good for Chiropractic?
Dear Editor:
I regularly read your newspaper to see what I can learn or what interests me. I have noticed that in the past nine months, I have only read one or two articles about the Medicare Demonstration Project. In those articles, chiropractors and chiropractic organizations consider it a milestone for chiropractors.
As you know, the Medicare Demonstration Project opens the reimbursement for ancillary chiropractic services. They declare it a budget- neutral project, meaning a complicated method that will analyze the payments for two years to see if they save money by shifting reimbursable services performed by chiropractors.
I don't believe this is good or beneficial for chiropractors or the profession. They are firm about keeping it budget neutral. They described how it would be budget neutral. During the two years, if the overall Medicare payments have increased, that amount will be made up by chiropractors across the country. Going with government conspiracy theory, this is a psychological manipulation to lower reimbursement. The government agreed to give chiropractic organizations a short-term win while they will have an overall victory. After the demonstration project numbers are in, the overall reimbursement rate for chiropractic manipulation will be lowered to recoup "excess" money paid out and the reimbursement will never go back up again.
The demonstration project only benefits a small percentage of chiropractors for a short period of time. It will be interesting to see who benefits most in the short term. Only after all the data is tabulated will we see if our political chiropractic organizations have the proper foresight.
Leonard L. Weiss, DC
Davenport, Iowa
Reaction Time and the Spine
Dear Editor:
I was looking over the JMPT abstracts (Nov. 7, 2005 DC: www.chiroweb.com/archives/23/23/12.html), when I noticed "The Relationship Between Spinal Dysfunction and Reaction Time Measures." This caught my interest. While in chiropractic college, I went to school with an MD who had served in the Soviet military. Evidently, the MDs have continued through history to perform manipulation in several Eastern European countries. He explained to me once that the Soviet Air Force pilots often were treated with manipulation if they were having a minor cold or allergies, to avoid the effects of medications while flying fighter aircraft. The pilots said they noticed improved reflexes and an overall sense of increased alertness, yet calmness at the same time. As I remember, my schoolmate explained that the Soviets had consequently studied the effects of cervical manipulation on pilot reaction times and behavior. This was more than 15 years ago. It would be wonderful to see what these studies were like, especially the outcomes.
Christian Zyweck, DC
Aguadilla, Puerto Rico
